José Antonio Lluch, head of the Health Promotion and Stages of Life service of the Generalitat, in Valencia.Mònica Torres, EL PAÍS
José Antonio Lluch has been working on vaccination campaigns since 1989. A specialist in Preventive Medicine is a member of the conference that has participated in the development of the Government's plan for the vaccination of covid-19.
Born in Requena 62 years ago, Lluch is a benchmark in his specialty in the Valencian Community, where he is head of the Health Promotion and Prevention in Stages of Life service of the Generalitat.
Question.
When did work begin on the government plan?
Reply.
The working group started having meetings and exchanging documents a couple of months ago.
This cannot be improvised and even if you have a lot of experience in vaccination in Spain, you have to plan all the actions, evaluate the target groups, know the characteristics of the vaccine, in short, analyze what can be done.
P.
However, there are voices that criticize lack of concreteness, delay ...
R.
Considering that we don't have the vaccines yet, it seems a bit risky to say that.
We also have all the previous baggage that we contribute to that planning.
As with all plans there will be defenders and detractors, but it has been done in a thoughtful way with professionals with extensive experience in the field of vaccination, also in sociology, bioethics, communication ...
Q.
Will it be possible to start vaccinating in January, as the Government has announced?
A.
There will be vaccines the day we have them.
It is true that some laboratories are already manufacturing the vaccine, they manufacture them at risk, that is, if they do not authorize them, they do not come out, but the information they have allows them to think that the probabilities of authorization are very high.
Once they are authorized, transportation to Spain will be almost a minor issue.
In the European Union there are already several vaccines in the evaluation phase for authorization.
January is a real possibility, as long as in this very rigorous process no problem is found that forces us to stop.
Q.
The ministry has advanced the first priority groups to be vaccinated. What has been the criteria?
R.
Here an approach has been made to protect the people most at risk and, on the other hand, most vulnerable.
Logically, the subsequent groups should be the rest of the elderly, people with pathologies, some groups of professionals who play a very important role for the normal development of social activities ... All these groups will surely be prioritized.
These are the groups into which the population will be divided to be vaccinated against covid
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Q.
Will the last be the youngest?
A.
Right now what we don't know is how the vaccine works in those under 18 years of age.
No laboratory has presented important data on minors so far.
From that perspective, it is logical to think that this group is the one that arrives later, without this prejudging anything.
Information and data change every day.
But it is reasonable to think that those under 18 will be, if not the last, the last to be vaccinated.
Q.
A study recommends vaccinating cashiers and cashiers first.
R.
Vaccination strategies have always been based on two types: one strategy is to vaccinate those who suffer the most, those who get sicker, who die the most;
and the other is to try to vaccinate those who are the most contagious to third parties.
The strategy of the cashiers and young people is due to the fact that they are people who move, with a very active social life, and therefore you are more contagious.
In my opinion, this strategy obviates some important aspects: we cannot leave people who are in a residence homeless, for example, thinking that if we get good vaccination coverage in people aged 18 or 20 within a few months they will be protected.
It would be unethical.
Q.
So there is no discussion about the order of priority?
R.
Nor would I want to encourage a certain controversy about whether my group goes first or goes after.
We have to focus on the reality of today: there is no doubt that there are very priority groups at a stage in which we do not know very well how many vaccines we are going to have, if the doses will reach us little by little or suddenly.
Let's focus now on that group and prepare for the rest with the best guarantees.
Q.
Will more resources and contracts be needed for Primary Care to vaccinate?
R.
We will have to have resources available for vaccination yes or yes.
The hiring is conditioned by when the vaccines will arrive.
If several million doses reach us in a very short period, then an effort will have to be made to equip ourselves with additional resources.
Its arrive little by little, as the system is able to absorb it.
Q.
There is a great fear of the new vaccine, what would you say to people?
R.
Everything unknown is a certain fear.
But the ignorance is more theoretical than real.
The only thing that the coronavirus has made easy for us is the development of the vaccine.
Q.
Why?
R.
Because the antigen [a substance capable of interacting with the immune system and capable of initiating a response] that we had to use for the vaccine was identified very early.
This has allowed a lot of centers and laboratories to get to work to develop different vaccine models.
In reality, the same is being done as with any other vaccine.
The difference is that much more money and resources have been invested.
The European Medicines Agency is doing a continuous evaluation.
It will not have a lower safety profile than other vaccines that we are using with children and adults.
P.
Why are not so many resources allocated to find a treatment, a cure?
R.
The tools to combat the viruses that we know best are preventive, vaccines: measles, hepatitis, rubella, chickenpox, papilloma ... When the flu treatment is prescribed it is always symptomatic, there is very little medication that has been shown to be effective against viruses, with exceptions such as HIV or hepatitis C. Furthermore, the world of vaccines has undergone a dramatic change with all systems of genetic engineering.
There are vaccines that are developed with
computer
software
, which is called reverse vaccinology, which sequences the genome of the virus and is capable of identifying which part of the genome is responsible for encoding each of the structures of the germ and finding which of these are the that provide us with an immune response that protects us.
All this is very attractive also for research centers.
Q.
Will keeping the Pfizer vaccine at minus 80 degrees be very problematic?
A.
No, for three reasons.
First, because the storage volume is relatively small.
In a 90-liter refrigerator, almost like the ones in hotels, but in an ultra-freezer, 30,000 doses can fit, a significant volume.
The second is that the laboratory's own containers contain dry ice, which can be easily bought in the market and at prices such as 5.8 euros for 10 kilos of dry ice.
With 12 or 15 euros it could be kept in these boxes for 15 days.
And then in standard temperatures, between 2 and 8 degrees in the refrigerator, today what is guaranteed is five days of stability of the vaccine.
And the last reason is that they have been talking about the storage conditions that have been used during clinical trials, but now they are working in reality.
For example, Moderna began by saying that between 2 and 5 degrees her vaccine had an activity of seven days.
Now it goes for 30 days.
Surely, Pfizer will also extend the deadlines.
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