There is little margin for Spain to increase its Covid-19 vaccination rates. A total of 79.3% of people in the country have had at least one dose of a Covid-19 vaccine – the equivalent of 90% of the vaccinable population, given that no vaccine has been approved so far for the under-12s, who account for 11% of the population. If this figure is added to the so-called “anti-vaxxers” (who represent around 4% of the population, according to the latest surveys), as well as the vaccine-hesitant (i.e. people who do not reject vaccines but have no interest or intention of getting immunized), and to those that the healthcare system has difficulty reaching, such as migrants in an irregular situation, it leaves a very small group that is still unvaccinated.
This can clearly be seen in the increasingly slow pace of the Covid-19 vaccination drive. During the spring and summer, the percentage of people who had received at least one dose went up by around three points every week. This figure began to fall in August, and last week the rise was just 0.4 points. As for the number of second shots administered, this data point saw the biggest leaps in July, with the percentage rising five points in a week. On Monday, the figure had only risen 0.9 points with respect to the previous week. In total, 76.8% of the population in Spain is fully vaccinated, and in four regions – which are in charge of their vaccination drives as well as containing the pandemic in their territories – this figure is more than 80%: Asturias, Castilla y León, Galicia and Extremadura.
But when forecasting the future progress of the vaccination drive, it is the data on first doses that are taken into account, given that most people who have had their first shot tend to have their second. And this is the figure that is rising at a slower and slower rate. Among the over-50s, nearly 100% have had at least one shot. But this data point falls as the age groups become younger, given that they are at less risk of developing a serious case of Covid-19. Among the 40-49 population, 87.8% have had their first dose, a figure that falls to 78% for the 30-39 age group. Indeed, this is the group that has the lowest vaccination rates of all demographics in Spain. According to the latest figures released by the Spanish Health Ministry, the 20-29 population has a marginally higher rate (78.3%), while the 12-19 age group is far ahead (82.5%).
José Antonio Forcada, the president of the National Nursing and Vaccines Association, believes it will be difficult for Spain to achieve more than 80% vaccination coverage while no vaccine is approved for children. “It is going to take a lot for us to increase the percentage among 20-40 years olds. Many people in these groups think the pandemic is over,” he explains.
Jaime Jesús Pérez, the vice-president of the Spanish Vaccinology Association (AEV), agrees. “The under-40s who did not get vaccinated during the fifth wave will not easily do so now that it is falling, particularly if we are just trying to convince them with campaigns and telephone calls,” he says. More than 20% of people in this age group have not been vaccinated. “It’s not that they are anti-vaxxers, normally it’s out of rebellion, laziness or disinterest,” he explains. “In other countries, such as France, which is traditionally more anti-vaxxer than Spain, requiring a Covid certificate to enter sites such as bars and restaurants has worked very well.” In France, more than 93% of adults have had at least one vaccine dose, according to the European Center for Disease Prevention and Control (ECDC).
Spanish Health Minister Carolina Darias, however, is still optimistic that the country will be able to vaccinate 100% of the target population. On Monday, she was at Los Olmos de Guadalajara nursing home, where the vaccination drive began on December 27, to oversee the beginning of the rollout of third doses in senior residences. “This 100% objective of hope is what is encouraging us to keep working with zeal, and of course, with great effort in all the regions and autonomous cities in our country,” said Darias.
Beyond concrete milestones, the Spanish government’s goal is to vaccinate as many people as possible. Achieving group immunity, which for some time meant having 70% of the population fully vaccinated, has turned into a pipe dream due to the emergence of new, more-contagious strains of the coronavirus, such as the delta variant. Although vaccination reduces the likelihood of contagion, it does not eliminate it all together. What it does do is significantly reduce the risk of a person developing a serious case of Covid-19, requiring hospitalization and possibly dying from the disease. During Spain’s fifth wave of coronavirus infections, the mortality rate was seven times lower than in previous waves, largely because most of the vulnerable population had already been vaccinated. According to experts, any future waves in Spain are not likely to take such a heavy toll on the healthcare system nor lead to as many fatalities due to the high vaccination rates.
But while a large share of the under-40 population remains unvaccinated, there will continue to be new coronavirus cases, says Pérez. “Perhaps not waves, but there will be outbreaks that will lead to some hospitalizations and also deaths,” he explains. “It is not that the vaccine completely prevents the circulation of the virus, but the closer we are to 100% coverage, the more difficult it will be for it to spread.”
And if children are vaccinated?
It is likely that a Covid-19 vaccine for under-12s will be approved in the next few weeks. This would, at least in theory, improve vaccination coverage rates in Spain. Vaccine manufacturer Pfizer-BioNTech has announced that its trials show its dosage for children is safe for those aged five to 11. Although these results have not been published nor validated by health agencies, the announcements the company has made during the pandemic have typically been confirmed by such regulators.
Both the European Medicines Agency (EMA) and its US counterpart, the FDA, will have to review the trial results and decide whether or not to approve the vaccine for under-12s. But even if it gets the green light, it will not automatically mean that Spain will vaccinate children. The vaccine expert team that is advising the government will be responsible for deciding whether or not to take this step. It will not be an easy decision. Among children, the risk of becoming seriously ill or dying from Covid-19 is extremely low, meaning it is not clear whether the benefit of vaccination outweighs its possible side effects, regardless of how rare they are.
Pérez believes the priority should be increasing vaccination rates among young people and administering third doses to people with compromised immune systems. “When [the vaccine] is approved for children, it will have to be studied with a lot of deliberation,” he says.
English version by Melissa Kitson.