How the suspension of the AstraZeneca vaccine is affecting the inoculation drive in each Spanish region

Spain’s decision to halt Oxford-AstraZeneca Covid-19 vaccinations due to the detection in the European Union of several cases of blood clots after its use has shaken up the country’s inoculation campaign. The regions were already facing a second half of March at a slow speed, with the doses arriving slowly. But the latest decision by the Health Ministry to suspend the use of the AstraZeneca medication has once again thrown into doubt whether the central government’s objective of immunizing 70% of the adult population by the summer will be possible.

The government has opted to wait until the European Medicines Agency (EMA) issues a ruling on whether there is a link between the vaccine and thrombosis cases, but it claims that this will not affect the calendar. According to the latest data from the Health Ministry, a total of 932,704 Covid-19 vaccines were administered last week, of which 304,705 were AstraZeneca (32.7%). That means that if the rate of jabs had been the same this week, the campaign would be nearly 33% slower due to the withdrawal of the Anglo-Swedish vaccine.

For now, some of Spain’s regions – which are in charge of their own vaccination campaigns – have started to cancel appointments to administer doses of AstraZeneca, which are aimed primarily at essential workers aged under 55 at this stage of the campaign. (Spain has opted not to give the medication to any older age groups right now until there is more clinical evidence of its efficacy.)

Since December 27, 2020, 5.7 million doses have been administered in Spain. But just 1.7 million people – 3.6% of the population – have had their two doses

Most of the essential workers in this age group have only been given their first jab, and require the second before they will enjoy the full protection of the vaccine. The Health Ministry said on Monday that “there is time” to complete the full inoculations, given that the second dose is administered 10 to 12 weeks after the first, according to the manufacturer’s guidelines.

Since December 27, 2020, when the vaccination campaign began, 5.7 million doses have been administered in Spain. But just 1.7 million people – 3.6% of the population – have had their two doses. The three vaccines being used in Spain so far – Pfizer-BioNTech, Moderna and Oxford-AstraZeneca – all require two doses. The healthcare authorities believe that the process will speed up in April, given that the Janssen vaccine is due to arrive – it only requires one dose – and the volume of the other medications already being used will also rise. The Health Ministry has stated that Pfizer, for example, will send 4.8 million doses to Spain in April.

Meeting the government’s objectives will eventually depend on how quickly the vaccines arrive, whether the healthcare system is prepared to ramp up the speed with which they are administered, and on there being no more unexpected developments, such as the temporary withdrawal of AstraZeneca.

“The decision to suspend the vaccination with AstraZeneca comes in a context of a lack of vaccines, and what’s more, this move will create a sensation of alarm, fear and panic in the population,” explains Amós García, the president of the Spanish Association of Vaccinology. “We will have to move heaven and earth to recover the credibility of this vaccine.”

The central government’s spokesperson, María Jesús Montero, insisted on Tuesday that the temporary suspension of the AstraZeneca vaccine will not “produce any alteration of the vaccine calendar,” and ruled out its definitive substitution.

Campaign progress

So far in Spain, nearly all of the target population in the first phase of the vaccination campaign – care home residents and healthcare workers – has been vaccinated. The focus now is on the 80-and-over population and people with serious disabilities. The regions are moving forward at different speeds, however. In Andalusia, for example, 52.4% of the 400,000 people aged 80 and over have got their first jab, while 23.72% have got two. In Galicia, by contrast, they are only just starting to administer the second injections, while in the Balearic Islands they are still focusing on people aged 90 to 94 after having inoculated the 2,600 people aged over 95. In Madrid, where there are 320,559 over-80s who don’t live in care homes, just 55.2% of this group have got their first dose.

The Health Ministry has also announced which groups among the chronically ill will be given priority for the vaccine. They include cancer patients receiving chemotherapy, anyone with lung cancer, transplant recipients or those on a waiting list for such a surgery, people with Down syndrome aged over 40, and dialysis patients. The ministry has announced that it will be the turn of this group once the 80-and-over population has been immunized. While Catalonia has already made a start on this segment, the central government is recommending that they overlap with the over-70s.

