What happens to people in Spain who refuse the Oxford-AstraZeneca vaccine?

According to the Spanish Health Ministry, due to the scarcity of Covid-19 doses, anyone who rejects the medication from the British-Swedish firm will not get a shot

A health worker receives the AstraZeneca vaccine in Valencia.
A health worker receives the AstraZeneca vaccine in Valencia.Mònica Torres
Pablo Linde

After a pause of one week and a day, Spain restarted the use of the Oxford-AstraZeneca Covid-19 vaccine on Wednesday, after the authorities in the country and several other European Union states put it on hold while cases of blood clots were investigated for their possible link to the medication. But the eight days without using the shots are a minor bump in the road compared to the doubts that now exist about the AstraZeneca vaccine among the general public, according to Amós García Rojas, the president of the Spanish Vaccinology Association.

Given the concerns surrounding the British-Swedish vaccine, there will be people in Spain who are now doubting whether or not to get vaccinated against Covid-19 with AstraZeneca. So what happens with them?

Covid-19 killed 161 people for every million inhabitants in February, a figure that is much greater than the occurrence of blood clots

The Spanish health minister, Carolina Darias, answered that question on Monday. “This is not included in the vaccination plan,” she explained, adding that for now, people who refuse the vaccine will not get a shot.

As García Rojas puts it, “vaccines are not yogurts, you can’t choose the flavor that you like the most.” The expert maintains that all of the vaccines are safe, are highly effective and that each person will be given the most appropriate type, given that there is a limited number of doses and that the aim is to protect the most vulnerable people from the most serious forms of Covid-19 – in particular older people, who have the highest mortality rates from the disease.

Over a short amount of time, Spaniards have heard a lot about concepts that are very common in the pharmaceutical world – pharmacovigilance, adverse effects, causal link – but are by no means familiar to the general public. Reservations and doubts are inevitable.

But the message from the health authorities is unwavering: despite thrombotic events being detected after the administration of the AstraZeneca vaccine, they are no more frequent than in the general population. Some particularly rare events have, statistically, been more common among those who have been vaccinated, but this is still at a level of one case among hundreds of thousands, fewer than other serious adverse effects caused by any regularly used medication. So far, no causal link has been established between the vaccine and these episodes.

The majority of European countries are doing the same as Spain: people cannot choose their vaccine in Germany, France, United Kingdom or Belgium. At least for now. The Italian authorities have announced that anyone who refuses an AstraZeneca shot will be able to get another type at a later date. But what is the same across the board is that if someone doesn’t want their vaccine now, there is no guarantee that they will get another.

Line to receive the AstraZeneca vaccine in Milan.
Line to receive the AstraZeneca vaccine in Milan.Luca Bruno (AP)

Those who turn down their vaccine are running a much greater risk than the possible side effects. Covid-19 killed 161 people for every million inhabitants in February, a figure that is much greater than the occurrence of blood clots.

Ildefonso Hernández, from the Spanish Public Health Society (Sepsas), is particularly happy that the AstraZeneca shot is being used once more in Spain. Partly because he believes it is good news in terms of ending the pandemic, and partly because, at the age of 64, he will soon be getting his AstraZeneca vaccine now that the Spanish authorities have raised the upper limit for its use from 55 to 65.

The European Medicines Agency (EMA), the World Health Organization (WHO) and the Health Ministry have repeatedly insisted that the vaccine is safe and that its benefits greatly outweigh its possible risks – which have not been proven, apart from recipients feeling somewhat unwell after getting their shot.

Vaccines are not yogurts, you can’t choose the flavor that you like the most
Amós García Rojas, president of the Spanish Vaccinology Association.

But this might not be enough to convince those who have doubts about it and would rather not get vaccinated due to their fears. “In this context, it is probably better for people to see some exemplary attitudes, people with a certain social relevance saying publicly that they will get vaccinated with AstraZeneca when it is their turn to do so,” explains García Rojas. “Perhaps political representatives, who don’t have to jump the line, but should publicly state their intentions.”

French Prime Minister Jean Castex understood this. As soon as the injections restarted in his country last week, he received a dose. The Spanish government’s spokesperson, María Jesús Montero, publicly stated this week that she and the rest of the Cabinet would get an AstraZeneca shot when it was their turn.

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Is this gesture enough? Marga Mateu, a psychologist who is due to get the medication herself, says no. “It would be good, for example, if the [Spanish] prime minister were to put out a message of calm or that he got vaccinated himself, as they did in France,” she argues.

Mateu was due to get her AstraZeneca shot the day that they were suspended from the campaign in Spain. After reports of the death of a 43-year-old teacher in Marbella after being vaccinated with AstraZeneca – an autopsy found no link to the shot – the psychologist opted to refuse the inoculation. She wanted to think about it, and get advice. They told her that they would call her again, and she has now decided that she will say yes when they do. “I’ve spoken to relatives who are doctors and they have told me that it is safe and I have seen that a lot of countries, not just Spain, have restarted their vaccinations, but with what was happening it was inevitable that there would be fears.”

A recent poll of 1,050 people found that 52% now consider AstraZeneca to be unsafe, double the figure from a month ago

Anyone who has doubts and rejects a vaccine should not be punished, according to Federico de Montalvo, the president of the Spanish Bioethics Committee and a member of the vaccination board that advises the Spanish Health Ministry. If they regret their decision, the best approach would be to get in contact again in order to arrange an AstraZeneca injection – but the option of choosing another vaccine should not be on the table.

“It doesn’t seem to make much sense for a vaccine to be taken away from the most vulnerable, those who are receiving the ARN messenger vaccines [Pfizer-BioNTech and Moderna] to give them to others,” he argues. “We need to let time pass, so that people see the vaccine is safe and continue to communicate well so that people regain their confidence, as they did when they saw the first seniors getting vaccinated.”

Surveys show that as the campaign is progressing in Spain, people are gaining confidence. According to a survey carried out by the CIS public research institute, those who were prepared to get vaccinated as soon as they could rose from 40% of those polled in December to 82% in February. There aren’t such trustworthy surveys for now about how all the noise about AstraZeneca has had an effect. There is just one poll from YouGov of 1,050 people which found that 52% now consider AstraZeneca to be unsafe, which is double the figure from a month ago.

English version by Simon Hunter.

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