Decreasing Vaccination Coverage in Spain After the Pandemic: Concerns and Challenges for Achieving Measles and Rubella Elimination

In Spain, despite having high pediatric vaccination coverage, after the pandemic, these have been decreasing considerably in relation to recent years. With respect to MMR vaccination coverage (measles, mumps, and rubella), which is often used as an indicator of generic vaccination coverage, the goal to maintain measles and rubella elimination status is to achieve and maintain coverage ≥95% with the first and second doses of vaccine.

The objective is met with the first dose, while with the second the coverage achieved is quite far from the objective, decreasing considerably in relation to that obtained in recent years. Seven autonomous communities show vaccination coverage below 90% with the first and/or second doseaccording to his own report of the Ministry of Health on vaccinations in Spain consulted by THE OBJECTIVE. These are: the Balearic Islands, the Basque Country, Asturias, Catalonia, Madrid, the Canary Islands and La Rioja.

The doubts that loom over the covid vaccine have been decisive and have spread to other vaccinesThis is what the experts say. As can be seen in the graph below, carried out by the Spanish Association of Pediatrics (AEP), in 2021 the figures for both the first dose (one percentage point, to 95.38%) and the second dose (2, 5 points, up to 91.22%), at the national level.

A 95.4% first dose coverage nationwide It would be a satisfactory figure, they acknowledge from the AEP, if this level of coverage were also guaranteed at levels of lower level geographical demarcations, so that it could reasonably be ensured that pockets of population with less coverage are not left behind. And this does not happen like this, because in the data by CCAA it can be verified that several of these move away from the objective in an important way: Basque Country 84.13%; Balearic Islands 85.23% and Catalonia 91.23%.

For their part, Murcia (94.03%), Cantabria (94.1%) and the Canary Islands (94.96%) are close to the target. The rest comply (>95%): Andalusia, Asturias, Castilla La Mancha, Castilla y León, Ceuta, the Valencian Community, Extremadura, Galicia, La Rioja, Madrid and Navarra.

However, the coverage of the second dose, according to the Ministry of Health, is 91.2%, well below the target (95%). 14 autonomous communities and cities (72.7% of the total population) do not reach the proposed target. The figures for some communities are really bad, the following stand out from the AEP: the Balearic Islands (79.5%), the Basque Country (81.4%), Asturias (84.8%), Catalonia (88%) and Madrid (88.7%). %). These communities represent 40% of the Spanish population. Thus, only four communities reach the target: Andalusia, Cantabria, Castilla y León and Murcia. Navarre and Com. Valenciana remain very close to 95%.

Confidence falls eight points in Spain

The report State of the World’s Children 2023 presented by Unicef ​​reveals that the perception of the value of childhood vaccines has fallen by almost eight percentage points in Spain (from 96.5% to 88.6%) after the start of the pandemic, and by more than a third (between 33 and 44 percentage points less) in South Korea, Papua New Guinea, Ghana, Senegal and Japan.

According to new data, compiled by the Vaccine Confidence Project (The Vaccine Confidence Project in English) and published this week by Unicef, China, India and Mexico were the only countries analyzed where the perception of the importance of vaccines remained stable or even improved. In many countries, people under 35 and women were the least confident in childhood vaccines with the arrival of covid. In the specific case of Spain, the drop in confidence was similar by gender and age, although somewhat higher among women (8.1%, compared to 7% in men).

“Despite the fact that the development of vaccines against covid was an unprecedented historical achievement that saved countless lives, the consequences of the pandemic have caused the biggest drop in recent decades both in childhood vaccination rates and in the confidence of society in immunization”, stated the executive director of Unicef ​​Spain, José María Vera, adding that in Spain “We can intuit that the doubts that hang over the covid vaccine have been decisive and have spread to other vaccines”.

«What is happening now, from the public, health and scientific authorities and from social organizations, is to reinforce the evidence: Point out what vaccines have achieved in these decades and what any type of setback in that immunization means, ”he emphasizes.

67 million children unvaccinated between 2019 and 2021

According to this same report, we attended the largest sustained decline in childhood immunization in the past 30 years. Thus, between 2019 and 2021, 67 million children were left without receiving immunization total or partial systematic vaccination, of which 48 million did not have a single systematic vaccination, which is known as ‘zero dose’.

In this way, the report reflects that, in 2022, for example, the number of measles cases was more than double the previous year’s total. Meanwhile, the number of children paralyzed by polio increased by 16% year-on-year in 2022. If the period from 2019 to 2021 is compared with the previous three-year period, the number of boys and girls who suffered paralysis due to polio increased eight-fold , highlighting the obligation to ensure that vaccination efforts are sustained.

“Although this trend will have to be confirmed in the coming years, these are data that represent a worrying alarm signal and in the face of which all of us, including governments, must redouble our commitment, increase financing for immunization and prevent systematic vaccination from being become another victim of the pandemic. If this happened, the next wave of deaths could be due to an increase in the number of children with measles, diphtheria or other preventable diseases», warned the executive director of Unicef ​​Spain.