On December 27, 2019, the Center for the Coordination of Health Alerts and Emergencies (CCAES) received the first news of pneumonia of unknown origin that doctors were alerting to in the Chinese province of Hubei.
A CCAES worker who was there that day relates that the notice came to them from several of the many sources they use to monitor from social networks to thousands of media around the world in search of new threats to health.
There were four days left for China to alert the World Health Organization (WHO) of what was happening and 11 for the origin to be discovered: a coronavirus similar to SARS that they provisionally baptized as nCov-19 (new coronavirus of 2019).
These immunizations will be the first of many. Those that will be injected into people in nursing homes – the group that experts have considered the most vulnerable and, therefore, a priority to vaccinate – will be those manufactured by the pharmaceutical companies Pfizer and BioNTech, a drug that in trials has shown an efficiency of around 95%.
If in March, when the epidemic began in Spain, they had told the researchers that a vaccine with these characteristics would be injected at the end of the year, they would not have believed it.
The set weighs about 35 kg. The vials can be kept for six months under these conditions, but the dry ice must be recharged every five days.
They keep the temperature for ten days unopened. Opened, they can be used for temporary storage by replenishing the ice every five days. The rest of the vaccination equipment (syringes, needles, diluent …) goes separately.
At that time, the majority position of the scientific community was that the research and manufacturing process of the drug that would free us from this pandemic would take between a year and a year and a half, if everything went well.
But, just as almost everything that could go wrong in controlling the virus has gone wrong, with the vaccine everything has turned out in the best way imaginable so far.
Spain, through the European Union, has signed contracts with seven companies, seven different vaccines, totaling 140 million doses, which would allow immunization of 80 million people (most require a double prick).
On Three Kings Day the authorization of Moderna is expected, which has already been approved in the US And, still undated, but imminent, that of Oxford-AstraZeneca.
The strategy consists, as explained by María Jesús Lamas, director of the Spanish Medicines Agency, in having more than necessary (Spain has 46.5 million inhabitants) committed to, since all of them are in the trial phase (including the trial Pfizer continues after approval), have enough in case something fails along the way.
Also, since there is an advance payment, production is stimulated so that there are enough for developing countries. Those that remain in Spain will end up there with different cooperation agreements.
The main drawback of Pfizer’s, which is beginning to be injected today, is the temperature of the distribution. This means that precisely this one probably does not reach developing countries, which are waiting for others whose logistics are easier. The drug has to be kept at around 70 degrees below zero.
The company made a commitment with the countries with which it has signed agreements to bring them to distribution points at these temperatures, in self-cooling boxes in which they can remain for 10 days. Once defrosted, they can last in a conventional fridge for five more days.
And, once diluted (something necessary for the puncture), they last about six hours. That is, they complete approximately one working day of a vaccination team.
The autonomous communities have already trained nurses to learn how to handle and thaw vaccines.
Each Ministry of Health will receive those that the central government has designated weekly, a number proportional to the population it has in this first vaccination group (not the total) until completing in a first phase about 350,000 weekly doses, 4.5 million in 12 weeks, which will give to vaccinate almost 2.3 million people before spring.
It is approximately the same number of the first group of the vaccination plan: people in residences, their caregivers, health workers and large dependents, which add up to almost 2.5 million.
Health has not yet confirmed which will be the next group, but it is more than likely that they are those over 64 and those who suffer from chronic diseases that make them more vulnerable to the virus. Although they will give them an appointment from their health centers, the communities have not yet detailed what this second phase will be like.
The doses will reach warehouses that in principle will not be revealed for security reasons. And they will be taken to senior centers and, later, to health centers and hospitals by the methods with which drugs are usually transported.
Sources from these ministries point out that beyond having centers prepared to receive them and keep them cold, the rest (since they can be refrigerated in a conventional way) will not be very different from the flu vaccination campaign: in some cases the teams they will go to the residences, in others it will be those who live in them who go to the outpatient clinics, depending on what is most operative in each case.
What is more cumbersome is its administration, since each vial contains five doses that must be distributed in five syringes with their respective serum.
The vaccines injected this Sunday are symbolic. The president of the European Commission, Ursula von der Leyen, announced last week that vaccination would begin on the 27th. And neither the Spanish government nor the regional governments have wanted to be left behind.
The photo of other countries vaccinating could not arrive before the Spanish one. But it will be little more than that, a photo and a few thousand doses administered. For reference, Andalusia will inject almost two thousand and in other smaller communities it will be only a few hundred.
The truth process will begin on Monday. Each week batches of 350,000 units will arrive in the communities, which will be vaccinated as available. The UK, which started on December 8, takes half a million people with the first dose.
At 21 days the second is administered and approximately a week later the vaccine reaches its maximum effectiveness. Between the first puncture and this moment almost a month passes.
But the plan started earlier. Since September the communities began to collect syringes and other materials to administer the vaccine.
In the first weeks of December, they asked for lists of residents in social health centers to put together a vaccination order in which the most vulnerable should come forward, that is, those with the most fragile people with a low percentage of them with antibodies.
Before the puncture, the person who receives it must sign an informed consent. In the case of patients with dementia, a designated tutor is consulted.
“If there is not, we are the guardians of that person and by default we would give him the vaccine, unless he explicitly says that he does not want to receive it, in which case we would not give it”, explains the director of nursing of a social health center .
The Ministry of Health will collect the reasons for those who do not want to receive the vaccine. It will be done, as Lamas explained, in order to study its causes and be able to launch campaigns that serve to raise awareness and remove fear from the population. In any case, the vaccine will be voluntary.
Although in different surveys there is a significant portion of the Spanish population that would prefer not to be vaccinated or not to receive the vaccine until it is more proven (between a third and a half of the population), the percentage of people who claim to refuse in any case, even If the doctor recommends it, it drops to about 15%.
With these figures, the health authorities hope to reach the 70% of the vaccinated population without problems that they consider necessary to generate herd immunity. This will happen, according to forecasts,
The availability of vaccines, initially limited, will increase during 2021. The European Commission is negotiating with at least six other production companies to have several available in the coming months. These are the stages to vaccinate population groups according to the number of doses available