The vaccine AstraZeneca has spent months testing the seams of relations between the government and communities for the decision to suspend its use in children under 60 years , and leave in limbo about two million people who had already received a first dose .
The determination of the minister, Carolina Darias, to avoid it at all costs – and of almost half of the communities to administer it – has led this week to the unprecedented decision to allow this group of citizens – essential workers such as police, military or teachers – choose whether to continue with Pfizer or continue with AstraZeneca.
This breaks the Vaccination Strategyand it contradicts what it said in its last update, just 10 days ago, where the voluntary choice of one or another vaccine was rejected. It also contradicts what the Ministry said in February: that in Spain there would be no “cocktail of vaccines . ”
The government and communities opened the door on Wednesday for those under 60 years of age with a dose of AstraZeneca to wear the second of the same brand. It will be the exceptional case , because the guideline says that it must be Pfizer. However, they can inject the British serum by signing an informed consent if they so decide “for reasons they deem appropriate, ” according to Darias after an Inter-territorial Council.
And, although the minister insisted that “it is not a matter of choice,” in practice it is, and with this, one of the containment dikes that erected the vaccination strategy to maintain order and justice in the country has been broken. process: that citizens cannot choose which vaccine they want to get.
“It should be taken into account that the vaccine to be administered cannot be at the request or choice of individuals or health personnel, on pain of undermining the principles and ethical values of the Strategy”, says this document in its last update, from the past May 11.
Less than two weeks ago, this text agreed by Health and Communities in the Public Health Commission ruled out offering AstraZeneca “to people under 60 who voluntarily want to be vaccinated.”
“It does not seem the right moment”, he indicates, because something like this “can not only contradict the ethical principles on which the Strategy itself is based, but also, if there is still not enough information available to make the decision more adequately, the value of informed consent as a guarantee of an autonomous decision would be highly debatable “.
The validity of this part of the document lasted exactly nine days, those that have passed since its publication and the Interterritorial Health Council that this Wednesday decided that those under 60 years of age with a dose of AstraZeneca can choose to receive the second of the same brand, Even when the instruction is for them to receive Pfizer, they always sign an informed consent that was discarded just over a week ago.
The confirmation that it has become obsolete came on Friday, when Health proposed to the communities to include a “note” with the latest events related to AstraZeneca -that the second dose is from Pfizer and the subsequent option to prefer AstraZeneca-, accompanied by the report of the Bioethics Committee, which has been “opposed” to choosing vaccines but has made an exception in this case, for reasons of “collective health”.
You would give against everyone
With contradictory decisions in just one day and exceptions to the norm, it is how a balance was achieved between two sides that AstraZeneca has faced for weeks. On the one hand, a Minister of Health, determined that the second dose should be from Pfizer, to the point of ignoring the opinion of her own experts from the Vaccine Conference and the reports of the European Medicines Agency (EMA).
On the other side, communities of all political signs that from the beginning opted to continue vaccination with AstraZeneca, despite the clinical trial of the Carlos III Health Institute that this week argued that the combination of doses of AstraZeneca and Pfizer is safe and effective. .
This has also been a matter of discrepancy in health matters between the Government and the Community of Madrid , but not only. Autonomies of the PP such as Andalusia, Castilla y León or Murcia were joined in this cause by other socialists such as Aragon or Castilla-La Mancha , as well as Catalonia or the Basque Country , governed by ERC and JxCAT and PNV. The result is an agreement that leaves the decision on which vaccine to put in the hands of affected citizens.
The origin of the controversy around AstraZeneca in Spain has to do with the sudden decision of April 7 to suspend vaccination with AstraZeneca to those under 60 years of age. For more than a month, police, civil guards, military, firefighters or teachers had begun to receive their first dose of AstraZeneca, within the group of essential workers who had been prioritized by the Vaccination Strategy after health workers, dependents or the elderly.
The progressive notification of rare but rare and serious thrombotic episodes throughout Europe set off all the alarms – and also the fears of bearing the political responsibility for very minor but serious adverse effects.
In a single day, the EMA certified that there were “possible links” between the thrombi and the AstraZeneca vaccine, the EU Health Ministers met urgently without reaching a common position on what to do and then, in Spain, the Council Interterritorial Health determined to administer it only to the population between 60 and 65 years old .
Thus, those under 60 years old, including those who already had a first dose, were left out, almost two million people who were left in limbo because then there was no answer as to how they should achieve full immunization .
The next day, there was a new change and Health prescribed AstraZeneca between 60 and 69 years. It was practically marked the narrow space in Spain for a ‘damn’ vaccine of which the EU for the moment will not buy more doses and that in Spain will foreseeably only be given to citizens in that decade, provided that there are no others available in the case of the over 65.
It has been precisely the search for an alternative for those under 60 with a first dose that has forced Health to renounce up to two times of its vaccination plans.
For one thing, Darias ruled out the vaccine combination in February and has now become the leading advocate for administering Pfizer to those who have already been vaccinated with AstraZeneca. To do this, it has shielded itself in a clinical trial that ensures that it is safe and effective and for which the minister promoted exceptionally extending the interval between the two doses, from 12 to 16 weeks.
The trial has been questioned due to its small sample, but its preliminary conclusions were the basis for the decision to combine vaccines, despite the fact that technicians from the Vaccine Conference have repeatedly proposed giving second doses of AstraZeneca to people between 40 and 60 years. Darias ignored this approach and the position of up to seven communities against combining vaccines.
From Aragon, which abstained because the opinion of the experts was not followed, to Madrid or Andalusia, which have been demanding for months not only administering AstraZeneca to those under 60 years of age with a dose set, but also eliminating the age limit to be able to administer it to any fringe.
Ultimately, that fragile decision to market Pfizer lasted less than 24 hours . The Interterritorial Council on Wednesday gave the green light to allow a choice between a second dose of Pfizer and AstraZeneca that will make almost two million people the prescribers of their immunization against Covid.