Minors win the race to vaccinate young adults

The successful vaccination campaign against covid in Spain hides some but. The goal of reaching 90% of the population over 12 years of age with the full guideline is about to be achieved, but it seems very difficult, if not impossible, for those in their twenties and thirties to exceed that threshold. Young adults, although with a significant rate —Around 80% have at least one dose—, they have lagged behind and have seen how They have been outnumbered by kids between 12 and 19 years old, with an average of 86.2%. Percentage, by the way, that in four communities exceeds the magic figure of 90%, according to reports from the Ministry of Health. The reason, specialists maintain, is very simple: the involvement of parents. Meanwhile, another challenge begins to appear on the horizon, the possibility of extending the campaign to those under 12 once the health authorities give the green light to the use of drugs at those ages.

“They are under the influence or depend on what their parents decide”, recalls to explain the figures Ángel Hernández Merino, member of the advisory committee of vaccines of the Spanish Association of Pediatrics and Ana Rivas, head of the Epidemiological Surveillance Service of Ceuta. 94.3% of children between 12 and 19 years of age in the autonomous city have at least one dose, the highest percentage of coverage for this age group in all of Spain, only behind Asturias (94.8%) .

The Minister of Health, Carolina Darias, already warned in mid-September that the rate of administration of punctures in the group of 20 to 39 years faltered. And two months later young adults have not been able to turn the numbers around. The differences in the ratios between this group and the immediately younger group is more than 10 points in some regions, as in the aforementioned Asturias, where 79.6% of thirty-somethings have at least one dose, a figure that rises to 84.4% for twenty-somethings, and is close to 95% in the case of minors.

Nor should we forget, according to specialists, that in general terms and not only in the case of covid, in Spain, “childhood vaccination has always been a very well-received type of health intervention. The degree of parental trust is very high and it is what has pushed them to take their children to be vaccinated. Nevertheless, young people are unaware of risk of the diseases against which we routinely vaccinate. No one has seen measles, the ravages of polio, diphtheria … And it is one of the risks that this generation can run, the lack of prevention in the future ”, points out Hernández Merino.

In the case of Ceuta, Rivas points out, the immense efforts of the Ministry of Health and other entities have also played an important role. communication and health promotion actions. “We have had the help of AD Ceuta [el equipo de fútbol de la ciudad], of civil protection, of the Police, of the House of the Youth, in addition to companies and other entities ”. With general and specific actions for the youngest, the city, as explained by the head of the Epidemiological Surveillance Service, has invested a significant amount of human and economic resources so that the vaccination campaign reaches each and every one of its citizens.

The selfie incentive

Ceuta began vaccinating children between 12 and 19 years old at the beginning of last July. Its small size, factor that has also played in favor of neighboring Melilla, has allowed him throughout the campaign administer the doses that were arriving in a fast and agile way. But for that group that debuted shortly after saying goodbye to classes and when the fifth wave began to shoot infections and the incidence throughout Spain, the Ministry of Health devised a specific campaign: ‘The immune superhero’, whose fundamental key was to encourage minors to take a selfie by getting vaccinated and share the image on social networks in order to raise awareness and add friends and acquaintances.

But this was not the only initiative, for the ‘Vacunarte Joven’ campaign they had the collaboration of the ‘influencer’ Blanca Hernández, a native of Ceuta and with more than 700,000 followers on TikTok, and in ‘Vacunarse es de guapos’ participated another very popular figure in the city, Fran Guerra, Mr. Mundo Ceuta 2021, and one of the workers immersed in the campaign. Too football team players They did their bit. Actions that, thanks to the popularity of their protagonists in social networks, allowed them to reach a multitude of people, explains Rivas when asked the key to the success that is hidden after having achieved more than 94% coverage among minors.

