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Portugal will have 22.8 million doses of vaccines against covid-19 that will arrive to immunize the entire population, but the process will be developed in three stages, the last of which may continue until the first quarter of 2022, taking into account Account of the planned schedule for the arrival of doses to Portugal, which is part of the vaccination plan against covid-19 presented yesterday. The population that is not included in the priority groups should only begin to be vaccinated from July 2021.
Citizens will have to give “their informed consent”, after being informed about the “precautions”, the “contraindications” and the possibility of “adverse reactions”, even if they are “rare or very rare”, it is specified in the document. The details have not yet been defined in a standard to be prepared by the Directorate General of Health (DGS).
In the first phase, which can last from January to April, 950 thousand people will be vaccinated, including those who live in homes and are admitted to long-term care units and the professionals who work there, in addition to the 400 thousand chronically ill patients. 50 years with pathologies with a higher risk of covid-19 (heart failure, coronary heart disease, more serious kidney failure, chronic obstructive pulmonary disease) and the 300,000 health professionals directly involved in the care of patients and professionals of the armed forces and forces security “considered critical service” whose “payroll is not yet refined,” explained the coordinator of the vaccination plan working group, former Secretary of State for Health Francisco Ramos.
Therefore, people over 65 who are healthy or who do not reside in homes or long-term care units will only be immunized in a second phase (there are 1.8 million in total), such as the 900 thousand citizens between 50 and 50 years. 64 years with other pathologies (diabetes, active malignancy, chronic kidney disease, liver failure, obesity, high blood pressure). This second phase should take place in the second quarter of 2021 but may extend until July, depending on the supply rate of six vaccines for which there are already prior purchase agreements.
Finally, in the third phase, the rest of the population, including all residents in Portugal, will be immunized, even if their situation is not regularized, if the expected delivery times are not changed in the meantime. If this happens, third and fourth priority groups will be defined. This segment of the population will only begin to be vaccinated from July.
For the definition of the priority groups, which can be modified according to the clinical indications that can be approved for the vaccines, the information available on deaths and hospitalizations, especially in intensive care, was taken into account. In the plan, it is emphasized that there is not enough data for now to recommend vaccination to children and pregnant women and it is emphasized that the effectiveness of the vaccines in development is not yet fully known.
The prime minister, despite his optimism, wanted to make it clear that the process is going to be long: “We already see the light at the end of the tunnel, but the vaccines do not arrive all the first day, but arrive gradually throughout the year. ”. , explained António Costa, who praised “the scientific community” for making possible in just over a year what would normally take seven years to become a reality. “This was the easy part. The difficulties will begin now ”, he warned.
The first phase will be carried out exclusively in the places where national vaccines are usually administered, health centers, taking advantage of the training and experience of the nurses who each year immunize thousands of children and young people here and also administer the flu vaccine. . There will be around 1200 points planned (which should include health extensions). At a later stage, it may be necessary to expand the network of vaccination points, admitted Francisco Ramos, without giving further details.
16 thousand vaccines a day
If the most optimistic scenario is fulfilled and it is possible to vaccinate 950 thousand people from the first phase until the end of February, it means that an average of 16 thousand people will be inoculated per day (counting weekends).
In this initial phase, only 400 thousand citizens with serious diseases will be immunized in health centers, but the number should not imply great difficulties for the teams, since in just over two weeks almost 1.5 million people were vaccinated there . against the flu, as the president of the Portuguese Association of General and Family Medicine had already stressed to the PUBLIC on Wednesday. In the second phase, the process will be more complicated, since there will be more than five million doses and it will be up to the health centers to make appointments.
Health center teams will still have to go to homes and long-term care units to vaccinate residents and workers if they do not have the resources to do so. Health professionals and other priority workers, on the other hand, should be vaccinated “within the scope of the respective occupational health services or other specific health services.”
Francisco Ramos guaranteed that it will be possible to know, at all times, who was or was not vaccinated through a registration system created for this purpose. To identify the chronic patients to be immunized, the information available in the health centers is used and, in the case of those that are not followed, the alternative is to submit a medical statement. “There will be a monitoring system for possible adverse reactions that should be robust” and clinical follow-up studies and vaccine effectiveness are planned, he added.
But the entire operation depends on the rate of delivery of doses and the schedule provided in the plan extends until the first quarter of 2022. According to the plan, in the first three months of next year, more than four million are expected to arrive. The doses of vaccine, in the second, will be more than 7.5 million, and in the third, almost 8 million. Finally, in the last quarter of 2020, more than two million will arrive, with the delivery of another 1.5 million in the first quarter of 2022.
The plan may need to be modified, as the rate of delivery will depend on the approval of the various vaccines. The president of Infarmed, Rui Santos Ivo, explained that in recent months several “acquisition agreements” have been signed, highlighting the concern to ensure an “expanded portfolio”. “Currently there are six agreements concluded. The first was AstraZeneca, on August 14, which has 300 million [de doses] for the European Union and 6.9 million for Portugal. The second for Sanofi / GSK, where not [as quantidades de] dose. The Johnson & Johnson group already in October, 200 million [de doses] for the European Union and 4.5 million for Portugal. Pfizer with 4.5 million for Portugal. The one of CureVac, the value is practically liquidated, between four and five million. The last contract signed, that of Moderna, has a lower amount, 80 million [para a Europa] of which we have 1.8 million ”, he listed.
As for the logistics operation that is being prepared in collaboration with the Armed Forces and the Ministry of the Interior (civil protection), no details were given. Francisco Ramos only revealed that the logic to follow will be that of “command and control”, “instead of the logic of decentralized management of the SNS”, with a central command in the Ministry of Health, for “time and the volume of uncertainty ”associated with this unique operation.
To guarantee effective communication, there will be a “place on the Internet” where all relevant information can be consulted and telephone lines of attention will be created for the general population and health professionals.
