Jaime Rodríguez, head of child infectious diseases at the German Clinic, assumed the presidency of the Minsal Advisory Committee on Vaccines and Immunizations (Cavei) at the end of November 2021, a position he will hold for three years. The instance that he directs, and which is made up of six other specialists, analyzes the information on vaccines on a monthly basis and makes recommendations regarding the different immunization processes.
In this context, one of the latest Cavei suggestions was to extend the inoculation against Covid-19 to pregnant women. This recommendation originated through a request from the Minsal, since the head of the National Immunization Program, María Paz Bertoglia, had asked about this possibility. Moreover, in the minutes that were released this Monday of the extraordinary session of March 8, the Cavei points out that “the panel discussed and considered that it is not applicable to issue a new recommendation to include pregnant women as a target group for the bivalent mRNA vaccine, since it has already been pointed out in previous recommendations that pregnant women do indeed constitute a group at greater risk”.
And he adds that “the Ministry of Health may determine to incorporate this group for booster vaccination, in accordance with the recommendations already issued. For example, in the recommendation of the third booster (5th dose), it was made explicit that ‘to the extent that the epidemiological situation warrants it’, the call can be extended to other defined groups”.
In addition, it points out that the head of the PNI (Bertoglia) “explained that the consultation was carried out from the Women’s Program to find out if the group of pregnant women will be prioritized for the call for reinforcement with bivalent mRNA vaccine. Currently this group is accessing only if they are also part of the other target groups called for reinforcement with bivalent mRNA vaccine as defined by the PNI.
Likewise, the agency reiterated its recommendation to extend the campaign against coronavirus to children from six months. In addition, it insists on improving risk communication because the pandemic is not over yet and emphasizing the call to get vaccinated, as winter is approaching and viral circulation always increases -sometimes to critical levels- at that stage of the year.
From expertise and as a member of the Cavei, Rodríguez maintains that looking at the current vaccination figures “we are falling into a very unfavorable scenario, because adherence to vaccination has fallen significantly. In fact, the bivalent vaccine process for populations at risk has been very slow”.
But in the minutes, the Cavei affirms that pregnant women can be vaccinated, that is, the target group would grow…
We were explicitly asked if the group of pregnant women fell into the high-risk category to be vaccinated with the bivalent and our unanimous answer was yes. Pregnant women fall into that risk category, so they could be vaccinated with the bivalent. And that’s very good. It has already been studied that the antibodies pass from the mother to the fetus, so the child is born protected. In addition, with breastfeeding antibodies are also transmitted, so this vaccination is beneficial for both the mother and the future newborn.
Since the campaign with the bivalent vaccine began -October 2022- around 30% of the target population has been vaccinated. How do you see the topic?
Progress with bivalent vaccination has been extremely slow, even among health personnel, who are supposed to be the most sensitive people. We are due and that is why adequate risk communication must be insisted on, because people no longer perceive Covid-19 as a threat, and they are already bored of being talked about a pandemic, but the threat still exists. People who have their vaccinations up to date have a much better evolution than people who have not been vaccinated or have an incomplete schedule. So, the call is for people to continue vaccinating and catch up.
Why did adherence drop?
It is due to two things. First, pandemic exhaustion, because people are already tired of always hearing the same thing. Second, there is not a good risk communication of the disease. So, in many places the pandemic is practically over, because people do not wear a mask, do not use prevention measures, only more responsible people are being tested, because there are many people with respiratory symptoms who are not tested, so we have a major underreporting. Risk communication was lost, so people are not aware of what is happening. That is why regularly in our meetings as Cavei we emphasize that the health authority improve risk communication.
What is the responsibility of the health authorities?
They have to do directly with the strategies they carry out as a health authority in relation to the messages they transmit. Now they are making some efforts with the influenza and Covid-19 vaccine. Some messages have appeared on television, but that risky communication that existed before has been gradually lost. It is not that they are directly to blame, because there is still a pandemic exhaustion, but there is responsibility.
And the figures for the fourth dose, are they also low?
The coverages are not as one would like them to be and clearly the fourth dose gives an important additional protection to the population, but people no longer remember. Since there is no risk communication, people are not aware of when they have to be vaccinated or if they are behind schedule. All that sensitivity that existed was also lost, and it is difficult to find the information. Although it is on the page of the Ministry of Health, but it is not so easily accessible. Before, one was up to date with the measures that were being taken.
Why is it so important to improve vaccination now?
A rather complex winter is coming our way, with common respiratory viruses and influenza and coronavirus. That was what happened in the northern hemisphere in the winter they are coming out of. So, it is time to put our foot on the accelerator and take advantage of the influenza campaign that is well embedded in the consciousness of the people, so that they catch up with the Covid-19 vaccine. And that is what the campaign launched by the Ministry of Health is all about. So, we must take advantage of this moment so that people are immunized.
As president of Cavei, he has worked with various administrations of the Ministry of Health. What differences has he noticed in the management of the health crisis?
Undoubtedly there are differences, but they have also had moments of the pandemic that are different. Initially, this was a global disaster and no one dared to go out for fear of dying, because it was a situation for which no one was prepared. This has evolved over time due to the genetic change of the virus and vaccination, so the disease has been contained a little more. It is difficult to specify if these changes in management policy are due only to political changes by the authorities or are basically oriented to the moment in which they lived through the pandemic.
How has the relationship developed with the current administration?
We have had a good relationship with the health authority, despite all the changes that have occurred, both in the national immunization plan and at the political level. We have had some small things, but the truth is that it has been smooth.
At their last meeting, they recommended vaccinating children from six months to three years of age against Covid-19. When could this measure be implemented?
There should be no problems with access to vaccines in the pediatric population, since there is a worldwide stock. We hope that the Minsal will soon accept our recommendation, ideally before winter, and begin to immunize young children. There is fear and anxiety in some segments of the population thinking that the vaccine could adversely affect children, but it is a small group because there are many parents who want to vaccinate their children and there are many families anxiously waiting for this to be launched and can immunize their children.
The recommendation has been made since February…
Yes, the technical recommendation from us is done.