Andalusia

Last week the southern region reached the threshold of one million people who had received the first dose of one of the three Covid-19 vaccines being administered in Spain. Over 1.1 million Andalusians have had their first shot, and 363,191 are now fully vaccinated. This means that 93% of all available doses in the region have been administered. This week, the regional health department is expecting to receive 79,960 doses of the Pfizer vaccine; 37,900 from Moderna and 40,500 from AstraZeneca.

Spain’s recent decision to temporarily suspend use of the AstraZeneca vaccine, in line with many other European countries, has forced Andalusia to stop immunizing target groups under 55 years of age who had already started to receive it, including health professionals who do not work in hospitals or healthcare centers, teachers and members of law enforcement and the armed forces.

As for other groups, on March 13 regional records show that 89.07% of frontline healthcare workers have received their first dose and 85.83% are fully vaccinated. And 52,24% of people in the 80-and-over age group have had their first shot, with 23.72% now fully immunized.

Aragón

Aragón had been expecting to distribute 17,772 doses of the Pfizer vaccine, 5,630 of Moderna and 13,200 of AstraZeneca this week. But the temporary suspension of AstraZeneca has put a halt on its administration. Regional records show that 25,652 doses of the British-Swedish vaccine have already been administered, out of a total of 47,600 available doses. Aragón’s chief of public health, Francisco Javier Falo, has admitted that the decision to halt AstraZeneca is “a setback in the vaccination strategy that will have to be assessed in the coming months.”

Meanwhile, vaccination is still underway for people over 80 and adults with severe disabilities who do not live in care homes. Aragón has administered 182,899 vaccine doses so far, representing 88% of all available doses, and 58,794 have had both jabs. The region is holding back 3,500 doses to ensure the availability of second doses in the event of delays in supply.

Asturias

The small northern region has administered 166,072 vaccines, or 85.6% of all available doses. Over 58,300 people have had both jabs. With AstraZeneca inoculations now on hold, regional health authorities said that the campaign will continue with target groups receiving Pfizer and Moderna shots. This includes the region’s oldest adults as well as people with severe disabilities who are being vaccinated in their homes.

Balearic Islands

As of Tuesday, the region had administered 110,608 doses, or 88.6% of the available stock. So far 40,000 doses of the AstraZeneca vaccine have already been administered, although inoculations have now been halted following national guidelines. This suspension affects 25,000 educators who work in the Mediterranean archipelago, as well as members of law enforcement, emergency services, firefighters, and members of the armed forces.

The vaccination drive in care homes has ended, and 80% of frontline healthcare workers have been vaccinated. As for other health personnel, 74% have received their first shot. Around 4,500 people with disabilities who live at home have had their first inoculation, as well as 1,400 of their carers. The region’s oldest residents, those over 95, have received their first dose, and those between 90 and 94 began getting it last weekend. People 80 and over are also a target group right now.

On March 12, people born in 1966 began getting calls for appointments for the AstraZeneca vaccine, but these have now been temporarily suspended.

Basque Country

The Basque health service has administered 79% of the received doses. On Monday, 30,420 Pfizer doses arrived along with 10,600 from Moderna. A total of 248,308 doses have been administered and just over 68,000 people have got both jabs needed for full protection. These are mostly residents and staff in senior homes, while 86.4% of doctors and nurses in the public system have already got their first dose, while 60% have had both. In the private healthcare system, 75.2% of staff have had the first jab. Among essential workers, 99.6% of regional police officers and 63.4% of teachers have had the first jab.

The suspension of the use of AstraZeneca has forced the cancelation of appointments for teachers, firefighters, police officers, among others. Around 24,000 were due to receive the vaccine in the region this week. The health service will continue to innoculate the 80-and-over population and public health professionals in the meantime.

Canary Islands

The archipelago’s health authorities have administered 37,166 doses of the AstraZeneca vaccine, but the drive has been placed on hold following national guidelines. This affects educators, members of law enforcement and the armed forces, and emergency personnel.

Vaccination of care home residents and workers, as well as frontline healthcare workers, is now complete. The campaign is still underway for people with disabilities who do not live in care homes and people aged 80 and over.

Cantabria

Cantabria has administered 81% of available vaccines and over 25,800 people have had both jabs. With the AstraZeneca inoculations now on hold, the immunization campaign will continue with people who are unable to leave their homes, those with severe disabilities who require daily assistance, and the 80-and-over group. The government of Cantabria is holding back between 15% and 20% of its stock as a safeguard against the possibility of supply and distribution delays.

