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While the pandemic in the country approaches one and a half million confirmed cases and exceeds 40,000 deaths, the Minister of Health, Fernando Ruiz, recognizes the delicate moment that it is going through; but at the same time he shows prudent optimism after announcing the expected vaccination strategy against covid-19 with a goal that aims to vaccinate seventy percent of the Colombian population, in compliance with phases that would begin in February and progressively seek to achieve herd immunity against the new coronavirus. Ruiz landed these elements in dialogue with EL TIEMPO.
(It may interest you: Colombia ensures 40 million vaccines against covid-19)
Minister, how is the pandemic going?
We are in a delicate moment. Fatigue with precautionary measures and the urge to celebrate Christmas are a dangerous mix. New cases are on the rise, although fortunately they are not having a significant impact on mortality. We don’t want to be a spoilsport, but we do invite Colombians to have less tumultuous celebrations.
What are the places that concern you the most today?
The most, Cúcuta. This week we had an ICU occupancy of 96 percent. In the last week we expanded from 312 to 330 beds, but the increase in severe cases is proportional. We hope to see soon the impact of the measures adopted, such as the peak and ID and restrictions on mobility. In the worst case scenario, we will have the wide availability of ICUs that we have in other cities.
In Cúcuta, they take extreme measures to prevent the spread of the virus.
Cúcuta City Hall
The country made an effort to double ICU beds, but today they are being used again. Where are we going?
The hospital expansion plan was not satisfied with avoiding the collapse of the ICUs, but rather sought to have a sufficient reserve for the eventuality that the number of cases skyrocketed. Since September we have had an availability of around 40 percent at the national level, an amount that gives us good room for maneuver. Last week we broke the historical record of people in ICU due to covid and other causes. Although we had almost 7,000 beds occupied, more than 4,300 were still available.
In some places there are already curfews, what are the chances of another quarantine?
Very low. A massive quarantine makes no sense in cities that today have high seroprevalence or where there is no exponential growth. The disparity in the behavior of the epidemic in the country does not justify adopting the same measure at the national level. We continue to believe that the best strategy is to focus on where it is most affected (Also: The FDA authorizes Moderna’s vaccine, the second against covid-19)
The projected death toll is being met, what do you think?
It is an ambiguous feeling. On the one hand, the technical rigor of the projections of the National Institute of Health is demonstrated, and, on the other, every lost life hurts me. My only consolation is the certainty that it could have been worse and that we have worked with rigor and dignity.
The country played it with Covax to buy vaccines, how firm is this mechanism?
Covax is a new organization and, unsurprisingly, it is struggling to implement. Even so, it already has 2 billion doses insured and the commitment to deliver them during the first quarter of 2021.
Negotiations with Pfizer and AstraZeneca are closed, what others are on the way?
As I am an enemy of empty advertisements, let me just tell you that we have significant progress with three other pharmaceutical houses. Let me give you new surprises.
Already with the vaccination strategy in the country, which is seen to be solid. How difficult is it to put it into practice?
It is a great challenge, but the forty years of experience of the Expanded Immunization Plan will not be in vain. We have a solid institutional framework that serves as a base and we have thought about how to solve each new detail that is going to be presented to us, particularly what has to do with the deep-freezing needs of Pfizer’s vaccine, the large volumes that we will handle and the scheduling of vaccination days (Recommended: A Colombian doctor who applied the vaccine in the US) speaks.
Do you feel they were delayed? Because there were many criticisms …
I understand that our silence generated anguish, but in the end I feel great satisfaction. Many governments, pressured by the media and the networks, had to rush out to announce intentions, but when people went to see there was nothing concrete. We endure the pressure, but if people go to see, the signatures of the contracts are there; no speculation. Also, my aunts taught me that putting all your eggs in the same basket is not a good strategy. I am sure that diversifying the portfolio will allow us quick access to the entire assortment of vaccines that is on the way..
On the one hand, you had the pressure of those who asked you to run, but, on the other, you also had the pressure of those who, out of fear of adverse events, asked you to slow down. What does it say to the latter?
I thank you very much because you have allowed society to have better informed and more considered opinions. Follow-up is just as important as vaccinating, and even more so when you don’t have all the information. So we are going to implement stricter mechanisms than usual. We have a plan that includes active and passive monitoring of possible adverse events and the acceptance of vaccines. All this will be supported by the nominal monitoring of vaccination through the Paiweb, a platform that we created to evaluate coverage and exchange information with the epidemiological surveillance system. We are optimistic but vigilant.
We endure the pressure, but if people go to see, the signatures of the contracts are there; no speculation
What role will EPS play?
Fundamentally, they will be our allies in identifying the prioritized populations.
What will be the regional vaccination dynamics?
We already have the calculations of the prioritized populations in each department. It is the same national strategy implemented homogeneously in each region.
Will vaccines that require ultracooling get everywhere?
No, they will go as far as we can guarantee their stability. The manufacturer will deliver them at the points we determine. We acquired 44 freezers to expand the vaccination area as much as possible. As we know that the freeze chain can be broken at some point, we also purchase vaccines that require the conventional cold chain.
Vaccinating almost 35 million Colombians is something unprecedented, is the country ready?
We are preparing for an unprecedented event. Enlistment has already begun to administer the vaccines, at the latest, in February.
Explain how it is that the pharmaceutical companies will not have responsibility for adverse events.
We are in an emergency situation. The condition that the industry put on the countries was that if they wanted to have vaccines quickly, they had to relieve them of the responsibility to compensate people who suffered severe adverse events. The solution has been to strengthen the surveillance of these events as much as possible to take timely action in case something goes wrong. The experience that other countries are having also works in our favor.
Can vaccines be marketed outside of the official strategy?
No, as long as they are approved under the emergency figure. The private purchase may be carried out when the vaccines obtain their sanitary registration and the industry assumes the responsibilities that fall under normal conditions. (Read: Colombia turns its eye on its ICU beds due to the pandemic)
How to prevent people from skipping the line, for example, with tutelas?
Conversing, arguing, creating awareness among the judges and reiterating that the health authority is the Ministry of Health. I have no doubt that the prioritization strategy has very strong arguments.
How to remove politicking from this process?
Politics is fought with technocracy.
Are you worried that some Colombians don’t want to get vaccinated?
Clear. But I am confident that we will achieve sufficient coverage so that the skeptics end up protected thanks to the responsibility of the well-informed.
What has this whole process meant to you?
Friday was one of the happiest days of my experience as a minister. My thing is public health, and if there’s one thing I have faith in, it’s vaccination. Having endured the pressure to carry a true, optimistic, well prepared and argued message gave me great satisfaction. I am very grateful to President Duque, who has trusted the criteria of the Ministry of Health officials, and to the other ministries and government entities, who have provided permanent support.
Four years ago, as Alejandro Gaviria’s deputy minister, apart from dealing with chikungunya and Zika, his office led the dispute to lower the price of imatinib, Novartis’s anticancer. Was that fight tougher than this negotiation with Pfizer and AstraZeneca?
Definitely, that vice ministry was the best training I could have to take on this ministry. At that time there were two great epidemics and the discussion about the declaration of public interest to lower the price of imatinib. Now, a pandemic and a string of negotiations with laboratories. They have been completely different negotiations, but with two elements in common: they were tough and resulted in the collective benefit.
What do we do while the vaccines arrive?
Not only while they arrive, but also while we achieve herd immunity thanks to vaccination we must maintain physical distancing, hand washing and, especially, the use of a mask. But now we can add the feeling that the horrible night is almost over.
HEALTH UNIT
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