Spain updates Covid vaccination protocol: under-55s who have recently had virus will only receive one dose

According to the new document, vulnerable groups under the age of 60 will get the vaccine once the inoculation of older demographics has been completed

A health worker administers the first dose of the AstraZeneca vaccine to a teacher in Seville.
A health worker administers the first dose of the AstraZeneca vaccine to a teacher in Seville.PACO PUENTES

The Spanish Health Ministry on Friday published the fourth update to the country’s Covid-19 vaccination protocol. The new guidelines establish that individuals under the age of 55 who have recently contracted the virus will only receive one dose of the vaccine. As per the previous update, this dose will be administered six months after the date of the positive diagnosis. This decision has been made given that people who have had the coronavirus generate 140 times more antibodies than those who have not. The change does not affect people aged 55 and over.

According to the updated protocol – approved by the Inter-Territorial Council of the National Health System, which brings together health officials from the central and regional governments – the next stages of the vaccination drive will target people aged 60 and over – a group that comprises 12.1 million people. Age is the variable more closely linked to serious Covid-19 cases and deaths – nearly 95% of all Covid victims in Spain were over the age of 60. Spain’s regions – which are in charge of the vaccination campaign as well as controlling the pandemic in their territories – have already begun vaccinating people aged 80 and over. According to the new document, this group will be followed by individuals aged between 70 and 79, then those in the 60 to 69 age bracket.

People who have had the coronavirus generate 140 times more antibodies than those who have not

Once these age groups are vaccinated, the council will target people under the age of 60 with serious conditions that make them vulnerable to Covid-19. This group will receive a dose of the Pfizer or Moderna vaccine, which is based on the RNA messenger, or another treatment that has proven in clinical trials to be effective among people with health problems. Spain has so far ruled out using the Oxford-AstraZeneca vaccine on people over the age of 55, on the grounds that there was not enough clinical evidence of its effectiveness in older patients. It also decided not to use the vaccine on individuals with certain pre-existing medical conditions, such as cancer and neurological disease, as they were not included in the clinical trials for the vaccine.

Experts, however, are struggling to define the new priority group as it is not clear from the current research which comorbidities should be prioritized when it comes to younger cases. People with organ transplants or who are suffering from obesity, diabetes or kidney problems are among the candidates who may be prioritized once all seniors are vaccinated. The updated protocol states that the decision will take into account what is most feasible. “A decision that, by trying to identify all groups that must be prioritized, makes the vaccination process so complex that it unduly slows it down or makes citizens confused about when they are going to be vaccinated, would not be ethical,” it says. Once the vulnerable groups are defined, people aged between 56 and 59 will receive the Pfizer or Moderna vaccine, or another treatment proved to be effective in this age group.

In the meantime, most of Spain’s regions have begun vaccinating essential workers under the age of 55 with the AstraZeneca vaccine. This group is made up of teachers in early, primary and secondary education, law-enforcement officers from the National Police, the Civil Guard, and regional and local agencies, firefighters and prison workers, as well as healthcare professionals who are not considered frontline workers, such as physiotherapists and occupational therapists. Once this group has been vaccinated, the AstraZeneca vaccine will be administered to people aged between 45 and 55. The updated protocol does not provide any more details. It is not yet known when the under-45s, who have no pre-existing medical conditions, will be vaccinated, but it is not likely that this will happen until summer, given that this group faces a very low risk of developing a serious case of Covid-19.

Nearly 95% of all Covid victims in Spain were over the age of 60

The new protocol from the Health Ministry allows for some flexibility. Regions can choose to vaccinate different priority groups at the same time in order to speed up the process. As the document indicates, the first phase of the drive – which prioritized staff and residents of care homes, frontline health workers and adults who need daily assistance but do not live in residences – has still not been completed, although it is close to reaching the end. “Although the percentage of people vaccinated in Spain remains small, just 3.7% of the general population, of the 351,936 people in senior residences and other care homes, 94% have received the first dose and 82% the complete treatment, and already a smaller percentage of hospitalizations from senior residences is beginning to be seen,” the protocol explains.

The type of vaccine administered to each group may also change in the future. Although the AstraZeneca vaccine is currently restricted to people between the ages of 18 and 55, this could change if more data becomes available on its effectiveness among older age groups, said the secretary of state for health Silvia Calzón last Thursday. Preliminary studies already support this possibility. On March 11, the European Union is also expected to approve a new vaccine by Janssen. Unlike the vaccines from Pfizer, Moderna and AstraZeneca, this inoculation only requires one dose, meaning double the population can be vaccinated with the same number of jabs. Spain’s Inter-Territorial Council of the National Health System will have to decide whether to administer this vaccine to anyone or only specific groups. According to the contract with Janssen, the first doses will start to arrive in April.

English version by Melissa Kitson.

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