Castilla-La Mancha

Castilla-La Mancha has administered 239,085 doses, accounting for 78% of all available vaccines. Health Ministry records show that 80,114 people are fully vaccinated. The region has also suspended the use of the AstraZeneca vaccine, which has already been administered to 15,465 people.

The campaign is currently targeting people aged 80 and over, of whom 41,570 or 30% of the total have been vaccinated. Frontline healthcare professionals are now almost fully vaccinated, as are 87.6% of care home residents.

Castilla y León

Castilla y León was this week expecting to receive 39,780 doses of the Pfizer vaccine, 20,400 of Moderna and 26,800 of AstraZeneca. Target groups are now healthcare professionals not working in hospitals or healthcare centers, people with severe disabilities and the 80-and-over population. There are close to 125,000 people who are now fully immunized. At regional care homes, over 88% of residents and workers have been vaccinated.

Catalonia

Catalonia has administered around 900,000 doses and 246,000 people are now fully vaccinated. The suspension of AstraZeneca inoculations has placed 127,000 doses on hold, according to the Catalan health department, which was going to administer second doses in the coming two weeks. The regional secretary for public health, Josep Maria Argimon, called for calm on Monday with regard to the reports of blood clots among some people who received the vaccine in other European countries. “First we have to see whether there is a coincidence in time, then if there is a cause-effect relationship and later whether the risk-to-benefit ratio is favorable or not,” he said.

With care homes and frontline health workers now almost fully vaccinated, health authorities have started to call people who have undergone transplants, considered a risk group by Catalan authorities. This group will start receiving their inoculations once the region’s elderly population has been vaccinated.

As for essential workers such as educators and law enforcement offices, immunization ranges between 60% and over 80% depending on the sector, but this campaign has been halted due to the suspension of the use of the AstraZeneca vaccine.

Extremadura

The regional healthcare authorities say that the campaign is going at a “good speed,” but complain that they are not receiving enough doses so as to be able to go faster. Extremadura has administered 151,000 doses and 53,832 have full protection. The region is expecting 14,040 doses of Pfizer, 6,900 of Moderna and 5,100 of AstraZeneca this week, although the use of the latter is suspended.

Up to 98% of residences (11,682 people) have been immunized, and there have been no new cases reported in them recently. Hospital workers, private clinic staff and primary healthcare staff have all been vaccinated (apart from those off sick, who will be inoculated when they return to work). Among people with disabilities not living in care homes, 8,637 people (95%) have been vaccinated. Among the 80-and-over age group living outside of residences, 22,816 people have been vaccinated – which represents 33%.

Until now, Extremadura has been focusing on the over-80s, essential workers and other healthcare workers, such as physiotherapists and hygienists.

Galicia

The regional authorities have nearly finished vaccinations in care homes, with 90% of users having received both doses. This week the region wil start to administer the second jab to the over-80s. The suspension of the use of AstraZeneca has put the inoculations of essential workers on hold – including police, teachers, firefighters and civil guards – and among those aged between 50 and 55. On Saturday, the vaccine was used to give first jabs to 15,000 of the 250,000 Galicians in this age group, who were called not just to hospitals but also to fairgrounds and cultural centers across the territory to get their injections. The approach was a kind of rehearsal for the planned mass vaccinations due in April, when 584,000 doses are scheduled to arrive in Galicia. For now, according to the latest data from the Health Ministry, the region has administered 350,571 doses, which is 91% of those received. Of a total of 2.7 million residents, 95,800 people have had both jabs.

La Rioja

This region will continue to vaccinate the 80-and-over population this week, and also complete other priority groups. Given the suspension of the use of AstraZeneca, however, jabs for teaching staff will be halted. The region has so far administered 7,456 doses of AstraZeneca to people aged between 19 and 55. The majority – 5,126 doses – have gone to essential workers, but also to care workers (1,199 doses), and medical staff (1,118 doses). According to the region’s plans, this week around 4,500 more doses were due to be administered to those in the group of essential workers. Since the start of the campaign, La Rioja has administered 46,881 doses – 93% of the total received. More than 14,000 residents have been given their two jabs.

