How Chile vaccinated 16% of its population in just 21 days

Chile began its Covid-19 vaccination campaign on February 3, and by Tuesday of this week, fewer than 21 days later, more than three million people had already received at least one dose – equivalent to 16% of the country’s 19 million inhabitants.

The percentage of vaccines administered not only easily outstrips those of its biggest neighbors – such as Argentina (1.65%), Brazil (3.43%) and Mexico (1.4%) – but is also above countries such as Spain (9.59%) and very close to the United States (19.44%).

The number of vaccines it has available and the speed of the operation, with at least 1,300 vaccination centers in the territory, has turned the South American country into a regional and global example.

Mexico, Colombia, Peru, Uruguay and Paraguay have called for help from the Chilean authorities, according to the country’s Foreign Relations Ministry. The success of the strategy combines historical elements along with circumstantial ones: the strength of the primary healthcare system since the 1950s, the commercial strength of one of the most open economies in the world and the negotiating skills of its president, Sebastián Piñero, who is a powerful businessman.

As a result, his government – which is serving a term that started in 2018 and is due to end in 2022 – is hoping to vaccinate 15 million people in the first quarter of the year, and as such, reach herd immunity for the Chilean population by the end of June.

In May of last year, Piñera ordered the undersecretary for International Economic Relations, attorney Rodrigo Yáñez, to work exclusively on closing deals with the laboratories that are manufacturing Covid vaccines. Since then, Yáñez has led the negotiations in constant contact with the president.

Shortly before the arrival of the first doses of the Chinese Sinovac vaccine (called CoronaVac), at the end of December, Piñera spoke directly to Chinese President Xi Jinping in order to expedite the bureaucratic process. While he has had serious political problems in this second term in office, the Chilean president continues to be widely recognized for his management abilities, such as those that facilitated the rescue of 33 miners who were trapped underground in 2010 during Piñeras’ first term in office.

The focus of Chile’s vaccination strategy has been pragmatism as well as the diversity of the laboratories with which it has been negotiating at the same time and via different routes. The management of alternative plans has been particularly beneficial, taking into account the delays being suffered to vaccine deliveries the world over.

In Chile, for example, there were no clinical trials of the Pfizer-BioNTech vaccine, but this medication was the first to arrive in the country, with 20,000 doses delivered on December 24. These doses were used to vaccinate healthcare workers assigned to the country’s intensive care units. What’s more, another 10 million doses were secured, and they are due to be delivered during the first quarter of the year. Unlike other countries in the region, Chile has managed to establish a good calendar for the campaign, with exponential growth.

From China to the US

The country opted for a different strategy with the Sinovac vaccine, given that clinical trials had been carried out in Chile. Paid for by the South American country, the testing process facilitated the availability of the vaccine. The prices were negotiated as well as an ambitious time frame that will allow for the delivery of 60 million doses in three years – although the quantities can be increased, according to Chile’s needs.

Two shipments with approximately four million Sinovac doses have already arrived in Chile. A crucial part of this process was the collaboration agreement reached between the prestigious Catholic University in Chile and the Chinese laboratory.

“In 2020, we were in an uncertain scenario because we didn’t know how each vaccine was going to end up,” explains Yáñez. “There had been no regulatory approvals and the laboratories had only just begun their production chains. But we tried to minimize the risk of the bet, with weekly – even daily – calls with Sinovac, for example, which allowed us to establish close links.

“Sometimes these bets pay off,” the undersecretary continues, “and fortunately with Sinovac it was an excellent bet, considering the availability of the vaccines at an early stage, and which have been complemented with those from Pfizer, which was able to deliver to us earlier but in smaller quantities.”

As for the Oxford-AstraZeneca vaccine, Chile is expecting around five million doses, with a first shipment due to arrive between April and May. At the same time, the Piñera government is seeking to extend its contract with Sinovac, and is also negotiating with CanSino, a Chinese-Canadian company that is also carrying out clinical trials in Chile. What’s more, it is in advanced talks with the Russian manufacturers of the Covid vaccine Sputnik V. The government is seeking to strengthen the inoculation process in the second quarter.

