In Spain, patients with serious conditions left out of AstraZeneca early vaccination

For now the Covid shots will go to teachers, law-enforcement officers, firefighters and other essential workers, while severely immunocompromised people are being told to wait

A dose of the AstraZeneca vaccine.
A dose of the AstraZeneca vaccine.EP
Pablo Linde

The Covid vaccine made by AstraZeneca will for now only be administered to essential workers in Spain, including teachers, law-enforcement officers, firefighters and members of the armed forces – but not supermarket workers.

Although the treatment has been approved by European authorities for anyone over the age of 18, the Spanish government is taking a conservative approach: first it ruled out people over 80 years of age, then it further reduced the target group to those under 55. And on Tuesday, a committee of experts advising the National Healthcare System established that individuals under 55 with certain pre-existing medical conditions will also be left out, at least during the initial phase.

Neither the Health Ministry nor the committee have provided explanations for their decision, but the reasoning is laid out in a draft document detailing Spain’s revised vaccination strategy, to which EL PAÍS has had access.

Eleven days after the European Commission greenlighted the vaccine, the Spanish government had yet to announce guidelines for its use

“Due to the characteristics of the AstraZeneca vaccine known to date [...] it is recommended for use on people between the ages of 18 and 55, except for those with severe immunodepression (including cancer patients undergoing chemotherapy treatment, uncontrolled cardiovascular disease, or severe liver, kidney, metabolic/endocrine or neurological diseases). People with these conditions and those over the age of 56 (born in or before 1965) will be vaccinated at a later date when their age group or risk group comes up, and with the most appropriate vaccine depending on availability and new available evidence.”

The reason for leaving out people with these underlying health conditions is that they were not included in the clinical trials for the vaccine. However, experts such as Ildefonso Hernández, the spokesperson for the Spanish Society for Public Health, had called for people with diabetes or high blood pressure under the age of 55 to be prioritized, as they are also vulnerable to the most severe manifestations of Covid-19.

The decision is not irreversible, and new reviews of the vaccination plan could include some of the age or risk groups that are now being left out. Health Minister Carolina Darias has also reiterated that the process must be the same across Spain, following announcements by some regional governments that they would begin administering the AstraZeneca vaccine without waiting for central authorities to reach a decision that did not seem forthcoming: 11 days after the European Commission greenlighted the vaccine, the Spanish government had yet to announce guidelines for its use.

Who gets the vaccine

Vacunacion Coronavirus Madrid
Teachers, police officers and firefighters are first in line to receive the AstraZeneca vaccine.Marta Jara (Europa Press)

The largest group slated to receive the AstraZeneca vaccine is made up of around 760,000 teachers in early, primary and secondary education, according to union estimates. There are also around 240,000 law enforcement officers from the National Police, the Civil Guard, and regional and local agencies. Some 120,000 members of the military are also eligible, as well as 23,000 prison workers and 20,000 firefighters.

The AstraZeneca shots will also be administered to healthcare professionals who are not considered frontline workers: physiotherapists, occupational therapists, pharmacy office workers, legal medicine workers, home assistance workers, and employees at day centers and centers for minors.

Not included in the list are supermarket employees, who were considered essential workers during the three-month lockdown between March and June of last year.

Eligible groups will receive 1.8 million doses that Spain is hoping to have in February, with more expected to arrive in the coming months. This process will run parallel to the ongoing vaccination campaign with the Moderna and Pfizer-BioNTech vaccines, which are being administered to care home residents and workers, frontline health workers and people with need for daily assistance who are not living in care facilities.

No adverse effects

The Spanish Medicines and Health Products Agency (AEMPS) on Tuesday released the second evaluation of adverse effects seen in coronavirus vaccines. The study analyzed 1.1 million doses administered to January 24 and did not find any cases of severe or unexpected adverse effects. The most frequently reported side effects were fever, pain in the injection site, headaches, dizziness, nausea and diarrhea.

According to the Health Ministry’s latest report from Tuesday, 2.1 million doses out of a total available stock of 2.4 million have already been administered. Around 832,000 people have received both doses. The vast majority of the doses available in Spain are made by Pfizer-BioNTech (2.1 million), followed by AstraZeneca (196,800) and Moderna (87,700).

Recommendations for those who have recovered from the coronavirus

The updated protocol recommends against vaccinating people under the age of 55 if they have recently had the virus. The recommendation is to wait six months from the date of the positive test result. This does not apply to people over the age of 55 or to those who are at high risk.

English version by Susana Urra.

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