Should we open the vaccination against covid-19?
QCOSTARICA – Six months after the start of the covid-19 vaccination, will it be time to open the campaign to those who want to protect themselves against this disease, without age limit or risk?
Five specialists were consulted: the pediatric immunologist and director of the Hospital Nacional de Niños (Children’s Hospital), Olga Arguedas Arguedas; demographer and health worker, Luis Rosero Bixby; infectologist and former Minister of Health, María Luisa Ávila Agüero; epidemiologists Ronald Evans, coordinator of the Research Unit of the Universidad Hispanoamericana (UH); and Juan José Romero Zúñiga, from the Universidad Nacional (UNA).
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These are their considerations.
Olga Arguedas: More vaccines are needed
For the director of the Children’s Hospital, a specialist in immunology, the opening of the vaccination depends on an essential factor: the availability of vaccines.
Because of this, she explains, she had to work in priority groups, vaccinating those at higher risk of death.
“If we had a significant arrival of vaccines, we could hypothesize that vaccination would open for this group (three) indefinitely”, specifies the immunologist.
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Arguedas is not concerned with the organizational and logistical aspects that could be linked to this opening. Costa Rica, she said, has always had an excellent response in organizing immunization programs.
Luis Rosero: “We must not open it yet”
For demographer Luis Rosero Bixby, vaccination should not be open yet. Here are the reasons, according to him:
- Economical: “The vaccine is still very rare with demand far greater than supply. When these situations of much more demand than supply occur, a mechanism is needed to ration. In the markets, this mechanism is the price: whoever pays it the most gets it.
“But the vaccine will not be marketed. How will the CCSS ration it if it opens? That people line up at dawn at vaccination sites? Make online appointments, like for driving tests? It is easy to imagine the problems that this form of rationing would cause. The hawks would probably benefit the most, ”Rosero said.
- Equity or distributive justice: This means, he explains, that the vaccine does not reach first to the one who has the most or the most adept with the Internet, but to those who need it most. The composition of the groups was made in part by this principle of equity, he explains.
- Epidemiological or health reason: With the vaccine, the health benefit of the population must be maximized and this is achieved by first vaccinating those who cause the most death and pain from this disease, he explains.
“The most effective way to identify those people who would be in more pain or at greater risk of dying is through age. You must continue to vaccinate in stages, from the oldest to the youngest, at least until 40 years old.
“Compared to people in their twenties, people in their fifties have a 20 times higher risk of dying if they catch it. Avoiding a contagion of a fiftieth year old is therefore 20 times more valuable than avoiding one of a fifties “, affirms the demographer.
“That comparison for people in their 40s is 7 to 1; that is, even then there are a lot of advantages to be followed in order of age. When you consider the 30-something, the benefit is no longer so great: 2 to 1 compared to the 30-something.
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“From this point of view, it seems to me that the vaccination should not be opened before having covered, at least, the 40 years.
María Luisa Ávila: “It’s time”
The pediatric infectologist and former Minister of Health, María Luisa Ávila Agüero, believes that the health authorities should decide soon to open the vaccination against covid-19.
“If people are called and there are people who do not want to be vaccinated, and there are others who are younger, without risk factors, but who can get sick and want to be get vaccinated, I think that’s a decision that needs to be made. taken as soon as possible.
“I would say yes. In the coming weeks, this decision must be made, given that many areas (of Health) are reporting that they are waiting for people who should be vaccinated, ”said l’vila.
Ávila points out that it is always necessary to go out to look for the elderly and those who have difficulty leaving their homes. “We need 70% of the vaccinated population to reduce the risk,” she warned.
According to the former health minister, opening up would eliminate the problems that have arisen; such as the modification of certificates on risk factors.
“It can be a 35-year-old person, without risk factors, who wants to be vaccinated … I believe we have to offer them that possibility,” said vila, for whom opening the campaign would have more advantages than inconvenience.
“There will always be people who criticize the measure, but we would avoid all the people who say they have a risk factor without having it; doctors who, unfortunately, unscrupulously give false opinions, benefiting those who need the vaccine.
“How do you solve all this? That there is already an opening of vaccination for those who want it, but saving vaccines for people at risk, ”she warned.
Ronald Evans: “It will depend on the suppliers”
For the doctor and epidemiologist Ronald Evans, the basic condition for even thinking about opening the vaccination is to have more doses and more pharmaceutical companies.
“The problem I see is not just the wishes and planning that the Ministry of Health or the Caja may have, but that everything will depend on the providers and the number of vaccines we receive. Now we depend on two: Pfizer and AstraZeneca.
“It is a sine qua non that there is a diversification of vaccines. From the start, I said that the government should broaden the range of contacts, not depend on one or two pharmaceutical companies. Other countries have been more daring.
“The Achilles heel is not in the operational capacity of the Caja Costarricense de Seguro Social (CCSS). Anyway, if there were more vaccines, I’m sure there would be a national movement to support it, but if there was a product, ”Evans said.
For the doctor, if the country intends to achieve collective immunity in the last quarter of the year, it must have more vaccines.
“The government should do everything possible to buy vaccines. If other countries are successful, why not us? This is the question I am asking myself.
“In addition, we have to start the procedures for this third dose, we don’t know if now in December, or in the first months of next year because, unfortunately, this virus is here to stay,” he said. warned.
Juan José Romero: “Logistics is not a problem”
“Without a doubt, the possibility of opening vaccination to people of any age, with or without risk factor, depends mainly on the arrival of vaccines in the quantity that this type of decision allows”, agrees Juan José Romero, epidemiologist at UNA.
If the amount the country receives were to be exceeded, he said, the CCSS would have the support of many non-governmental organizations, businesses and universities.
“I think (the opening) is definitely going to have a very positive effect. (…) Of course, we are talking about several doses of vaccines. We have already seen that even for group 3, with risk factors, the mass vaccination campaigns were successful, and this is what allowed us to reach 230,000 people or more in a single week.
“On both sides, I see it as extremely positive. I think it is possible to do it but it depends on the number of doses.
“In addition, the fact that the interval between doses was extended to 12 weeks would make it easier to cover a large part of the population, at least with the first vaccine, while the second has a chance,” Romero said. .
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