Vaccines for covid: from rationing to not knowing what to do with them

When the pandemic began, in 2020, covid vaccines were a dream; only a year later they were already available and became a precious object of desire reserved for priority groups; today they are a problem for rich countries, who do not know what to do with all the ones they have bought. Contracts with pharmaceutical companies are secret, but countries like Spain budgeted more than a billion euros each year in 2022 and 2023 to have enough doses for the entire population. And half of those received are unused.

In Spain, 105 million doses have been inoculated since the vaccination campaign began in December 2020. The country has received an additional 103.5 million that have not been used so far, according to data published by the Ministry of Health. The second booster campaign (fourth dose for the majority) has not had the same response as the previous ones: since it began, in autumn, only 60% of those over 60 years of age (7.5 million people) have taken it ) and the figure has been stagnant for weeks: so far this year it has barely advanced four points.

In summary, what this salad of numbers comes to say is that many more have been bought than have been injected and that the vast majority of those in charge do not seem to be going to inject themselves, according to the vaccination guidelines recommended by the moment (vulnerable people and people over 60) and the response of the population.

The Ministry of Health justifies that it is necessary for Spain to have a stock sufficient to be able to face potential changes in the epidemiological situation. “All countries have strategic reserves of medicines that are stored in anticipation of potential unforeseen events and that, fortunately, in some cases it is not necessary to use. It is part of the necessary preparation against public health threats,” says a ministerial spokeswoman.

The problem is that these reserves have an expiration date and can be spoiled if they are not used, as has already happened with 14 million doses of those that arrived. They belonged to the first generation and were discarded when new ones arrived prepared for the omicron variants. But now these are at risk of expiring. However, Health remembers the date is not set in stone: it is being modified (it has already been done) when verifying that they remain stable for longer than initially planned. “The date corresponds to the period of validity authorized by the EMA (abbreviations in English of the European Medicines Agency) and is likely to be extended as the incumbent laboratories provide new stability data over time and request extension of the period of validity ”, adds the spokesperson for Health. For this reason it is not clear how long they can last stored.

It is a problem that the EU countries have been thinking about for months. In a response to the European Parliament this Wednesday, the European Commissioner for Health, Stella Kyriakides, explains that the Commission is working with the Member States and the industry to find “a solution to the imbalance between demand and supply” of vaccines. “Several amendments to the purchase agreement with BioNTech-Pfizer have already been approved to allow us to partially cover the needs of Member States. Nonetheless, the Joint Negotiating Team continues to negotiate a reduction in the number of doses to be delivered in 2023″, she notes.

As published this week by Financial Times, this agreement consists of delaying deliveries until 2026, which were scheduled before the end of the year. This does not solve, however, the problem of all the doses purchased that are in danger of expiring, since international agreements establish that they cannot be given away or sold once they have been received (the Government has donated 70 million of those purchased through the Covax consortium that have not passed through Spanish soil).

Is a fourth dose necessary?

Health had bought with the anticipation that all Spaniards would need new doses, as Minister Carolina Darias already stated in June. And, although it can happen, and that a memory is necessary at some point, today it is not like that. As Marcos López Hoyos, president of the Spanish Immunology Society, explains, the first booster, added to the two initial doses and the natural infection that “the majority of the population” has suffered, makes a fourth injection unnecessary for young and healthy people.

In Spain, the health authorities recommend the fourth dose (or second booster) only to people over 60 years of age and to those who have a health problem that makes them more vulnerable to the virus, such as an immunodeficiency that reduces their defenses. With this indication, the vaccination campaign began last fall. Later, in December, the ministry authorized the rest of the population to inoculate it if they needed it for administrative reasons (to enter a country that requires it, for example) or for whoever wanted to inoculate it, as long as they were older than six years and had a contraindication.

But this has generated some confusion among the public, who have not always been able to interpret this door that the Public Health Commission left open without further explanation as to whether or not it was appropriate to receive it. The fact that anyone can inoculate it does not mean that it is recommended for everyone or that it will benefit them. The effects of the three doses, and especially if the infection has passed in the last year and a half, since omicron arrived, has proven to be sufficient protection so as not to suffer complications in the event of a new contagion.

To the question of whether a fourth dose is necessary, the biologist Nuria Izquierdo-Useros answered a few weeks ago in this newspaper: “At this moment and, when we talk about messenger RNA vaccines, what we know is that compared to the second dose, the third increases the immune response for a longer time. However, the fourth dose does not exceed the maximum levels obtained with the third and its effect wears off about three months after vaccination. Therefore, the time to get vaccinated should coincide with situations in which community transmission is high and the risk of contagion is very high. In this sense, the next booster doses of the vaccine should be planned to coincide with times of the year with greater risk, as is the case with the flu vaccine.

Scientists are now checking how long the immunity generated by both vaccines, infection and the combination of both lasts. “In the future it will be necessary to see if the covid behaves as seasonal and how long that immunity lasts in people. We are carrying out studies to verify different scenarios and, based on that, decide if there are groups that need seasonal vaccination each year,” says López Hoyos, who sends a message to people without immunodeficiencies who are already vaccinated with a booster and have passed a omicron infection: “Another dose is not necessary for the moment.”