Of the 31 and a half million doses of the AstraZeneca vaccine purchased, Spain has received two million, of which it has been able to administer half. On March 24, vaccination with this serum was resumed after the preventive stoppage for a week to review its safety. What happens to people who, without medical cause, do not want to receive the AstraZeneca vaccine after this setback? "This is an issue not contemplated in the strategy," said the Minister of Health, Carolina Darias, at the press conference after the Interterritorial Health Council on Monday, March 22. "In principle, if they are not vaccinated, for now they would not be vaccinated," he added, leaving the door open to the possibility of a play-off in the future, although there is no guarantee for this either.
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At the foot of the vaccination facility the day the administration of the serum was restarted, many people expressed to elDiario.es their uncertainties about possible adverse effects of the vaccine. The eleven cases of rare cerebral thrombosis investigated by the European Medicines Agency (EMA) cast shadows on the drug developed by the University of Oxford.
Although it is not public, the health administrations know who and for what reason rejects the vaccination with AstraZeneca and the rest of the vaccines when they are summoned to receive their dose. According to the resolution of the Ministry of Health last December in which the information strategy regarding the COVID-19 vaccination was planned, the regional health authorities must provide a series of information on each vaccinated person: date of birth, sex, place of residence, date of administration, brand of the vaccine and pharmaceutical company, reason for vaccination —if it is health center personnel, an essential professional, a person of special vulnerability…— or reason for non-vaccination, that is, if a person does not want to be vaccinated or their health condition advises it —as is the case of pregnant women—, it will be reflected in a centralized registry.
The objective of collecting this information is, according to Health, to carry out a detailed analysis of the data later on. But collecting this information is not always possible. José Antonio Forcada, president of the Nursing and Vaccines Association, thinks that it is interesting to accumulate this data, but "it cannot be a priority" because "the vaccination teams already have a sufficient workload such as calling those who do not come to ask them the reason , there is no excess human resources, these must be dedicated to vaccinating or performing other functions that are being left out in health centers in order to vaccinate".
In the Community of Madrid, those under 65 who are professionally active and fulfill an essential function for society, as well as teachers and personnel from Security Forces, Emergencies and Armed Forces, are cited in some of the two mass vaccination centers where the AstraZeneca vaccine is applied: the Isabel Zendal Pandemic Hospital and the Wanda Metropolitano stadium. These people receive an SMS that takes them to a web page where they can accept or not the appointment that has been assigned to them. This is how a worker from the psychosocial area of the Community of Madrid, 59, explained it while waiting for his turn for vaccination at the Atlético de Madrid stadium: "If you want the appointment, you accept it, but if you don't want to get vaccinated, I suppose that you have to keep postponing the appointment to infinity", he said last Wednesday.
Different criteria between communities
On the other hand, in Madrid health centers, where people over 80 are being vaccinated, they are called by phone. The centers have received some lists that they have verified that they were not updated, since they included people who had already died. A center receives ten vials per day, from which they must extract six doses per vial. Therefore, they need to make appointments for 60 patients in one day, condensed into one shift (morning or afternoon). In a primary care center in the Madrid district of Chamartín, they inform this newspaper that as of March 26 they receive more vials from Pfizer, which implies vaccinating 40 more elderly people per day, as well as some vials from AstraZeneca to vaccinate daily. to 10 patients, caregivers and caregivers of the elderly already vaccinated. This increase represents a total of 110 daily appointments. Patients are scheduled six by six, which is about fifteen or twenty minutes per session. If there is no increase in the nursing staff, and given that the time for patient care cannot be reduced nor is the time allocated to vaccination going to be extended, the rest of the nurses will stop attending their daily consultations to dedicate themselves to only vaccination.
In Galicia, the Servizo Galego de Saúde indicates that those who refuse to be vaccinated will be "labeled" in the Galician health system. These people will be called back when the vaccination is over to ask if they have changed their mind: "It is not taken off the list. What happens is that it will be offered to other people. If someone has said they do not want to get this, we will have to move on", said the Minister of Health, Julio García Comesaña. The Xunta wants to know what are the reasons for the absence of 4,000 people summoned to be vaccinated with AstraZeneca the weekend before Spain temporarily suspended vaccination while the EMA studied thrombosis cases, just in case some of them were due to a possible rejection of the vaccine.
In Castilla-La Mancha, teachers have received an instruction in which it is clarified that "whoever renounces vaccination will enter the general schedule provided by Health". That is, he will go to the group that touches him due to her age or personal circumstance.
On the other hand, and despite the Health directive, other communities affirm that they are not registering the refusals. In Catalonia there is nothing foreseen in this sense in the vaccination strategy and the computerized appointment system does not have a rejection option. According to the Generalitat, so far no problems have been detected in this regard and the only indication is to insist again with those who have not confirmed the appointment.
Neither in Castilla y León, where the Ministry of Health has warned that if a person does not want to be vaccinated, they lose their vaccine. In the same sense, the Minister of Health of Cantabria said last Monday that "if someone says no, then they say no" and that "this cannot go through second rounds continuously. We are not going to force anyone to get vaccinated at the moment , but we cannot spend all day recapturing and going back to groups that had said no and that change their minds. That does not mean that we will not attend to them, but they will go in the end".
The informal system of second chance also works in Andalusia, where if the person summoned does not accept, they are allowed to pass to establish a "play-off" mechanism later. "Each Community is doing what they want", assesses José Antonio Forcada, "it is not surprising that some say yes and others no because there is no uniformity when establishing the criteria". The opinion of the president of ANENVAC and a public health nurse is that "those who refuse vaccination without just cause" should be left for last and devote themselves to vaccinating the elderly. "When the time comes, we will try to do a pedagogy with them and offer them vaccination," he adds.
With information from elDiario.es Galicia, Pau Rodríguez (Catalonia), Ángel Villascusa (Castilla y León), Rubén Alonso (Cantabria), Javier Ramajo (Andalusia) and Francisca Bravo (Castilla-La Mancha).