Spain will not have to wait for herd immunity before it can leave the coronavirus pandemic behind. With four out of every five citizens fully vaccinated, and a coverage level of 95% among the vulnerable population, the country is entering a new stage in which learning to live with the virus will become a part of everyday life.
New, more-contagious variants of the virus and the percentage of the population that has not been vaccinated – 5.2 million under-12s in Spain, for whom no vaccine has yet been approved, and 4.6 million people above that age who are yet to receive a single dose – have led experts to believe that it will be impossible to completely eradicate the coronavirus. There will continue to be outbreaks and vaccinated people will be among those infected, but the circulation of the pathogen will slow and the serious cases will fall until Covid-19 becomes just another infectious disease, like the flu is now.
Amós García, the president of the Spanish Vaccinology Association (AEV), explains that the virus “is here to stay and we will get used to living with it. But we have to impede its circulation and avoid dramatic overloading of hospitals and deaths. We have the tool to see it become a mild pathology, and that tool is the vaccines.”
Variants in circulation need to be sequenced so that we can anticipate if any emerge that could pose a challengeÁfrica González, a professor of immunology at the Biomedical Research Center
While countries such as China or New Zealand have opted for a zero-tolerance policy toward the virus, an approach that has seen whole cities confined once a small group of cases appears, Europe has chosen a gradual approach where restrictions are toughened and then relaxed according to each wave.
The waves seen across the continent this summer, the experts and public officials consulted by EL PAÍS agree, should be the last – barring, that is, any unexpected developments. There may, however, still be some minor spikes.
One of the data points that is leading to this hopeful outlook in Spain is the accelerating fall in hospitalizations and new admissions in the country’s intensive care units (ICUs). According to the latest Health Ministry report, released on Friday, there were 837 coronavirus patients in ICUs. This relatively low figure had not been seen since June, although at that point not even half of the population had been vaccinated.
In this scenario, the question is the speed with which the restrictions that have dominated the lives of citizens for the last 18 months can be lifted. Countries such as Denmark have already left them behind, but in Spain, there are still doubts about which steps to take.
“We need to achieve three things first,” explains África González, a professor of immunology at the Biomedical Research Center (CINBIO). “The incidence needs to fall below 25 cases per 100,000 inhabitants [over the previous 14 days],” she argues. On Friday, that figure was at 69.37 and has been steadily falling for weeks now. “Variants in circulation need to be sequenced so that we can anticipate if any emerge that could pose a challenge. And we need to protect those with compromised immune systems,” she concludes.
Ildefonso Hernández, a spokesperson for the Spanish Society of Public Health and Health Administration (SESPAS), agrees that monitoring will be key in the coming months. “We need to do sequencing, but we also have to do a good search of cases and outbreak control, something that should be possible given the lower incidence,” he says.
With a few nuances, the experts agree that this should be the beginning of the end of the pandemic. There should be caution and flexibility with the withdrawal of protection measures, and the vaccination process should continue to advance – one in every five people aged 20 to 39 have not received a single vaccine dose yet. But the high level of immunity achieved should prevent the virus from recovering the terrain that the end of the restrictions will liberate.
A study in Catalonia shows that 75% of the population has antibodies, either thanks to the vaccines or due to an infection
A report from the Public Health England (PHE) agency showed two weeks ago that 95% of the English population aged over 17 now has antibodies against the virus. The study, based on monitoring blood donors, explains that nearly 20% have developed these antibodies thanks to having had an infection, while the rest is due to the vaccines. These percentages mean that immunity is nearly 85% among the general population of England, with a trend that is still slowly rising.
In Spain, there have not been similar studies carried out so far, but the available data point in the same direction. Those offered by the Catalan regional government, for example, show that 75% of the population has antibodies, either thanks to the vaccines or due to an infection. The difference with England can be explained because the system used by the PHE allows for the detection of antibodies in people who have had an asymptomatic infection, while Catalonia only includes those who have contracted the virus in the last quarter. What’s more, the region is nearly four percentage points below the Spanish average in terms of vaccine coverage.
This optimistic view of the future is not, however, free of several elements of uncertainty. “For now, we do not have sterilizing vaccines that avoid all infections,” Ildefonso Hernández points out. “They largely protect against serious cases and deaths, but the virus will still be out there with [these vaccines].”
Nor is it known how long the protection offered by the vaccines will last, and if booster shots will be necessary in the future. The European Medicines Agency (EMA) and its US equivalent, the FDA, are currently claiming that, based on the available evidence, the vaccines have until now stayed effective and only those people with compromised immune systems and seniors have required a third dose. In this case, the aim is not to slow a fall in defenses but rather to help these groups develop the same levels of immunity as the rest of the population has with two shots.
The vaccination of children aged under 12 is still one of the issues yet to be resolved. Vaccine manufacturer Pfizer-BioNTech has announced that its trials show that its dosage for children is safe for those aged five to 11, and has begun the process of seeking approval from regulatory agencies. The experts point out, however, that the results of these tests are yet to be published.
“We are waiting for them to closely analyze them and to confirm that there are no signs for alarm,” explains Quique Bassat, an epidemiology researcher from the ISGlobal institute. “We need to see that the cases of myocarditis that have been detected in adolescents and young adults do not occur among children,” he explains. “My opinion is that while they could be approved for these ages, it is likely that mass vaccination will not be necessary.”
José Miguel Cisneros, the head of infectious diseases at the Virgen del Rocío Hospital in Seville, says: “This will be a difficult decision that will require major ethical evaluation. Children would not be vaccinated because they suffer serious cases [of Covid-19], but rather to help to protect adults. And that requires being completely clear that the vaccines are totally safe for them.”
At the same time, despite the high vaccine coverage achieved in developed countries, in Africa, the percentage of those with coverage is barely 7% of the continent’s 1.2 billion inhabitants, according to Oxford University’s Our World in Data website. The experts agree that given this stark contrast, in the name of social justice and to avoid new variants, “the most intelligent thing to do would be to make a global effort to send vaccines to these countries and to help them immunize their populations.”
While keeping all of these different elements in mind, the near-unanimous opinion among experts and administrations is that the time has come to deal with the definitive deescalation of coronavirus measures. How to do this was one of the questions that occupied a good part of the meeting held between regional health chiefs and the central Health Ministry on Thursday, on the Balearic Island of Menorca.
“The withdrawal of many measures has already begun, such as limits on meetings, timetables and capacity,” explain sources who attended the meeting. “It would be desirable to do this in a simple and ordered manner in order to avoid the disparity of decisions that we’ve seen in the last year. Citizens are weary and the best thing would be for just the essential restrictions to remain and with a clear horizon for their elimination.”
France has already announced that masks will no longer be required in elementary schools from October 4 onward, one of the most-awaited decisions on the part of Spanish families and schools. “What remains now for us is to confirm that the return to schools and to the workplace does not considerably change the current trends. If they don’t alter in the next three or four weeks, then we can leave behind these last protection measures. But it would be hasty to do so without confirming first that the situation has not gone into reverse,” says Quique Bassat.
“We’re close to the end,” concludes Amós García. “But caution is needed [...]. We need to continue to increase vaccine coverage and check that every measure we withdraw does not have an effect on the falling indicators. That’s the only way we can reach the goal soon and in a safe manner.”
English version by Simon Hunter.