AstraZeneca's vaccine will not be injected for people over 65 years of age, at least. The Public Health Committee of the National Health System, made up of technicians from the Government and the autonomous communities, has been debating this Thursday whether to set the limit at 65 or 55, without reaching an agreement, so it will resume talks on Friday, according to sources present at the meeting. In clinical trials of the drug, there was not a large enough sample of people over 65 to yield a conclusive result about its effectiveness in this group, and the vast majority of participants were under 55. At least seven countries in Europe have already announced that they will only apply it to those under 65. Germany, for example, has decided to set the age limit at this age, while Italy's advisors lower it to 55. Poland is in the middle ground, which sets it at 60. This will force select a priority group to which to administer this medication, of which 1.8 million doses will arrive this month.
The Ministry of Health has reported late on Thursday that the AstraZeneca vaccines that arrive this weekend are intended for health and social health workers who are not included in group 2 and 3, that is, those who are not on the front line. After them, you will have to look for other groups of younger vulnerable people (65 or 55, depending on the age that is decided) or other essential workers. The next segment within phase 1 of the plan, large dependents, is largely made up of people over 65 years of age, so it cannot be intended for them either. And the next one, already in the second phase (once they finish residences, toilets and large dependents, around 2.5 million people) are those over 80 years of age.
In Spain there was not much scientific controversy about whether the AstraZeneca vaccine should be given to people over 65 years of age. The medical societies that have some relationship with the matter (Epidemiology, Public Health, Preventive Medicine, Vaccinology and Geriatrics) agree that this drug should be reserved for children under this age, for whom it has been shown effectiveness.
The argument that spokespersons for each of them have given to EL PAÍS is similar and can be summarized in this explained by José Gutiérrez, an expert in vaccines from the Spanish Geriatrics Society: “For now and until more evidence is generated With the studies that are still underway on this vaccine, it is indicated to continue using the Pfizer and Moderna vaccines in this age group [over 65]. It can be considered at this time that the vaccination is safe [in them] and that it can produce mild side effects. The problem is that it has not been verified whether, in older people, the vaccine is effective and generates a sufficient immune response to provoke humoral and cellular immunity that prevents the consequences of infection by the virus.
AstraZeneca's vaccines, continues Gutiérrez, may be used in other population groups. “All this should not delay the planning that has been proposed. In fact, we can begin to think that we will soon have various vaccines against the coronavirus and each of them will be indicated in a different risk group. This leads one to think that possibly the vaccination order proposed in the vaccination strategy in our country is not as linear as expected and the vaccination of different population groups begins to overlap”, he adds.
Despite this consensus, it is not an easy debate and is full of nuances. As with any medicine, it is about finding a balance between risk and benefit. Contrary to the rest of Europe, in the United Kingdom they have assumed that although there is no conclusive evidence of its effectiveness in the elderly, since clinical trials have shown a good immune response in them, the risk of it not being fully effective is offset by the lives that could be saved if it finally shows similar results to other age groups.
“A perfectly acceptable view is that we know the vaccine is safe at older ages, that the evidence of the antibody response strongly suggests that it will be protective, so it seems reasonable to assume that it will be,” says Martin McKee, Professor at the London School of Hygiene and Tropical Medicine. “If you are in a country where you have a lot of other vaccines, like the one from Pfizer BioNTech, then you might justify giving that vaccine to older people and AstraZeneca to younger people. Therefore, each regulator will have to make their own decision and it is difficult to criticize one who adopts any of these points of view. Personally, I think we have enough evidence to justify giving it to older people, but I would not criticize others who decide not to, as long as they have adequate supplies of other vaccines for those older people," continues this expert, one of the most respected in the field. field of public health.
More than 1,300 deaths of people over 80 a week
Kent Woods, who was director of the European Medicines Agency (EMA), criticized in statements to the AFP agency that European countries ( at least seven of them have already announced it) reject the AstraZeneca vaccine for the elderly. He accused the leaders of these countries of doing politics and "putting the lives of their citizens at risk." Although they are really decisions or recommendations by the technicians of these governments, Woods refers to the tug of war between the EU and this pharmaceutical company, which will deliver fewer doses than promised. This expert was surprised that while the EMA has approved the drug for anyone over 65, countries veto it "just for those who need it most."
In Spain, every week in January more than 1,300 people over the age of 80 have died due to the coronavirus, according to data from the Carlos III Health Institute, to which must be added the deaths that have not yet been accounted for, with which it is more than likely that this figure will increase. Although there is a slight drop in infections in February, the epidemic in Spain continues at “extreme” levels. Every week that goes by without vaccinating hundreds of older people are dying. Those who are over 80 years of age represent 66.5% of all official deaths from covid in Spain in the second wave, although they only add up to 6% of the population (2.8 million people).
But, does the decision mean a delay compared to what was already planned? Actually, it is not a delay, but if the AstraZeneca vaccine were applied to the elderly, it could be brought forward compared to the current schedule. The point is that, according to the Government's vaccination plan, it is not your turn yet. Before they do, the vaccination in residences, already quite advanced, must be completed for the 1.7 million toilets that are included in the first phase, and that of 367,000 large dependents. This makes it very difficult to start before March with those over 80, something that surely could happen if AstraZeneca's was used for them. Other countries, such as Germany, did include the elderly in the priority group, and they have already pricked more than half a million with those of Pfizer and Moderna.
Almost all those consulted agree to use AstraZeneca's in people younger than 65 years. But they put a tagline: "As long as we have enough of the other vaccines for that age." Given the scarcity situation, Elvis García, a doctor in Public Health from Harvard University, is in favor of vaccinating the elderly with AstraZeneca drugs now: “Yes, the vaccines are safe, even if the efficacy has not been fully demonstrated in this population group, it would not hurt to vaccinate them. Many people are dying and, seeing what we have seen, and given the uncertainty associated with the distribution of vaccines that we have seen these weeks, waiting for vaccines to arrive is risking it ”.
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