Madrid

In Madrid, there are 320,559 people aged 80 and over who live outside care homes and up until Monday just 55.2% of them had received their first jab. That means that nearly half of this high-risk group is still without protection. On Wednesday, the speed of this process will rise with the first Moderna jabs for 20,553 members of the group who have mutual health insurance coverage outside the public system, to be administered at the new Isabel Zendal hospital.

Meanwhile, the second Pfizer doses will start this week for seniors who were inoculated in their primary healthcare centers. According to the calendar, from April 12 the remaining holders of mutual health insurance policies will get their first dose, as well as any remaining people aged 80 and over, those with disabilities who can attend their healthcare centers, and carers aged over 55.

Madrid has already inoculated more than 40,000 members of the security forces, more than 62,000 teachers and more than 5,300 people with disabilities.

Murcia

Murcia is expecting to receive 14,040 doses of the Pfizer vaccine and 7,200 of the AstraZeneca, but the use of the latter medication has been suspended. This means that the vaccination process that started last week for teachers and teaching staff aged under 55 (around 40,000 people in total) has been put on hold. The region will continue with its campaign in the 45 healthcare centers across its territory and also at mass vaccination sites for the 80-and-over population and people with major disabilities.

The region has already administered 180,650 vaccines and nearly 58,000 people have been given their two jabs.

Navarre

On Monday, Navarre received 10,220 new doses – 7,020 from Pfizer and 3,200 from AstraZeneca. It is due to get a further 38,610 doses of all three approved vaccines before the end of the month. In April, the regional government is expecting the weekly deliveries of the Pfizer vaccine to rise to 16,000 doses. The region has administered 89,261 doses in total of the 109,485 received so far (81.5%). A total of 28,566 have completed their vaccinations, the region reports. On Monday, the vaccination of the 80-and-over age group restarted for Pamplona and the surrounding area at a new vaccination point set up at the Navarre Public University (UPNA), with another center due to be established at the site of the former Hermanos Maristas school.

Valencia

On Monday, the vaccination of teaching and auxiliary school staff aged below 55 began in the Valencia region, the majority of them with the AstraZeneca vaccine. The suspension of this medication by the Health Ministry changed all of the plans on Monday afternoon. On Tuesday, the region’s healthcare chief Ana Berceló met with the members of the vaccination technical commission to replan the campaign. Around 74,000 people were due to receive a vaccine this week, and in six days a total of 116,032 teachers and auxiliary staff.

What’s more, the campaign has now moved on to workers from the Home Help Service (SAD) and social workers from local councils. The process continues for those with major disabilities, the 80-and-over age group and healthcare workers, as well as other social workers. The majority of these collectives are being given the Pfizer vaccine, a total of 56,710 doses.

This week a total of 17,350 doses of Moderna have been allocated for the 80-and-over populations, hospital patients over 80, the disabled in care homes and public hospital workers. According to the Health Ministry, the Valencia region has received 608,650 doses of all three vaccines and has administered 486,767, which is 80% of the total.

Ceuta

The North African exclave city was planning to continue vaccinations this week with the AstraZeneca vaccine, but has put this on hold after the central government’s decision to suspend its use. Until Friday, the authorities were vaccinating the over 80s with their second dose, along with over-70s and essential workers, including teachers and the security forces. The campaign to vaccinate the under-55s in this group with the AstraZeneca jab, however, is now on hold. Ceuta has administered all of the doses it has received (9,190), vaccinating 2,533 people of a total of 84,200 inhabitants.

Melilla

The North African exclave city will this week receive 2,340 doses of the Pfizer vaccine, around 1,170 more than initially programmed. The local authorities and healthcare general secretary have criticized the low number of doses received, something that is slowing down the vaccination strategy. Melilla is the territory that has administered the highest percentage of received doses (95.8%), but is at the bottom of the list in terms of the percentage of the population that has been fully inoculated: 2,370 people, or 2.5% of the population.

With reporting by Emilio de Benito, Juan Navarro, Mikel Ormazábal, Ferran Bono, Lucía Tolosa, Eva Saiz, Laura J. Varo, Sonia Vizoso, Elisa Tasca, Diego Estebanez, Lucía Bohórquez, Josep Catà, Isabel Valdés, Bernat Coll, Jesús A. Cañas.

English version by Simon Hunter and Susana Urra.