According to data from the Chilean Health Ministry, a total of 3,037,063 had been vaccinated by Tuesday. Chile has the capacity to innoculate 87,264 people in a single day, but the speed will start to accelerate even further as younger age groups are called up. Until now, the majority of the over-65s in the country have been immunized with a first dose. From next week onward, they will start to receive the second, given that 28 days will have passed from the first jab. Different risk groups have also been vaccinated, such as older teachers, for example.

On Wednesday it was announced that new shipments of Sinovac and Pfizer vaccines would be arriving, meaning that around nine million doses will be available by Friday. This will allow for Chile to progress with the vaccination of the 250,000 teachers in the country, kidney patients who need dialysis, and people aged between 60 and 64. On March 8, the campaign will move onto the chronically ill of any age.

Prior commercial agreements

Chile has 30 commercial agreements in place with the principal countries and blocs in the world. As such, while it is a small country, it is well-positioned in the global economy and has well-oiled foreign-trade mechanisms that were activated when needed at the time that early negotiations were required for the Covid-19 vaccines.

An additional element turned out to be crucial for this strategy: despite the problems in a state that needs modernization and is suffering from a polarized political climate, Chile did not get caught up in bureaucracy and managed to make decisions with ease. It did so from the level of the president down to technical bodies such as the Institute of Public Health (ISP), which can independently authorize medications and vaccines, among other tasks. Before approving the vaccine from Sinovac, for example, its officials traveled to the Chinese company’s installations.

The Chilean government has placed particular attention on the execution of the contracts, a particularly complicated phase in the process. In recent weeks, undersecretary Yáñez has had to manage issues such as import restrictions from the European Union, the interruption of the vaccination schedules and logistical problems such as flight permits.

The shipments that are due to arrive this week in Chile with new Sinovac vaccines will arrive in a container for Uruguay. “Cooperation exists exclusively in terms of transportation,” explained Chilean Health Minister Enrique Paris on Tuesday. “The Uruguayan government has acquired these vaccines and we are bringing them here from Santiago making use of this journey and they will immediately be sent to Montevideo.”

The negotiations have been particularly complex with the EU and the United States, which are very inflexible when it comes to their clauses. For the US, Chile hired the Skaden law firm in order to mitigate the risks.

The vaccination process was assigned a budget of $200 million (€163 million), although the Foreign Relations Ministry estimates that another $100 million (€82 million) in North American currency could be required. The government, however, does not believe money was relevant to the success of their strategy given that similar countries in the region have access to the same amount of funding.

While the government was criticized during the early stages of the pandemic for not having given the primary healthcare system a key role for tracking and tracing, it is now recognized for having put the vaccination operation in its hands. “Despite the vicissitudes that the Chilean health system has faced, such as the privatization onslaught during the Pinochet dictatorship, Chile managed to preserve the structure of a national health system in the entire territory, one that has its origins in the 1950s,” explains Socialist doctor Álvaro Erazo, who was health minister in the first government of Michelle Bachelet (2006-2010). “Later, the plan to strengthen the primary healthcare system was the first strategic task in the return to democracy, in 1990,” he continues.

“Currently the primary healthcare system is showing its worth and its historical memory, which has been marked by major vaccination campaigns, which are on a level with developed countries. As it has a presence in the whole country, Chile has a huge capacity to distribute vaccines in complex logistical chains, despite its geography,” the former minister explains.

The first Covid-19 case in Chile was detected nearly a year ago, on March 3, 2020. Since then, in a population of 19 million inhabitants, there have been 805,317 registered infections and at least 20,151 people have died after contracting Covid-19. The Health Ministry is fearful of a rise in cases in March, after the summer vacations come to an end. According to the latest report, only 186 intensive care unit beds are currently available.

English version by Simon Hunter.