As Covid vaccine program gets started in Spain, what happens next?

The Covid-19 vaccination campaign got going on Sunday in Spain, in a senior home in Guadalajara, in the region of Castilla-La Mancha. There, Araceli Hidalgo, 96, became the first person in the country to receive the first of the millions of injections that are due to be administered in the coming months. But what happens now? Here are some of the main unknowns – some of which have responses, and others that don’t.

When does the vaccine begin to take effect?

The Pfizer vaccine, which was the one that was symbolically administered on Sunday in all of Spain’s regions, needs two doses, separated by 21 days. Total immunity – at a level of around 95%, according to clinical trials – is reached around a week after the second dose. After that, the immune system begins to activate and it is less likely that the recipient will develop the illness than those people who haven’t been given it, but the drug has yet to achieve its maximum potential.

How long does the immunity last?

This is not known, and is something that happens with all new vaccines: it is unknown how long the immunity lasts until the moment that the vaccine is no longer effective. Laboratories and healthcare services will be monitoring when this takes place. For now, it has not been ruled out that a booster shot will be necessary a year or two after it is first administered, as is the case with other vaccines. In fact, the vaccine could be needed on a yearly basis. But this will only become clear with time.

When and how will Spain’s healthcare centers start to offer appointments for vaccinations?

Sunday saw the start of the first phase of the vaccination plan, which covers residents of senior homes and their carers, and will continue with healthcare workers and adults with major dependencies – i.e. those who need daily assistance. This first phase, which will see approximately 2.5 million people given the vaccine, will last around three months. Once it is over, it will be the turn of the next group, although the Spanish government is yet to confirm who this will include. The most likely approach will be the over-64s and the chronically ill. While the plans for this phase are yet to be confirmed, it is expected that these people will be given appointments via their primary healthcare centers. “Citizens will be given a citation, according to the risk group to which they belong, to attend their healthcare center,” explained Health Minister Salvador Illa on Sunday. “It is voluntary and free. It is an act that will benefit both the person who receives the vaccine and the collective.”

Who is considered to be a dependent?

According to the Health Ministry’s vaccination strategy, this group includes people considered major dependents (grade III) according to the Dependency Law of 2006, those who have requested recognition as such and those who are yet to do so but are accredited medically to have an illness that requires intense support measures during their day-to-day lives, whether or not they are institutionalized. “The vaccination will take place as soon as possible, taking into account the characteristics of storage and usage of the available vaccines,” the ministry strategy adds. “Personnel who professionally care for these people with a major dependency will be able to get vaccinated during the same visit.”

What happens for those people with private health insurance?

The vaccination will be free and will be administered by the National Health System in the order that the Health Ministry establishes.

What measures must be followed when the vaccine is received?

In principle, the same as those being observed until now, until there is a sufficient amount of the population vaccinated so that herd immunity is reached. This is estimated to be about 70% of the population. While it is known that the vaccine is highly effective at avoiding the development of Covid-19, it is not yet so clear up to which point it avoids the spread of the virus. This means that it is possible that a person who has been vaccinated could still spread the virus while asymptomatic and thus become a vector for transmission.

When will enough people in Spain be vaccinated in order to achieve herd immunity?

As time passes, more vaccines will arrive – not just from Pfizer, but also, most likely, from other manufacturers too. While the initial rhythm is expected to be around 350,000 injections a week, as more and more pharmaceutical firms get approval for their vaccines this number is likely to rise. The Health Ministry calculates that between May and June around 20 million people will be vaccinated and that by the end of the summer a sufficient percentage of the population will be immunized in order to reach herd immunity.

How will people who have been vaccinated be monitored?

All citizens who receive the vaccine will get a vaccination card that will include the kind of immunization that has been administered as well as the batch number, the date the first dose was delivered and the planned date for the second injection. The card will also contain contact details should there be a suspected adverse reaction as well as a phone number to call should there be any side effects not included in the prospectus. This is the start of what is known as Phase 4 of the clinical trial. In the previous stage the frequent side effects – such as fatigue, tiredness, fever the next day – were found to affect at most one in every 30,000 people. But to detect rarer effects, those that manifest in one case per 100,000 or 1,000,000, the vaccine will be monitored as it is administered in the population. Also, more precise data will be collected on population groups that was not possible during the first trials. This will be done via the primary healthcare system using a centralized database in each region, and will be connected to a national and European system.

English version by Simon Hunter.