High vaccine acceptance lets Spain avoid the debate over mandatory inoculations

With vaccination rates at around 90% for healthcare staff and care home workers, the Health Ministry and the regions consider it unnecessary to follow in the footsteps of France and Greece

A Covid-19 vaccine is administered in Seville.
A Covid-19 vaccine is administered in Seville.PACO PUENTES (EL PAÍS)
Oriol Güell

Social value as well as personal benefit, and persuasion ahead of coercion. Those are the principles that have guided the vaccination of children in Spain for decades, and as a result the country has one of the highest vaccine coverage rates in the European Union. Given these good results, the administration has not considered it necessary to make any changes in the fight against the coronavirus. Nor is any special strategy needed among healthcare workers or staff in senior homes, where a positive case can have devastating consequences for patients or residents.

The data available in Spain show that the staff at Spanish hospitals and healthcare centers have responded en masse to the country’s Covid-19 vaccination campaign, with percentages that are close to 98%. The take-up rate is somewhat lower among staff in care homes, at 90%.

A similar situation is not to be found in other countries on the continent. France and Greece announced on Monday that vaccination will be obligatory for healthcare staff after the fifth wave broke out, and evidence that there is still hesitancy among many professionals in the sector.

“Healthcare professionals must have received their second [vaccine] dose by September 15,” stated the French Health Minister Oliver Veran this week, adding that anyone who refused to be immunized would not be able to work or get paid.

In Spain, fortunately, we know very well the advantages that vaccines have for each of us and for society as a whole
Amos García, president of the Spanish Association of Vaccinology (AEV)

The measure was adopted in France after weeks of little progress of vaccination among healthcare workers after coverage reached 60%. “We need to move toward the vaccination of the entire French population, this is the only way to return to a normal life,” stated French President Emmanuel Macron, who included this obligatory vaccination plan within a package of measures aimed at the entire population of a country where resistance to vaccines has grown notably over the last two decades.

In Greece, Prime Minister Kyriakos Mitsotakis has been equally forceful. “We are not going to shut down the country again just for the fault of a few,” he said. “It is not Greece that is in danger, but rather the Greeks who have decided not to get vaccinated.” While the government has not made public the vaccination data among healthcare workers, the trend in the country is of concern: the rate of the vaccination campaign has slowed at a time when barely 41% of Greeks have full coverage from the vaccines, a six-point deficit compared to Spain.

The Greek Bioethics Committee had recommended obligatory vaccination for all healthcare workers and those who deal with seniors as a “last resource” should the efforts to promote vaccination among them not have an effect.

“In Spain, fortunately, we know very well the advantages that vaccines have for each of us and for society as a whole,” says Amos García, the president of the Spanish Association of Vaccinology (AEV). “The coverage that we are achieving among the population and reached among healthcare personnel are both very high.”

With the current percentages, this specialist believes that implementing obligatory vaccination would be “counterproductive.” “It’s always better to persuade than to coerce,” he said. “And doing so when it isn’t necessary can have an undesirable effect and produce rejection of vaccinations and strengthen arguments for the few that are opposed to it.”

José Miguel Cisneros, the head of the infectious diseases service at the Virgen del Rocío Hospital in Seville, agrees that the “rejection of vaccines is marginal in Spain, unlike what is happening in countries such as France.” He cites as an example the acceptance achieved in his hospital, where more than 99% of the nearly 9,000 members of staff have been vaccinated.

People wait after receiving the Pfizer-BioNTech COVID-19  vaccine at a vaccination center in Lyon, in central France, on July 7.
People wait after receiving the Pfizer-BioNTech COVID-19 vaccine at a vaccination center in Lyon, in central France, on July 7.Laurent Cipriani (AP)

“Spain should continue with the strategy it has used until now because it has achieved very good results and because individual freedoms should be preserved as much as possible,” he says. “When we enjoy a situation that is very close to an optimal one, with vaccines accepted as something that contributes to the common good in a way that goes far beyond individual benefit, I see no reason to make changes,” Cisneros concludes.

The Health Ministry has insisted on voluntary vaccination as being one of the principles that must inspire the campaign, which got going at the end of December. With a coverage in hospitals and other healthcare centers of around “99%,” according to the ministry, there is no reason to follow the lead of France or Greece.

The data offered by Spain’s regions is also very high, although in some cases it dips. Catalonia reports that 90.2% of its healthcare staff have been fully vaccinated (92.5% have one dose), with 88.1% among workers in care homes (90.4% with one dose).

Andalusia puts the figure above 90% for both collectives, while 95.6% of Valencia’s healthcare staff have full protection offered by the vaccines, as do 88.3% of senior residence staff. That percentage rises to 100% and 97.5%, respectively, for those with the first dose.

In the Canary Islands, 99.4% of healthcare workers and 81.3% of social care workers are fully vaccinated, with nearly 100% of both groups having had the first dose. In the Balearics, the figures are around 90%.

In Murcia, the authorities say that 97.5% of healthcare professionals are fully vaccinated, while 100% have the first dose. Meanwhile, 93.3% of social care workers have one dose and 89.3% are fully inoculated.

Citizens lining up outside Enfermera Isabel Zendal Hospital in Madrid to receive their vaccination.
Citizens lining up outside Enfermera Isabel Zendal Hospital in Madrid to receive their vaccination.Mariscal (EFE)

Some regions have not supplied data or declined to answer requests from this newspaper for information, but all the sources consulted suggest that there is little difference from territory to territory, and the percentages are similar throughout Spain.

Despite this positive data, it is necessary to “continue to work to obtain the maximum coverage possible,” Amos García argues. The danger is clear, as was evident in May in a senior home in Girona, where the coronavirus caused the death of an elderly lady who was in ill health and had been vaccinated. Of the 37 workers at the center, 17 had opted not to be vaccinated. A number of residences in Spain have suffered outbreaks in recent months, where the presence of unvaccinated staff has facilitated the circulation of the virus.

“In cases where staff are dealing with very vulnerable people, and lives are clearly being put at risk, I do consider it necessary to open the door to starting the debate about [making the vaccines] obligatory,” the AEV president continues. “But it would be better for the focus to be case by case and to seek concrete solutions.”

The common position among experts and the regions is that before major changes are introduced that could end up being complicated and create resistance, the good results of the Spanish strategy suggest that the current course should be held for now, and more drastic measures should only be adopted when strictly necessary. The Balearics, for example, have introduced a decree “that permits for the establishment of obligatory vaccination in specific collectives should it be deemed necessary,” although for now the authorities have not had to use this option.

The Health Ministry and the regions agree that, whatever the case, any changes should be decided on by the Inter-Territorial Council of the National Health System (CISNS), which brings together the central Health Ministry and the regions. Until now, only Galicia has moved to make vaccination obligatory. This was appealed in the courts by the Health Ministry in the Constitutional Court, which is yet to issue a final ruling. “It is only possible to restrict fundamental rights via national legislation,” said the then-central government spokesperson María Jesús Montero at the time.

With reporting by Margot Molina, María Fabra, Mikel Ormazabal, Isabel Valdés and Lucía Bohórquez.

English version by Simon Hunter.

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