A woman receives the Pfizer vaccine in Medellín (Colombia), on July 24.JOAQUIN SARMIENTO / AFP
At the beginning of 2021, the Colombian government set itself a clear objective to get out of the pandemic: 35 million people with their complete schedule of vaccination against covid at the end of the year. That was equivalent to roughly 70% of the country's total population, a figure that became a benchmark around the world. Today we know that coverage of that level will certainly be insufficient to completely drown the contagion of the virus, but until today many countries, including Colombia, maintain it as an initial goal, at least. At the end of September, the authorities are still more than half way from that point.
Seven months after the first dose administered in Colombia, some 16 million inhabitants already have their full regimen.
19. Of them, nine already have one of the two necessary.
But another 10 do not have any.
The gap between the current situation and the declared objective is not insurmountable, but now it seems more difficult.
This gap that has been opening between people with a single dose and those fully vaccinated has been seen in several cases of people who say that they have not received the second dose to complete the regimen.
Until the end of June, the daily vaccination rate in Colombia grew more or less constantly. It was during that month, in fact, that the true acceleration was achieved, with days in which more than 300,000 or 400,000 doses were managed. The first weeks of July saw a decrease in the rate, but at the end of the month and facing August again, records were achieved (the highest: 550,832 doses in a single day; more than 1% of the Colombian population). However, beyond these exceptional days and weeks, Colombia has not been able to maintain a stable rate in the application of doses.
To reach the 70% target, Colombia must administer a minimum of 22 million doses between now and December 31. To the nine million second doses that are missing, another nine million of the Janssen vaccine can be added that have been purchased but have yet to arrive in the country. That would leave another two million people who would need a double standard of any of the other available vaccines - 22 in total. As other vials are used instead of those committed to Janssen, the number will be higher. And, in any case, the daily average of vaccination should be sustained at a minimum of 220,000 doses, including weekends. Colombia has reached this figure on numerous occasions, but so far in September the average has been less than 100,000.
And, indeed, the accumulation curve shows that the Colombian cruising speed has been at the level of the Mexican or Peruvian, but notably below the Brazilian, Argentine or even Ecuadorian, without the need to compare with the regional champions (Chile, Uruguay ).
Colombia
On paper, Colombia has acquired extra doses to meet this objective: 78 million if those bought bilaterally from each pharmaceutical company and those acquired through the multilateral Covax mechanism are added, of which Colombia is part as a self-financed country.
Under this mechanism, the country pays for its own acquisitions, unlike what happens with lower-income nations, which do receive subsidized vaccines from Covax.
To this must be added almost seven million in donations.
But one thing is signed and another is delivered. Sinovac and Pfizer have complied with practically all of their commitments. But the situation with the others, particularly with Janssen and Moderna, is very different: less than one in 10 of the vials purchased from these pharmaceutical companies has arrived in Colombia.
Moderna's delay, with 680,000 doses arriving just this weekend, probably explains part of the delays in second doses. In fact, the Colombian Government has extended some of the deadlines for receiving it: people under 50 years of age without significant comorbidities will receive their second from Pfizer or Moderna at 84 days, as was the case with AstraZeneca. They can, yes, choose to have it at three or four weeks respectively if they prefer. This is the recommendation of both laboratories, although there is evidence that delaying the doses could produce powerful immunizations with these mRNA-based vaccines: the United Kingdom, for example, was a pioneer in delaying doses of Pfizer, with good results in the effectiveness studies . But,For both the Colombian government today and for the British government then it is likely that this decision has more to do with pragmatism to adapt to the irregular arrival of doses, than with hopes of improving immunization.
This irregular arrival continues to be the main bottleneck for completing the Colombian objective even today.
Despite the fact that the supply restrictions are much less severe than those suffered at the beginning of the year, when dozens of countries were fighting to receive just a few tens of thousands of doses, they continue to affect with particular intensity those countries that are neither producers nor form part of an alliance that contains them (like the European Union), neither are they particularly wealthy, nor did they play their international trade cards with exceptional skill (like Chile or Uruguay).
With this, the gaps between people with some dose and with a complete regimen have widened in several Latin American nations, not only in Colombia.
Internal inequalities
From all the above it can be inferred that, if the difficulty of the arrival of necessary doses is saved, Colombia could reach its target of 70% before the end of 2021. However, the question remains whether these doses would reach all its corners at the same rate, and if the remaining 30% would be distributed symmetrically throughout the country. The data so far suggest not.
The text of the Colombian National Vaccination Plan took a clear position on the dilemma between efficiency and equity that accompanied the process: it established a rigid line, divided into five stages according to the degree of risk against covid, to receive immunization. This row followed criteria for age, comorbidities and workplace. But it did not contemplate differences by socioeconomic stratum, rural / urban location, or coverage of the protection system (except for the explicit different mandate to immunize migrants in an irregular situation). It is these differences that affect access to health in Colombia, notably easier for high-income people in urban centers and regions with a strong state presence. If there is no division into stages,these profiles would have been the first to receive their immunization regardless of their risk.
However, in the middle of the implementation of the Plan, the Ministry relaxed the queue by overlapping some stages with others. In doing so, it was implicitly yielding in its preference for fairness over efficiency. The advantage was that the available doses reached the arms that needed them more quickly. The downside is that they weren't doing it fairly. A glance at the map of doses per inhabitant today in Colombia shows these breaks.
The dose gap between Vichada and Boyacá is similar to that between Costa Rica and Guatemala.
Bogotá is as vaccinated as Croatia;
Buenaventura, like Venezuela.
The difference widens when territories with a weak urban and state presence, usually rural, are contrasted with urban centers.
And it is that the degree of vaccination of each area correlates, indeed, with the level of poverty that exists in it.
All this suggests that, even if the floodgates of the arrival of doses were opened, the avalanche would follow the channels marked by structural inequalities in Colombia, so that 70% is an achievable goal for the country in 2021, but perhaps it will not be. for many of its component parts.
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