"All vaccines will be safe", an antidote for mistrust

BarcelonaFrom fearing covid-19 to mistrusting the vaccine. Almost half of Spaniards (47%) refuse to be vaccinated and 13% doubt whether to do so, according to the latest barometer of the CIS. These percentages are rising and breaking with the traditional predisposition to immunization that exists both in Spain and in Catalonia, where coverage among infants reaches 95%. This is probably due to the confusion caused by the improvisation of health authorities when making and communicating decisions. "We have seen a vaccine race that was more like a Grand Prix", which has aroused suspicions of hidden interests, fed by the dance of figures on vaccine efficacy and by the bursting of the stock exchange market, sums up Carlos Rodrigo, clinical director of paediatrics at the Hospital Can Ruti in Badalona - and vaccinologist.

In reality, the experts believe the process that has been followed for coronavirus vaccines is the usual one, with the only novelty being that the amount of overexposure has been counterproductive, and in no case are "either safety or efficacy" compromised, stresses Magda Campins, a member of the board of the Barcelona Medical Association and director of epidemiology in the Vall d'Hebron hospital. In fact, it will not be the fastest vaccine to be developed: in 2009, the N1H1 vaccine was ready in less than five months, as Campins recalls. Quickness has been possible due to the use of sophisticated technological platforms, and because "personal and financial resources, both public and private have been allocated in a way that has never been seen before".

This has allowed for "phases to overlap", thus accelerating the process. In addition, Campins adds that 30,000 volunteers is an unusually high number for the tests that allows for the ruling out of serious complications.

High demand

Despite looking at the effectiveness with a magnifying glass - effectiveness that the pharmaceutical companies have announced through headlines - "the most important thing is safety" because the virus is being inoculated in healthy people, Rodrigo says. This is also corroborated by Adelaida Sarukhan, doctor in immunology and scientific editor of ISGlobal: "Effectiveness is negotiable, safety is not". And here there is no doubt that the demands are, as always, extremely high. It will be the regulatory institutions, the European Medicines Agency or the American FDA, who will have the last word when they have all the data. Thus, there is no doubt about their management; additionally, research has sometimes been temporarily halted, or hopeful drugs have been ruled out - which far from being a failure, is unequivocally a sign that people's safety is being prioritized, says Campins.

In Sarukhan's opinion, there is no room for mistrust because she assures that "all the vaccines that reach the market will be safe" since they will have surpassed the requirements with a high mark. Whether the first doses arrive or not, errors will have to be fixed, says the ISGlobal expert, who points out towards the need to have a "good communication plan to rebuild the confidence" of the public, who need to understand that in no case during the research process "have shortcuts been taken" that compromise safety.

The distribution of the millions of vaccines that will be needed will be a great challenge. For the moment, the Spanish government has established 15 groups that will receive the doses in a calendar of phases until the summer, and if possible, the campaigning will start at the beginning of 2021. Prioritization is essential, forced by the product limit, and there is consensus that the first ones vaccinated must be the most vulnerable and their caregivers.

Obligatory nature ruled out

The health service also rules out compulsory vaccination, a point shared by Itziar de Lecuona, deputy director of the UB's Bioethics Committee, who believes that it should be "a free and informed decision". The transmission of "clear" information and regaining good leadership are key points, she maintains, to reduce reticence. Campins and Rodrigo agree that forcing could even be counterproductive, as is the case in Italy, where, despite having a lower vaccine coverage, they refuse to create an immunology card that divides the population.

From Médecins Sans Frontières, nurse Miriam Alia stresses that in mass vaccination campaigns, "the more decentralised the better", and that not having enough vaccine in the middle of one of the phases could be disastrous because "many people will not come back". Alia has worked in several emergencies in Africa (such as the Ebola emergency) and, despite her commitment to vaccination in primary care centres, she says that, in order for it to be effective "staff must be hired". The NGO has campaigned for "more transparency" in the vaccine race so that the most impoverished countries are not left on the side, noting that opacity "has created mistrust".

This mistrust is new, fed by the changes in the strategy taken against the virus - differences in the use of the face mask, initial speeches beliefs such as "it's like a flu", or the diversity of restrictions according to territories - but also by the "fall in popularity of the experts". These are the thoughts of José Mansilla, author of La pandemia de la desigualdad ("The Pandemic of Inequality"), which points to the "fragmentation of society", partly due to the "disappearance of great referents" that mark the way - and because "individualism" is gaining ground.

For Aran Solé, of the Catalan Association of Psychologists and Sociologists and Master's in Political Analysis at the UOC, the anti-vaccine movement continues to be residual, but in this mistrust one can find both those who "defend the decontamination of the planet" and those who believe in unlikely "G5 conspiracies, the laboratory virus, or the control of China".

Whatever the case, one thing is clear to all scientists until at least 60% of the population is immunized. The only vaccine is already present: mask, distance, and hygiene, says Campins, who says that "the fear towards the virus is losing ground" and predicts a 2021 with - yet again - restrictions.