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Residents in nursing homes, with no age limit, employees of these structures, health professionals who directly serve the population, in addition to the elderly with serious illnesses, are included in the priority list in a preliminary version of the proposal that the committee of experts in charge of the Directorate General of Health (DGS) to define the first target groups for immunization, former Secretary of State Francisco Ramos, coordinator of the workgroup created by the Government to outline the vaccination plan.
The security forces, and eventually the prison population, could also be included in the first phase of vaccination, as well as other people with serious illnesses, added Francisco Ramos, who estimates that this initial stage could reach about a million people. However, it emphasizes that the finalization of details is still in progress and that The definition of the priority groups should not be known until next week.
But in the working document that was not yet final – the deadline for submission of the final proposal of the technical committee ended this Friday and a meeting was still scheduled in which several adjustments were foreseen. – in the rest of the cases, an age limit of 75 years was established. Why 75 years? “The question of possible limits [etários] it has to do with the characteristics of the vaccines. We are working on scenarios, in the midst of great uncertainty, ”explains the coordinator of workgroup.
In preparing this preliminary version, which is subject to adjustments, specialists from the DGS team focused on the weakest link in the current epidemiological situation, the intensive care units. And what the data indicates is that these have been occupied mainly by people between 55 and 79 years old with other pathologies.
They also relied on data available to date from pharmaceutical companies on the safety and efficacy of vaccines (which have not yet been approved by the European Medicines Agency). And the problem is that, according to the experts of the PUBLIC, if there are already data for up to 75 years, for the elderly group there are only “very preliminary results with very small samples.” These are data resulting from phase 1 and 2 trials (the first phases, with fewer participants), in which the immune response was evaluated through blood samples and not exactly the effectiveness of the vaccines. “The relationship between the concentration of antibodies and the ability to not become infected, the immune response and protection against the real agent is still not understood,” they explain, highlighting that pharmaceutical companies only say that they have a percentage of people over 65 years of age. . in the essays, but does not elaborate.
“The problem is that very little is known about the results of phase 3 trials,” confirms António Silva Graça, infectious disease, who regrets the disclosure of this proposal, which is “a working document and not the final version.” The infectious disease specialist specifies, by the way, that both Pfizer and Moderna, two of the pharmaceutical companies that have already provided some data on phase 3 clinical trials, mention that they included people over 65 years of age, but without great details. Moderna says that they are 25% of the total and Pfizer does not quantify, it needs. “What can be done at this stage is to outline criteria that will then have to be adjusted, depending on the vaccines that are approved, among other things because little is known. What we have for now is what the pharmaceutical companies have disclosed ”.
Therefore, both the specialists of the technical vaccination committee, such as Francisco Ramos, workgroup of the Government, emphasize that at any time the preliminary proposal can be revised, since pharmaceutical companies are publishing additional information on the results of the phase 3 vaccine trials. The expert assessment has also taken into account the previous experience of vaccination against other diseases, which indicates that the immune response up to the age of 60 is very good and then decreases.
In the case of nursing homes, the inclusion of all without age limits is justified taking into account the epidemiological component in these structures, where outbreaks are frequent and there is a very high risk of contagion, due to the exchange of rooms and other common spaces. .
Since there was no communication from the DGS on the subject, it was up to the Secretary of State and the Deputy Director of Health to address the more technical issues, but also political ones. “Given that the most vulnerable groups have always been a priority for this Government, that is, the elderly, it would not be now – it will not be safe – that age is a limit for vaccination. Obviously, as we know, there are certain vaccines that, due to certain criteria and characteristics, are indicated for certain age groups ”, explains António Lacerda Sales.
This is the only limitation and it only has to do with the characteristics of the vaccines “, stressed the official, recalling that it is” a very complex process. “We don’t know what the first batch of vaccines will be. We will have to adapt this batch to come “, he added, highlighting another important factor that determines which strategy will adjust to reality:” The vaccines will arrive in sections and there will be priority groups according to these vaccines. ” It will not be possible to vaccinate all at the same time, but Lacerda Sales reinforces that with the 16 million doses that Portugal will receive, it will be possible to “achieve a degree of coverage and a very broad spectrum”.
The preliminary version of the proposal is in charge of the vaccination technical committee that the DGS appointed in early November specifically for the COVID-19 And that includes 11 specialists, from doctors to virologists, epidemiologists and pharmacists. It is this commission that It is convenient to suggest priorities, but the proposal, which is purely technical, must then pass the scrutiny of the Government and the workgroup – which was created on Monday and has one month to present the global vaccination plan, which will include all logistical aspects (transport, storage, distribution), the vaccination strategy and communication with the population and pharmacovigilance.
With Ana Maia
