Spain to stop using AstraZeneca vaccine on people under 60

Spain has announced plans to stop administering the Covid-19 vaccine made by Oxford-AstraZeneca to people who are under 60 years old.

The change in criteria comes after the European Medicines Agency (EMA) found a “possible link” between this vaccine and “very rare cases of unusual blood clots with low blood platelets.”

Up until now, the vast majority of the 2.1 million AstraZeneca doses administered in Spain have gone to essential workers – mostly teachers and members of law enforcement agencies and emergency services – as well as to healthcare workers who were not immunized during the first phase, and to the general population between 60 and 65 years of age.

Spain has changed its age limit for the AstraZeneca vaccine repeatedly. First, it set an upper threshold of 55, then raised it to 65 after temporarily suspending its use over a European health scare. Now, those under 60 will no longer be eligible for the shot.

This latest change of tack poses new challenges for Spain’s vaccination drive. There are thousands of essential workers, most of whom are under 60, who do not know which vaccine they will receive or when. And individuals who have already had their first dose may find themselves without the second one.

Experts warn about a risk of creating a widespread perception that “there are good vaccines and bad vaccines”

Health Minister Carolina Darias said that in the coming days a decision will be made regarding people under 60 who have already had their first AstraZeneca shot. Speaking at a news conference, she said there were two options on the table for now: either use a different vaccine brand for the second dose, or not provide a second dose at all. Darias said that the first dose is 70% effective against Covid-19.

The Health Ministry said it will also consider how to proceed with the 65-and-over group, which until now had only been receiving the Pfizer and Moderna vaccines.

While Spain has speeded up its vaccination drive, the current pace of around 600,000 people a week will not be enough to hit the central government’s target of immunizing 70% of the adult population by September.

“This will inevitably delay the vaccination calendar, and create more pressure to use the scarce amounts of Pfizer and Moderna vaccines,” said Daniel López-Acuña, a former official at the World Health Organization (WHO), about the latest decision.

Experts also worry that the constant strategy changes will further erode the public’s confidence in vaccines. “Trust will be significantly undermined,” said López-Acuña. And Amós García, president of the Spanish Vaccinology Association, warning that it risks creating a widespread perception that “there are good vaccines and bad vaccines.”

Strategy changes across Europe

In recent weeks other European countries such as the Netherlands and Germany had already restricted use of the AstraZeneca vaccine to older adults only. This decision followed a scare in March over several reports of blood clots and deaths that led to a temporary suspension of the Anglo-Swedish drug across Europe while the EMA conducted an investigation.

Vaccination resumed in Spain following the EMA’s first report in mid-March. But on Wednesday morning the Spanish region of Castilla y León unilaterally halted immunization with AstraZeneca, saying it was waiting for a new EMA report on the vaccine’s safety.

The unexpected move prompted Spain’s central government to underscore that vaccination decisions are not in the hands of regional officials. After the EMA report came out later in the day, the Health Ministry said that the target age group would be changed to 60 and over “following the principle of precaution,” in light of the fact that most reported cases of thrombosis have occurred in women under 60.

Other countries have also adjusted their vaccination strategies after the EMA said on Wednesday that “unusual blood clots with low blood platelets should be listed as very rare side effects” of the vaccine. Britain’s vaccine advisory committee now says that people under 30 should be given an alternative vaccine whenever possible, while Belgium has proposed limiting it to over-55s. Italy has said it will administer the second dose to those who have had the first, but will otherwise focus on the 60-and-over population.

At a meeting of central and regional health officials held on Wednesday, Health Minister Carolina Darias proposed stopping the use of the AstraZeneca vaccine on individuals under 60. According to people familiar with the meeting, most regional governments agreed with this measure, although Madrid opposed it, saying that the under-60s should not be excluded.

With reporting by Daniel Verdú, Isabel Valdés and Juan José Mateo.

English version by Susana Urra.