Spain’s vaccine have-nots: the 70-year-olds squeezed between younger and older target groups

In Spain, members of one specific age group have been watching people both younger and older than themselves get vaccinated against Covid-19, while they are told to wait.

They are the people born between 1942 and 1956, and who are now in their late sixties and seventies. Even though they represent one of the biggest risk groups in terms of developing a severe or even fatal case of Covid-19, there is a good chance that they will not be getting their shots before mid-April at the earliest.

Of all the fatalities since June 2020, 64.5% were 80 and older, while 20% were between 70 and 79

The government’s guidelines are prioritizing the 80-and-over population, and health officials have now also authorized Oxford-AstraZeneca’s vaccine for adults under the age of 65.

There is a chance that this age limit will be expanded at a Tuesday meeting of the Public Health Committee that’s advising the government on coronavirus matters. If not, 6.5 million people between the ages of 65 and 79 will have to keep waiting.

Spain’s chief epidemiologist, Fernando Simón, director of the Health Emergency and Alert Coordination Center, on Monday said that the AstraZeneca vaccine is being used on increasingly larger segments of the population, as new evidence emerges. “The fact there is a debate about it at the [...] Public Health Committee shows that it is not an easy or a clear decision to make. A lot of variables have to be taken into account.”

If the Public Health Committee keeps the 65 age limit in place, most of the people over the age of 80 will have to be vaccinated before the 70-to-79 age group starts getting calls for appointments. And those between 65 and 69 years of age will have to wait even longer, until most of the three million individuals in the 70-to-79 group have been inoculated.

Expanding the target group

The AstraZeneca vaccine was originally authorized for the under-65s across Europe because of a lack of scientific evidence of its effectiveness on older adults. But new data has emerged since early March, and many countries have now eliminated that age limit, including Germany, France, Italy, Portugal, Greece and Austria. The United Kingdom never set an upper age limit, and neither did the European Medicines Agency (EMA) or the World Health Organization (WHO).

Spain had originally set a conservative upper age limit of 55, but recently raised it to 65. Health Minister Carolina Darias justified this decision by saying that the AstraZeneca vaccine had only been tested on younger people, and that’s why Spain was planning to use it on essential workers up to 65 years of age. But new data on the drug’s effectiveness has since emerged, and on Wednesday of last week, Spain began administering it to the general population, not just essential workers.

Ángela Domínguez, the coordinator of the vaccination working group at the Spanish Epidemiology Society, believes that it makes no sense to keep limits in place with the new available evidence. “We’ve seen very high effectiveness, and even if it went down, it would still be better to administer the vaccine to older people than not to,” she says.

Statistics show that age is the main determining factor in risk of death from Covid-19. Of all the fatalities since June 2020, 64.5% were 80 and older, while 20% were between 70 and 79. The percentages keep falling in line with age: 9.2% of deaths were among the 60-to-69 age group, and 3.5% among the 50-to-59 group. Only 1.4% of people who died of Covid-19 were under the age of 50, according to figures provided by the Carlos III Health Institute.

Use of the AstraZeneca vaccine was further hampered by a temporary pause caused by a health scare, after several EU countries reported cases of blood clots among a few recipients. After the EMA defended the use of the vaccine, administration resumed in Spain last week.

Different region, different pace

The pace of vaccination is very different depending on the region. Andalusia is going very fast and recently announced it might get started with people in their seventies by mid-April. Catalonia is lagging behind and does not expect to begin inoculating this target group until a month later.

The month of March is coming to an end, and Spain has not managed to vaccinate 80% of the 80-and-over group as it had been planning to. But the Health Ministry does not provide official figures, and not all regional governments do, either, so it is hard to determine exactly how much progress has been made. Based on conversations with regional health departments, around 60% of older adults may have already received their shots.

A survey on the vaccine rollout published by the European Centre for Disease Prevention and Control showed that one of the challenges in Spain was the lack of homogenous progress across the regions.

English version by Susana Urra.