Social value in addition to individual benefit and persuasion rather than coercion.
These are the principles that have inspired the vaccination of the child population in Spain for decades and, given the good results - the country enjoys one of the best coverage in the European Union - the Administrations have not considered it necessary to change them in the fight against to the coronavirus.
Nor among health personnel or among nursing home workers, where a possible positive case could have devastating effects for patients or residents.
The data available in Spain show that the staff of hospitals and health centers have participated massively in the vaccination campaign against the coronavirus, with percentages that are close to 98%.
Acceptance is somewhat lower among nursing home staff, where it is above 90%.
It is not the situation in other countries on the continent.
France and Greece announced this Monday the mandatory vaccination of their health personnel due to the irruption of the fifth wave and the evidence that reluctance remains among many professionals in the sector.
"Health professionals should have received the second dose on September 15," declared the French Minister of Health Oliver Veran, who reported that those who do not accept immunization will not be able to go to work and will stop receiving their salary.
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The measure has been adopted after several weeks in which the percentage of vaccinated health workers in the country barely advances after reaching 60%.
"We have to go towards the vaccination of the entire French population, it is the only way to return to a normal life," said President Emmanuel Macron, who included the mandatory vaccination of health personnel in a package of measures aimed at the entire population in a country where resistance to vaccines has grown dramatically in the last two decades.
In Greece, Prime Minister Kyriakos Mitsotakis was just as forceful.
“We are not going to close the country again because of some.
It is not Greece that is in danger, but the Greeks who have decided not to get vaccinated ”, he proclaimed.
Although the Government has not made public data on vaccination among health personnel, the trend in the country is not promising: the rate of vaccination has slowed down when only 41% of Greeks have completed the pattern, six points less than Spain .
The Greek Bioethics Committee had recommended compulsory vaccination of health workers and care for the elderly "as a last resort" if efforts to promote vaccination among them were not successful.
“In Spain, fortunately, we are very aware of the advantages that vaccines have for each one of us and for society as a whole.
The coverage that we are achieving among the population and those achieved among health personnel are very high ”, says Amos García, president of the Spanish Association of Vaccination (AEV).
With the current percentages, this specialist considers that imposing the obligation to be immunized would even be “counterproductive”.
“It is always better to persuade than to force.
And doing it when it is not necessary can have an undesirable effect of provoking a rejection of vaccination and giving strength and arguments to the few who oppose it ”, defends Amos García.
José Miguel Cisneros, head of the infectious diseases service at the Virgen del Rocío Hospital (Seville), agrees that “the rejection of the vaccine is marginal in Spain, unlike what happens in countries like France”.
He gives as an example the acceptance obtained in his health center, above 99% among the nearly 9,000 workers.
“Spain must continue with the strategy followed so far because it has given very good results and because individual freedom must be preserved whenever possible.
When we enjoy a situation that is very close to optimal, with vaccines accepted as something that contributes to the common good in a way that goes beyond individual benefit, I see no reason to introduce changes ”, concludes Cisneros.
The Ministry of Health has insisted on voluntariness as one of the principles that should inspire the vaccination campaign against the coronavirus since it started last December.
With coverage in hospitals and health centers that figures at "99%", he also sees no reason to follow in the wake of France and Greece.
The data offered by the autonomous communities are also very high, although in some cases somewhat lower.
Catalonia reports 90.2% with the complete regimen among healthcare personnel (92.5% with a first dose) and 88.1% among nursing home workers (90.4% with one dose).
Andalusia places it above 90% in both groups.
The Valencian Community has 95.6% of the health workers and 88.3% of the social health workers with the two doses, a percentage that rises to 100% and 97.5% with a single puncture, respectively.
The Canary Islands have 99.4% of the health personnel and 81.3% of the social health personnel with the completed schedule (in both cases those who have received the first dose are close to 100%), while in the Balearic Islands these percentages are around 90%.
Extremadura states that the "percentage of rejection of the vaccine has been decreasing to 0.45%" among health professionals since the beginning of the campaign and La Rioja and Castilla-La Mancha place the acceptance of immunization at "practically 100 % ”Of health and social health workers.
The Region of Murcia states that 97.5% of health professionals already have the complete regimen (and 100% the first dose), while among “social health professionals, the percentage of vaccinated reaches 93.3% with one dose and 89.3% with complete regimen ”.
The rest of the communities have not provided percentage data or have declined to answer, although all sources suggest that there are no major differences between them and that the percentages are similar to the previous ones.
And despite these good data, experts insist, it is necessary "to continue working to obtain the maximum coverage possible," defends Amos García. The danger is evident, as it happened in May in a residence in Esponellà (Girona), in which the virus caused the death of an elderly woman with a delicate state of health despite being vaccinated. Of the 37 workers at the center, 17 had declined to be immunized. Several residences in Spain have suffered outbreaks in recent months in which the presence of unvaccinated personnel has facilitated the circulation of the virus.
“In the cases in which very vulnerable personnel are being cared for and people's lives are clearly being put at risk, I do consider it necessary to open the door to open the debate on the obligation.
But it is better that the approach is case by case and look for concrete solutions ”, continues the president of the AEV.
The common position between experts and autonomies is that before proposing major changes that can later be complex to implement and generate resistance, the good results of the Spanish strategy invite us to follow the path set so far to adopt more drastic measures only when it is necessary. essential.
The Balearic Islands, for example, have endowed themselves with a "decree that allows establishing compulsory vaccination in certain groups if deemed necessary", although for the moment it has not considered it necessary to resort to it.
Health and communities agree that, in any case, any change should be agreed within the Interterritorial Health Council.
Only Galicia has proposed to date the mandatory general vaccination against the coronavirus.
She was appealed in March by Health before the Constitutional Court, which left her on hold.
"It is only possible to restrict fundamental rights through state legislation," said then the spokeswoman for the central government, María Jesús Montero.
With information from