Who should we get the coronavirus vaccine first when it arrives?

The hopes that Spain had placed in the oxford vaccine against covid-19 have been paralyzed, just three days after the Ministry of Health announced that it had arranged 3 million doses for December. Pharmaceutical AstraZeneca has stopped the trials for a possible adverse effect in one of the patients in which it is being tested.

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Although we Spaniards believed we touched this remedy against the coronavirus with the tips of our fingers, the truth is that currently there is a total of 173 vaccine projects (distributed all over the world) in different stages of development registered by the WHO, of which 31 are in clinical experimentation phase.

Possibly one of these ongoing projects is the one that delivers the first vaccine against covid-19 to Spain; But there are still several questions: from the time it will take, to the number of doses that will arrive at the beginning and, above all, which population should we vaccinate before.

Calling for "calm, prudence and patience" until there is a vaccine that is truly safe and effective, the former director of Sanitary Action in Crisis Situations from the WHO, Daniel López Acuña, points out to El Confidencial that “when the time comes for a safe and effective vaccine to exist, it is important have a very detailed plan prepared on which population to vaccinate in each autonomous community, which must be part of a joint plan of the country ”. “This should determine the different dose availability scenarios to establish a priority based on epidemiology. In this case, it is not about priority places or people, but about risk groups that have to be protected in the first place ”, explains the epidemiologist.

Elderly, sick, health workers and police

Assuming that when a vaccine arrives only a handful of doses will arrive, the public health expert points to two fundamental questions to determine who should receive it: "Prevent the greatest number of deaths possible and prevent the infection from affecting those most susceptible to contagion and severe disease." For this reason, it considers that prioritize the population over 65, Specially to those who live in residences, “Since they are more exposed to mass transmission”.

Photo: EFE / Juan Ignacio Roncoroni

Likewise, the epidemiologist believes that priority should also be given, within these risk groups, to “the general population with pre-existing pathologies that pose a risk of increasing severely ill ”. "For this, a clinical and epidemiological criterion will have to be established so that these people are identified and the distribution of the vaccine is dictated." The public health expert exemplifies with some population groups – which are already known to have a greater risk of speed in the development of covid-19 with less favorable prognoses – such as diabetic or pulmonary hypertensive.

Another of the groups to which these first doses would have to go, according to López Acuña, are the groups whose work involves a greater risk of contagion and that, in addition, are key to controlling the pandemic. Thus, the epidemiologist refers to health personnel and law enforcement.

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In the same line that López Acuña shows Vicente Baos, primary care physician in the Community of Madrid, which has been on the front line fighting COVID-19. For the health worker, who suffered the coronavirus in his own meats, the first doses of a hypothetical vaccine should be destined "to the same priority groups for flu vaccination. The most vulnerable based on their level of risk, which depends on age and associated diseases ”.

In the same way, he points to the need to give priority to public services personnel: “Because of the clear importance for the health community, not only because it affects us, but also so that we do not miss work and can fight against the covid. It should also be taken into account police and essential services”.

It is a similar idea to the one they have in the Ministry of Health. Minister Salvador Illa pointed out this Monday that the first people to receive the vaccine should be those who present the greatest risks and the groups that are in contact with these most vulnerable groups.

Dr. Baos is cautious when talking about the timing of a possible effective vaccine: “There is so much problem with the pandemic right now that talking about vaccines in an illusory way is a danger. We have a very serious current problem of cases, a very serious problem of saturation and overflow of work in health centers ”.

Outbreak vaccination

For its part, virologist from CSIC Margarita del Val raises to this newspaper various scenarios of vaccination based on the effectiveness of a hypothetical vaccine. “Let's imagine that the first vaccine that comes to us limits transmission, it is not spectacular, but it does effective and safe. In this case I would start vaccinating the risk groups and, in parallel, around the buds”, Describes the immunologist.

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In this case, aim at the same groups than the other two experts: elderly (with emphasis on residences), nursing home workers, people at risk and health, among others.

It also raises a vaccination in social settings where the sprouts are generated "To the entire municipality where there is an outbreak or to all contacts, even the distant third level."

Photo: EFE / David Borrat

On the other hand, it outlines a situation in which I arrived a vaccine that works in an intermediate way, with an efficacy that is short-lived. The virologist would use for sprouts: "It would serve to stop an uncontrolled outbreak."

But he concludes that the answer to whom the first vaccines should go "is not easy", because at the moment the efficacy of none has not been 100% proven. "Until vaccinated people are infected and there is no clinical trial, we won't know", Add.

Ebola: two vaccines in record time

In modern history there has not been a pandemic of these characteristics in which a vaccine has been so readily developed. The Ebola crisis of a few years ago is the closest, in terms of rapidity of treatment development, since two effective vaccines were developed at full speed.

Ebola outbreak in the Democratic Republic of the Congo amid the coronavirus pandemic


But this example it can't be a mirror where to look to know who we should inoculate the vaccine first. According to the epidemiologist López Acuña, in that case the lethality was the same for all population groups, so vaccination took place in areas where the virus was more developed.

For the moment, experts agree that we must be cautious when talking about a possible vaccine; and that to end the pandemic we must maintain the hygiene precautions and social distance.

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