QCOSTARICA – The exact date is not known, but the plan has already been drawn up and about 200 people work daily to organize the first national vaccination campaign against covid-19.
Three million Costa Ricans would be immunized against this new virus tentatively starting in the first quarter of 2021 and throughout that year.
The foregoing made it necessary to activate, months ago, an unprecedented coordination process between several institutions to guarantee optimal use of the 6 million doses that will enter the country.
Pedro González, Deputy Minister of Health, estimates that the Costa Rican health system faces one of the greatest challenges in its history.
González pointed out that organizing a campaign to apply a vaccine that is not yet available, but that is long awaited worldwide, requires attention to many details.
It is an effort that requires the synchronization of countless scientific, diplomatic, legal, administrative and logistics processes.
As an example, the Deputy Minister said that it was necessary to reform several decrees in order to expedite the purchase of vaccines from pharmaceutical companies.
In fact, the tasks of the team involved range from organizing the delivery of the doses, to training those who are going to apply them and choosing who is going to receive them.
For this reason, personnel from the Caja Costarricense de Seguro Social(CCSS) – Costa Rican Social Security Fund, the Ministry of Health and the National Emergency Commission (CNE), the Ministry of Foreign Affairs, the Ministry of Finance and the Presidency, among others, are involved in this process.
“It is an articulated work that brings together people from different institutions, all working from their trenches,” said Leandra Abarca, coordinator of the Expanded Program of Immunizations of the CCSS.
“We will all have to work, it is a shared challenge, because then the population must collaborate with their part and go to the vaccination centers at the time indicated,” added Abarca.
The group began to form and work intensely since the end of July. Only in the case of Health, for example, dozens of employees from different offices such as the minister’s office, Health Surveillance, Legal Directorate and Customer Service are involved. The single largest group is that of CCSS, which has more than 100 people whose work is directly related to logistics.
Initial plans
The process that will lead to the first vaccination against covid-19 started with the preliminary talks that President Carlos Alvarado; the Minister of Health, Daniel Salas; and the executive president of the CCSS, Román Macaya, held with different pharmaceutical companies.
At the beginning of August, a technical-political table was formed with the incorporation of officials from the different institutions involved, who meet weekly to see the progress of the project.
According to Deputy Minister González, the country had three options to obtain vaccines:
1- Negotiate directly with one or more pharmaceutical companies.
2- Joining COVAX, an initiative sponsored by the World Health Organization (WHO) and the Global Vaccination Fund (GAVI) that seeks to provide vaccines to 20% of the people at highest risk in the countries that register. COVAX leaders are in talks with 18 companies that have vaccines under study.
3- Wait for the vaccines to be ready and buy them directly.
“This last option was ruled out from the beginning because our priority was to have the vaccine soon. And it was defined that better, to lower the risk, we were going to use the first two mechanisms,” said González.
The National Commission of Vaccination and Epidemiology (CNVE), made up of health officials, the CCSS and the Costa Rican Pediatric Association (ACPE) specializing in vaccines and immunology, was in charge of choosing the vaccine and defining the groups that will receive it first.
As indicated so far by the CNVE, health workers who are in greater contact with the virus would be the first to receive the doses, along with people with the highest risk factors.
“There are two large groups of priority people: those who have a higher risk of becoming infected and infect others, who are health personnel who pass in the first line of care and, on the other hand, those who, due to their health status, have a greater risk of dying. if they were to become infected,” said the deputy minister.
Regarding the process of choosing the vaccine, this task took several months for CMVE, since minimum rules of efficacy (that the product works) and safety (that the adverse effects do not exceed the benefits) had to be met.
This work was very difficult to carry out considering that the clinical trials of the potential vaccines were still in process.
Once the doses arrive, they will only be available for Social Security.
At the moment, the sale to private companies is not contemplated.
“The same pharmaceutical companies do not have the capacity to produce vaccines for all the inhabitants of the world at first; it is limited. The priority for everyone now is public health,” González insisted.
Slow work
Personnel from all CCSS managements and from each region of the country work on planning how vaccination will be carried out in each medical center. The purpose, according to Abarca, is that no person with risk factors is left without receiving the vaccine, no matter where they live.
“Internal logistics are challenging. Any inclusion of a new vaccine in the scheme obliges the CCSS to strengthen the system that it already has consolidated,” said Leandra Abarca, coordinator of the Expanded Immunization Program of the Fund.
Based on the experience of previous vaccinations, several lines of work were established.
The unknown
At this time, however, there are many details that are not known, given that the vaccines have not yet completed their testing and are not approved by regulatory agencies.
“One of the questions is which will have any kind of contraindications. We will know that when the trials are finished and the prospectus is published and indications and contraindications come; that would be taken into account for the vaccination strategy,” said Abarca.
Another question is whether there will be an age limit, given that clinical trials are for people aged 85 or younger.
“It has a lot to do with the recommendation of the pharmaceutical company when the product is ready and with the approval of the FDA (in the United States). If the recommendations say that there is no age limit.
“It is highly probable that there is no limit and they can be applied to people over 85 years of age, but we still have to wait to see what the recommendations say,” González stressed.
At the moment, these 200 people are working hard to prepare the ground for the arrival of the covid-19 vaccine. But they know that when the doses are in the country, another stage will begin to protect the lives of as many people as possible.
