The proximity of summer and, with it, the mobility of thousands of Spaniards who will travel to other communities to spend their vacations has brought a new debate to the table: the possibility of getting vaccinated at the summer resort instead of in the autonomy of home. The director of the Center for Health Alerts and Emergencies, Fernando Simón, opened the door on Monday to receive the second dose of the vaccine in another community, but the Ministry of Health, when asked by this newspaper, refers to the national vaccination strategy, which plans to inject the dose in the place “where people are residing”. That is, where they are registered and have their health card. However, a spokesperson added: “A document of specific exceptional cases is being worked on.” But he did not clarify which ones, or how an eventual change in the vaccination site would be articulated. Some communities, such as Andalusia, Cantabria or the Valencian Community, agree to do so, while the Basque Country has not planned it. Experts, for their part, disagree on the convenience of the measure: they assure that it can complicate the logistics of the vaccine campaign, although they admit that it is viable.
In the absence of common guidelines on how and when to be vaccinated in other communities – Health indicates that the document of exceptional cases has to be approved in the Public Health Commission – the autonomies begin to move tab. The Minister of Health of the Valencian Community, Ana Barceló, has revealed that, in her case, second doses are already being inoculated to tourists from other communities, after processing the health card for the displaced person. It is a management that many vacationers do and, in fact, there are health centers that are opened just for them. With this document, they are included in the sanitary census and they are summoned when it is their turn to be vaccinated. Barceló has, however, asked that Health establish a criterion for reciprocity and has demanded that an adjustment be made between the number of doses received and those injected with the arrival of these displaced persons.
Andalusia, for its part, has assured that it is studying the possibility of vaccinating vacationers in its community, but has not specified how the mechanism to summon people from other autonomies would be articulated. According to a spokesperson, a debate on the issue is pending within the Health Commission and the Interterritorial Council. The Balearic Islands, for their part, have been open to vaccinating people from other regions, but with nuances: “Always at the hands of the Ministry, officially, and ensuring the arrival of these vaccines,” said the Director General of the Health Service from the Balearic Islands, Juli Fuster. For now, he assured, he has not received any indication from Health “officially or unofficially.” “We have a significant percentage of people who come to work and those people who have already received a dose we will give them the second dose,” said Fuster.
Precisely, the distribution of doses and the administrative logistics of vaccination are two of the elements that complicate the proposal, according to experts. Currently, vaccines are distributed according to the reference population, with data from the National Institute of Statistics.
Alberto Infante, emeritus professor of International Health at the National School of Health of the Carlos III Health Institute, contributes these ideas: “It is true that until now they are distributed on a population basis, but whoever does so also knows how this mobility phenomenon develops in summer towards the coastal areas and a forecast could be made of how much the population decreases in inland areas and how much it increases in the coastal areas. That estimate can be made and deliveries can be corrected based on this factor ”.
However, Daniel López-Acuña, former director of Emergencies of the World Health Organization (WHO), sees more difficulties than advantages: “Opening the floodgates to vaccinate in another community introduces logistical problems of data collation, people who can stay in a limbo, difficulties in the volume of procedures for the displaced … We are complicating ourselves more than necessary ”.
Spain is immersed in the vaccination of the group of people aged between 40 and 49 years, the largest (eight million people). Predictably, it will enter the summer administering first and second doses to this group and making way for the thirty-somethings. In total, 16.7 million people between the ages of 25 and 49 who, according to government estimates, have to be vaccinated before the end of the summer. The problem is that, with vacations in between, the vaccination campaign can be altered, especially due to the risk that the appointments coincide in the middle of a trip and far from the usual place of residence. “In the context in which we are, it is about vaccinating as many citizens as possible,” says Amós García, president of the Spanish Association of Vaccination. And Professor Infante agrees with him: “Anything that makes it easier for people to get vaccinated is good. There is no need to hinder it. Vaccination is being done a lot and very quickly and I don’t think that what happens will influence the pace of the global campaign much, but it will all depend on how many people are moving and how we get to the end of this month with the coverage of the 40 and 50 age group”.
Fernando Simón already advanced on Monday that there was the option of pricking the second dose in another autonomous community, although it would be appropriate in that case to do the procedures to request the health card for the displaced person. However, he admitted, it is easier to change the appointment and get vaccinated at the place of residence. “The second dose has a minimum time from the first dose, but nothing happens if it is put a little later. The communities give a margin of flexibility to adapt the date and modify the appointment, ”he said. According to the experts consulted, although the ideal is to comply with the technical data sheet, the studies show that the second dose of Pfizer, for example, scheduled for 21 days after the first, could be administered up to 42 days after the first puncture.
Cantabria is another territory that does not see problems in applying second doses to people from other autonomies who are in its community. The Cantabrian president, Miguel Ángel Revilla, has declared: “Whoever has a vaccine and be here, because it is put here. From the health center, wherever you are, you will be called. You will have to communicate the date on which you received the first dose and, within the deadlines, the corresponding health center will vaccinate you ”.
The one who does not plan, however, to vaccinate people who are in this community for vacation reasons is the Basque Country. “Osakidetza” (its health service) “guarantees vaccination to the people who live here,” said Health Minister Gotzone Sagardui. And he explained that people who cancel their appointment to be vaccinated because they decide to go away on vacation will have to wait for a new appointment to be provided. In any case, it has indicated that this issue should be discussed between the ministry and regional governments. “The priority is to continue with the immunization process, not vacations,” he has sentenced.
The same discrepancies that exist between communities are also found among experts. Along the lines of Sagardui, López-Acuña has claimed “to privilege health care” over leisure. “This is putting the cart before the oxen: we are prioritizing the logic of vacations over the logic of vaccination. Logistically, it is easier to complete the vaccination guidelines in the place of residence ”, points out the expert, who fears computer problems and the transfer of the second dose schedule between communities.
For his part, Amós García, president of the Spanish Association of Vaccination, considers the proposal to vaccinate outside the autonomy of residence “logistically viable”. “The dose distribution can be readjusted and I don’t think there will be so many people either. In the Balearic Islands or the Canary Islands there may be more demand, but it is rectifiable ”, he adds. Infante agrees and defends that, like any benefit of the National Health System, citizens can receive it wherever they are when it is their turn.
With information from Mikel Ormazabal, Lucía Bohórquez, Javier Martín-Arroyo and María Fabra.