Will it help prevent a spike in cases at Christmas?

The situation in Spain in recent months is enviable when compared with other moments of the pandemic or with other countries in Europe. However, the slow but progressive increase in cumulative incidence is unleashing the nerves. Will we come to Christmas in the middle of a new wave? At this point in the pandemic and without such a direct impact on hospital saturation, no one wants to go back to the harshest measures. However, the pressure to act increases before the situation spirals out of control. For this reason, some autonomous communities are studying the possibility of implant the covid passport What requirement to access certain spaces, such as hotels and other entertainment venues. Everyone would have to show the certificate at the door to show that they are vaccinated.

The health departments and the courts are already studying the viability of this new restriction in Aragon, the Canary Islands, Murcia, the Basque Country, Catalonia, the Valencian Community and Navarra, Galicia, Andalusia and Castilla y León. In parallel, some communities ask the Ministry of Health to set a criterion. However, one wonders if the measure makes sense, considering that vaccination can limit but does not prevent contagion. On the other hand, Fernando Simón himself has focused on the limited utility it would have in a population that has reached 90% vaccination coverage: “If everyone is vaccinated, why do you need to know it every time you enter a bar? ? “, asked the director of the Center for Coordination of Emergencies and Health Alerts. Or is it about convincing the 10% of Spaniards that, for now, they have decided not to get vaccinated?

Once again, the complexity of the measures against the covid, its multiple nuances, its direct and indirect consequences and the lack of scientific evidence on its usefulness entangle the political and social debate. Without completely rejecting the idea, experts are skeptical. “It might make sense in certain circumstances. It’s not about saying yes or no in absolute terms, and it depends on the objective we want to achieve “says Pedro Gullón, epidemiologist at the University of Alcalá de Henares, in statements to Teknautas. Let’s analyze what effect the requirement of the covid passport can have when it comes to stimulating vaccination and stopping infections.

Encourage vaccination

Although it is the least declared objective, probably due to its indirect and coercive nature, the requirement of the covid passport seeks to promote vaccination. This issue has hardly been relevant in Spain due to the great acceptance that vaccines have had. Within the target population (those over 12 years of age), 90.7% of Spaniards have at least one dose and 89% the complete regimen. Nevertheless, other countries have used this strategy to encourage its citizens to inject the doses. For example, it happened in France at the beginning of the summer: the requirement of the vaccination certificate in cinemas, restaurants and swimming pools drove vaccination among young people, who were being more reluctant than other generations.

“In certain countries where the coverage was not particularly good, the introduction of the passport has motivated some people to get vaccinated,” says Óscar Zurriaga, vice president of the Spanish Society of Epidemiology (SEE). In this sense, as a public health measure, “it may make sense if you have a population group with some reluctance but not extremely contrary, so that with certain stimuli they can agree to be vaccinated,” says Gullón. In the case of France, “it was an impulse for those who were thinking about it.”

At the moment, there are hardly many studies that put concrete figures on the impact of the covid passport on the increase in vaccination. An investigation published on the ‘medRxiv’ platform (without peer review) indicates that its requirement has a relatively large effect on the number of people vaccinated, especially among those under 30 years of age. This analysis takes as a reference data from France, Israel, Italy, Switzerland, Denmark and Germany between May and August of this year. These countries, which took some kind of restrictive measures for the unvaccinated in that period, are compared with others that did not. Usually, the increase in vaccinations was quite pronounced in France, which had figures below the European average, but insignificant in Germany, which was achieving better coverage. However, the authors acknowledge the limitations of this evaluation, which has to speculate on what the number of vaccinated would have been in a scenario without a covid passport.

What would happen in Spain in the current situation? “The impact would be small because reaching 100% of people vaccinated is very difficult,” says Zurriaga. Right now, “add new points of increase of the vaccination coverage It is very difficult; it’s like a marathon, the last kilometers cost much more. “Among other things, it is very likely that the 10% of the population that remains unvaccinated is really reluctant to do so, unlike the young French women who were in doubt. By now, all Spaniards “have had many opportunities to be vaccinated, so surely these are not people who are thinking about it,” says Gullón. However, before drawing conclusions, it would be necessary to analyze the profile of the unvaccinated. ” what it seems, we cannot simplify saying that they are anti-vaccine people“, says the epidemiologist.” Surely it is a heterogeneous group, made up of people who have reluctance, but also others who perhaps have more access problems or little contact with the administration, “he points out. In any case,” it would be necessary to assume that there is a ceiling and that not everyone can be reached unless other measures are imposed, such as compulsory vaccination. ”

The impact on advocacy

The second reason to implement the covid passport in a generalized way to access interior premises would be to reduce the incidence directly. This argument also has many implications. First, the vaccine is not designed to prevent infection, but rather serious disease. However, although there have been quite a few doubts and contradictory information in this regard, in practice those vaccinated do have less risk of infecting and getting infected. This is explained by a study published in ‘The Lancet’ at the end of October it already included the delta variant, despite the fact that the viral load may become similar.

Thus, in theory, “by preventing certain activities in people not vaccinated, could you cut enough drive chains, at least if we see it from a strictly epidemiological point of view, “explains Gullón. However, if we take this idea back to the current context of Spain, it loses much of its meaning.” You would only be preventing activities from 10% of the population. population. It is true that in relative terms, an unvaccinated person is more at risk; but in absolute terms, you are letting the virus circulate equally in nine out of ten people, so the measure would have a very limited effectiveness. “On the other hand, this type of calculation implies assuming that the unvaccinated are randomly distributed among the population, although in reality it is not like that because they are probably more related to each other.

Zurriaga agrees that the impact of this measure on community transmission would be very small. However, given that many outbreaks occur precisely in entertainment venues, the passport could have some impact on the consequences, since generally the vaccinated do not end up in the hospital. “In itself, we are not preventing transmission, but it would not generate a very high proportion of serious cases,” he points out.

Ayuso reacts to the increase in infections, but rules out requiring the covid certificate

Ignacio S. Calleja

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However, the vice president of the SEE warns of another danger. “We can ask for the passport, but if we do it at the door of a closed area, without ventilation, where the safety distance will not be maintained and where everyone will remove their mask, it would be giving us a false sense of security “, he warns. Adding a new measure does not mean that you can do without the others and, if that is going to be the result, it would be totally counterproductive. In this case, we run the risk of thinking that we are in a safe environment because we share space with other vaccinated people, but the reality is that the risk is similar.

In any case, beyond this point and the fact that its effectiveness would be small, the experts do not believe that other types of objections could be raised in the situation. covid passport. “Before the summer there was already talk of this measure and many epidemiologists warned of the problems and injustices that its implementation entailed. At that time there were people who had not been able to get vaccinated, not because they did not want to, but because they had not yet touched them, so it seemed unfair to us. However, from an epidemiological point of view it would have made much more sense, “says Zurriaga. On the contrary, today “It has no problem from an ethical point of view, because everyone has been able to get vaccinated. “However, doubts about its effectiveness arise.

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