Meanwhile, the mobile vaccination unit that Ceuta has at its disposal continues to tour the streets of the city to try to squeeze even more data and health experts are wondering about the next step. “Maybe, the next thing will be to vaccinate those under 12 years of age, or put the third dose to those who go from 65 to 70. These are the two ideas that are on the table, which are being valued right now, ”says Rivas.

What will happen to those under 12

Precisely, the possibility of expanding the vaccination campaign so that children under 12 years of age receive some of the drugs against covid is the great immediate challenge that Spain is going to face. The European Medicines Agency (EMA) is expected to make a decision, in late November or early December at the latest, on the suitability of administering Pfizer serum to this group. But the questions in this scenario multiply and the experts disagree.

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For Hernández Merino, the first thing to keep in mind is that we are in a situation of uncertainty, faced with a disease of which only a part is known and whose incidence is going to condition the near future. “We don’t really know where it’s going to go and that justifies one country making one decision and another another. It is something that can be shocking, but it is not because we still do not know exactly what we are facing or what surprises it may have in store for us ”, he defends.

If the EMA finally gives the green light, and everything indicates that it will, the scenarios are multiple and the premises to be followed, too. First of all, what to expect from vaccination, Hernández Merino illustrates, it is a benefit for the children themselves. Limit the impact of the disease on them, because, although most of them suffer from it in a mild way, “there is a significant cost in life and health if we consider the data in an absolute way. In Spain several dozen children have died directly or indirectly by the covid and there have been 177 admissions to the ICU. Children who develop the serious disease are very few if we compare the data with adults, but they are victims and they are cases that must be avoided ”.

The second objective, to contribute to reduce community transmission. The pediatrician remarks that on this second aspect “it is not known with absolute certainty if childhood vaccination would help in any way. Maybe it will do it a little or a lot, but in this case the benefit would be for the entire population as a whole, vaccinated and unvaccinated adults ”.

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Another variable that is on the table is reaching a sufficient level of herd immunity to control the transmission of the virus. Children under 12 years of age account for approximately 10% of the total population, and if this figure is added to the 10-15% that constitute the unvaccinated, it means that one in five people is not immunized. “It is difficult to achieve a sufficient level of blocking leaving 20 or 25% of the unvaccinated population, in this case child vaccination could be important ”, concedes the expert.

But all this, he adds, could depend on the level of transmission. If a country is in a favorable phase, such as Spain at the moment, the argument of administering serums to the smallest to reduce transmission and achieve a higher level of group immunity would lose force.

And the last reason given by Hernández Merino in favor of vaccination in minors points to the importance of school activity and the objective of guaranteeing the presence in schools of all children. The closure of classrooms “can have health and well-being costs for their whole life. It is an impact that is difficult to measure but one that undermines equity objectives and the impact is especially negative on families with a more unfavorable socioeconomic situation ”.

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But against it, one of the arguments that the expert uses are possible side effects. “In adolescents between 15 and 20 years old, males, an adverse effect has been seen, myocarditis cassis, and although most of them have been resolved, there is a margin of uncertainty about the future evolution and it must be taken into account. Pfizer dosages for minors are one-third of those for teenagers. This could alleviate the risk of adverse effects, but it is something to study”, He illustrates.

Different stages

The specialists of the Presentation of Vaccines, a body dependent on the Ministry of Health and in which all communities as well as other entities are represented, must take into account all these factors when agreeing to their final decision. An opinion that could choose one of these three scenarios: “do not vaccinate any child and trust that the evolution is favorable, surely some country opts for this option, vaccinate all children between 5 and 12 years with its pros and cons. cons, or only administer the vaccine to those most at risk. Children with neurological diseases, immunosuppressed, with cancer or chronic ailments ”.

Regardless of the option Spain chooses, the specialist is convinced that it will not be able to delay its final decision for long. If the EMA decides by the end of November, the ministry should pronounce itself in a couple of weeks. “It cannot be delayed because you have to buy the vaccines and then distribute them. They are new and all that takes a while ”, ditch.

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