The bill presented by two deputies of the front of all brings to Argentina one of the global discussions of Covid: must be compulsory the vaccine against him coronavirus?
In Europe, with a high percentage of anti-vaccines, the discussion began earlier and Austria has already announced that, starting next month, it will become the first country in the continent in establishing the mandatory for the entire population. And as of February 15, Italy will set the same measure for those over 60.
The initiative proposed here establishes the obligation for all residents over 18 years of age and those under 3 to 17 with comorbidities.
What does it mean that a vaccine is mandatory?
In Argentina, the obligation goes both ways: of the State in guaranteeing its free coverage and of the citizens in applying it to them. But if they don’t get vaccinated, there is no penalty. The vaccination card is requested when entering school, and if it is not complete, the education system encourages parents to vaccinate that child, but that is the issue.
Already in April of last year, the World Health Organization had released a paper on compulsory vaccination. In it he did not recommend it, and said that the first option should always be persuasion.
“Such policies may be ethically justified, as they may be crucial to protecting the health and welfare of the public. However, because the policies that mandate an action or behavior interfere with individual freedom and autonomy, they must seek the balance between the common welfare with individual freedoms”, they pointed out.
In Argentina, the positions are also found. And the first point is if a law is necessary for the Covid vaccine to be mandatory.
For Ignacio Maglio, a lawyer specializing in public health, a member of the Board of Directors of the Argentine Society of Vaccinology and who works at the Huésped Foundation, the Muñiz Hospital and the Finocchietto Sanatorium, the law is absolutely unnecessary because there is already a legal framework that makes it compulsory.
“The current legislation clearly allows that only with an administrative act of the Ministry of Health, the national government declare the Covid vaccine mandatory and introduce it within the national vaccination calendar”, affirms Maglio, who recalls that already in November of last year, before the start of the third wave, the Board of Directors of the Faculty of Medicine of the UBA had recommended compulsory vaccination for all adults.
The request also comes from other voices. In a note with Clarion this week, the Minister of Health of Jujuy, Antonio Buljubasich, requested that the vaccine be mandatory and assured that “in the Federal Health Council (Cofesa), the majority thinks the same. The vaccines are there and it makes no sense to delay this decision.”
Maglio remarks that getting vaccinated is an “individual fact, but at the same time it is a social fact” in which there is a transcendence, an act “even loving in terms of collective compassion” in the sense of community protection. And so it shouldn’t all be the same. “I don’t care who doesn’t get vaccinated because he believes in kryptonite, than who puts his arm up and plays it for the community,” he emphasizes.
Note that Argentina has a high adherence to vaccination, but understands the possible mandatory nature of the vaccine “from an ethic of conviction, of responsibility. In some cases you have to resort to some tool. Say there’s a limit you can’t cross”.
Access and information
In Argentina, however, the main problem of ceiling that the Covid vaccination is approaching seems to be more related to access and lack of information. And there is also a “grey”, a group of the population that is not anti-vaccine but has particular doubts about it because of the context in which it was approved: a global pandemic with extremely accelerated deadlines like never before in the history of medicine.
“Argentina should try to find mechanisms to facilitate accessibility to the vaccination centers: if you have to queue or they are not open after your work hours, they take away the incentive to go get vaccinated”, explains Graciela Ocaña, deputy and former Minister of Health, on the first point.
And regarding the second, he points out that a significant number of children remain to be vaccinated and that this has to do “with the lack of information” and demands that the ANMAT and the Ministry of Health “generate a lot of information and transparency in the process.”
Along these lines, he believes that it would be important for the pediatric use from Pfizer “That would be an opportunity for many parents who do not vaccinate their children because they do not have information” about the Sinopharm vaccine. It even asks at this time that the State face a study to understand why those who were not vaccinated were not vaccinated.
In this point, an important clarification: all the referents consulted in this note emphasize safety and efficacy of the vaccines against Covid authorized in the country, and of vaccination as a effective health strategy in this and in all communicable diseases. The nuances of the debate arise regarding the procedure with which they were approved: Can someone be forced to be vaccinated with an authorized emergency drug?
emergency approval
“I have my doubts about compulsory vaccination. I believe that for a vaccine to be mandatory it has to go through the sieves of the regulatory entities, and not through an emergency approval. It seems reasonable to me that it is not mandatory until the international agencies and the ANMAT say that it is a vaccine that has passed through the usual long-term efficacy and safety filters”, says Adolfo Rubinstein, Master in Clinical Epidemiology and former Secretary of Health of the macrismo.
From the Argentine Society of Pediatrics (SAP) they do not have a position taken on the obligation. But in a personal capacity, Elizabeth Bogdanowicz, a member of the entity’s Pediatric Infectology Committee, responds. For her, the path has to be the recommendation and not the obligation, since although all the approved vaccines have demonstrated safety and efficacy, “they are all new vaccines, except those with inactivated virus. The viral vector and messenger RNA are recent developments”.
“Phase III studies should be closed and phase IV pharmacovigilance studies should begin to then decide on the obligation”, Marks Bogdanowicz, who estimates that when the time comes this definition “must first be considered for the adult population, which is the one that has suffered much more from the impact of Covid.”
For Maglio, going back to the point of emergency authorization does not add up. “That a vaccine has emergency authorization does not signify weakness or data limitation in terms of security, but times were accelerated to prevent the spread of an unknown pandemic, ”he clarifies.
The expanded phase III pharmacovigilance studies give today, he says, sufficient evidence in terms of safety and efficacy. “We are going through a totally exceptional situation and you cannot analyze it in the same way that you analyzed the smallpox or measles vaccine,” he maintains.
fine print
The national vaccine law It was approved at the end of 2018 and replaced the previous law, from the time of the dictatorship. In it, there is a key item, the number 7.
“The vaccines of the National Vaccination Calendar, those recommended by the health authority for groups at risk and those indicated in an epidemiological emergency situation, They are compulsory for all the inhabitants of the country. in accordance with the guidelines established by the enforcement authority.
The expression “those indicated in an epidemiological emergency situation”, Does it reach the Covid vaccines?
Here too there is a double interpretation. For Bogdanowicz, in this article the law refers “to vaccines that are authorized and known over time, in an epidemiological situation of risk”. And he gives the example of the measles vaccine, which in 2018 it was decided to apply doses outside the calendar due to an increase in cases of this infection.
Ocaña has the same position: “To enter the vaccination schedule, the vaccines must have an authorization for use. And the current ones, all over the world, have an emergency clearance. In Argentina, in addition, there are two vaccines, Sputnik and Sinopharm, which are authorized by the Ministry of Health, they are not even authorized by ANMAT like AstraZeneca and Pfizer”.
But for Maglio, article 7 of the law It is precisely the one that enables the Ministry of Health to authorize the incorporation of the Covid vaccine to the calendar. “If there is an indication, that the vaccines have been approved in an emergency situation it is not a restriction or a limit to be mandatory. In addition, after more than two years have passed and millions of doses have been applied in which there were no significant adverse effects, the excuse that it was approved in an emergency situation falls away,” he says.
And he emphasizes that, faced with a problem of interpretation, one must refer to the general principles of the vaccine law, and that it is made explicit that “vaccination is an effective public health strategyabove any particular interest.
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