Spain has achieved the main objective that governments around the world had set themselves to face the pandemic, to vaccinate 70% of the population with the complete guideline against the coronavirus. It has predictably done it this Tuesday, although the daily report of the campaign of the Ministry of Health will not reflect it until this Wednesday since it collects the information of the previous day. According to these data, Spain ended on Monday with just over 200,000 complete guidelines from exceeding the milestone, while the forecasts - based on the first doses inoculated in recent weeks and the vaccination rate in recent days - were that this Tuesday will be will complete about 300,000.
There are a total of 33.24 million citizens and an unprecedented effort of the public health system that stands out on the international scene. With 47.45 million inhabitants, Spain ranks 27th on the list of the most populous countries. None with a similar or larger population have managed to vaccinate faster, according to the Oxford University repository Our World in Data. The only one that has come close is Canada, with 67%. Then you have to go down to 60th place, occupied by Chile, to find a country of more than 10 million inhabitants with a similar percentage of protected population. And at 83, where Portugal is, to reach one of that size with better records (73%).
All the others that reached this milestone before have much smaller populations —Denmark, Uruguay, Iceland, Malta… -, while the closest and most comparable, such as Italy, France and Germany, have barely managed to exceed 60%.
The countries that began to vaccinate earlier due to their agreements with pharmaceutical companies, the United States, the United Kingdom and Israel, are also significantly slower due to the reluctance of part of their population to be vaccinated.
"Spain started with some advantage over neighboring countries, such as greater confidence in the health system and better acceptance of vaccines," explains sociologist Josep Lobera, professor at the Autonomous University of Madrid (UAM) and one of the experts that week after week has designed and adapted the vaccination strategy from the Vaccine Conference of the Ministry of Health.
The greatest attachment of Spaniards to their health system and vaccines has its roots in Franco's times, when polio still hit children hard while the disease had already subsided north of the Pyrenees. "This delay with respect to other countries and the importance of public health is a generational memory that survives in our elders", describes Lobera.
This starting position, however, does not always guarantee good results. “It is something that must be taken care of because we are facing very dynamic processes in which several factors are interrelated and have something of a snowball effect. If you have doubts but your environment is vaccinated, in the end you do too. And backwards. It is true that we have good children's coverage, but the initial reluctance to the coronavirus was high. It was necessary to avoid that this was reason for political confrontation, because that increases the reluctance. Solidarity also stands out, because by getting vaccinated you protect yourself, but you also protect the vulnerable. That favors some people who take the step for their elders or society ”, emphasizes Lobera.
Experts, however, insist that all is not yet done. That in Spain there are still more than five million people to be vaccinated and that if a third dose is needed in a more or less generalized way because of the delta variant, there is no guarantee that success will be repeated. This variant is what has made the achievement of 70% of the vaccinated population no longer sufficient to achieve group immunity. Experts are now divided between those who think it will be impossible to achieve it and those who see it possible to do so if coverage above 85% is achieved.
Miguel Hernán, professor of epidemiology at Harvard University, considers that Spain has been favored by two factors: “A quality health system and the absence of relevant anti-vaccine movements. If you look at the curves of Israel, the United Kingdom and Spain, they are very similar in their first phase. It is true that they begin to rise in different months, but that was due to the availability of vaccines in each country. That initial power is given to you by a good health system, similar in the three countries in this regard, capable of mounting an effective vaccination campaign ”, he explains.
As the weeks passed, however, the scene began to change. “In Israel, already in late February or early March, the curve begins to flatten due to the rejection of vaccines, mostly for religious reasons. In the UK, the reluctance has other reasons, but they exist, and the same thing happened a few weeks later. Fortunately, not in Spain ”, adds Hernán.
Although much smaller, in recent weeks population pockets have been consolidated in which vaccination is barely progressing, especially between 30 and 69 years - among the youngest it is still not possible to detect them because vaccination continues to advance. An approximate estimate, accepted by experts and taking into account that there is no approved vaccine for children under 12 years of age (11% of the population), indicates that between two and three million people are reluctant to be vaccinated in Spain (up to 6% of citizens).
It is a very heterogeneous group, which includes the openly anti-vaccines, those who have doubts about their safety and others who are apathetic. “Those who are openly and unswervingly opposed to vaccines are very few, although now they make a lot of noise on social networks. It is a space in which grays dominate, with critical positions that do not necessarily always end in rejection ”, explains sociologist Mar Griera, a researcher at the Autonomous University of Barcelona (UAB).
Before the pandemic, he explains, these positions were mostly defended by a profile of followers of alternative therapies, critical of conventional medicine and of the middle class. “It is a group that uses social networks, but that moves preferably in other areas. The public debate was very small. This has changed in recent months, with the emergence of profiles linked to the far-right that are much more active. The two groups are kept separate, although they may coincide at certain times, such as criticism of masks in schools ”, adds Griera.
These suspicions about vaccines have greatly complicated the advancement of the campaign in other countries. In France, Germany, Italy and the United Kingdom for years, reluctance to get vaccinated has sunk child coverage and has become a public health problem that has allowed diseases such as measles to re-emerge. The Italian Government, which attributes the slow vaccination to the pause caused by the holidays, places at 60% the percentage of the population that has already received the two doses. France, one of the countries most skeptical about vaccination, raises that percentage to 65% (59% according to Our World in Data) in a campaign that has received harsh criticism from the beginning for its slow start and that has lived its most tense this summer, with protests against the obligation to use the vaccination passport for social life.
Germany also narrowly exceeds 60% and is testing formulas to increase coverage, such as the commuter train that circulates in Berlin since Monday with doctors who vaccinate using the Janssen single-dose formula. In the United Kingdom, the British Prime Minister, Boris Johnson, celebrated on August 10 the “great national achievement” that three out of four adults in the United Kingdom had their complete vaccination schedule, although if one takes into account the of the entire British population, that percentage drops to less than 65%, according to Our World in Data.
The United States and Israel were, together with the United Kingdom, the countries where vaccination began before. In the first, however, the pace has slowed for months and has barely protected 52% of the population. Miguel Hernán attributes this fact to some actors, such as the Republican Party that "implicitly, and sometimes explicitly, supports non-vaccination." The delta variant has been primed mainly in Republican states such as Texas and Florida, where protection measures are almost nil. The rate is much higher in Canada, where 67.5% of its population is already inoculated.
In Israel, it has been religious issues and the youth of its population that have hampered vaccination. It was one of the first countries to start the campaign and in March it had already vaccinated half its population, but since then it has only managed to increase this percentage to 62%. Almost a quarter of Israelis are under the age of 12 and 12% of those over that age - in particular Arab minorities of Palestinian origin and ultra-Orthodox Jews - have refused to be immunized.
In Latin America, the differences between countries are abysmal.
Uruguay, with 72% of the population immunized, is among the most advanced in the world, while Mexico has barely achieved it with 33 of its 126 million inhabitants (26%).
In this case, logistical difficulties and a very weakened health system are compounded by the delay in obtaining the supply of doses due to the monopolization of rich countries and the difficult penetration of the vaccine in certain remote and population territories. indigenous.
In Asia, only three small and rich countries have managed to exceed the 70% threshold: Singapore, Qatar and the United Arab Emirates.
China is at 62%, Japan does not reach half the population and South Korea barely reaches 30%.
The average for the continent is 29%, a percentage that plummets to less than 3% in Africa.
With information from
Silvia Ayuso, Inma Bonet, Rafa de Miguel, Antonia Laborde, Carmen Morán, Lorena Pacho, Juan Carlos Sanz
and
Elena G. Sevillano.