If we continue to vaccinate for “clusters”, we will accumulate doses in the warehouse | Interview

If we continue to vaccinate for “clusters”, we will accumulate doses in the warehouse | Interview
If we continue to vaccinate for “clusters”, we will accumulate doses in the warehouse | Interview
In the second phase of the vaccination campaign against covid-19, citizens will be able to choose the date and place through self-registration in a site that is being created for this purpose, but that will be organized by age groups. It starts first at the age of 70, then moves on to the age of 60, and so on, explains Vice Admiral Henrique Gouveia e Melo, coordinator of the working group (task force) responsible for the operation. In the program Hora da Verdade, by Rádio Renascença and PÚBLICO, Gouveia e Melo revealed that the first test of this new methodology should advance in the third week of April. As for the vaccination of teachers and school staff, he says it is being used to “test the vaccination process” en masse and believes that it will not affect the immunization of the other priority groups, because most of the 280 thousand will be vaccinated by the end of -week of 10 and 11 of April, when almost 100% of the elderly from the age of 80 and the most at risk patients will have already taken the first dose. The vice-admiral defends the use of the age criterion, arguing that, by continuing to vaccinate by “small groups”, we are going to accumulate doses in the warehouse that could be protecting people.

The first phase should have ended by the end of March. When will all elderly people over 80 and people with higher risk diseases be vaccinated?
According to our estimates, after the second week of April. We are making a very big effort so that, by 11 April, practically 100% of the elderly and people with phase 1 co-morbidities are all vaccinated. Of course, 100% is never guaranteed, because there are always bags of people left behind, because they were unable to contact each other.

How are you going to solve the problem of these grants?
We have a finer process with the help of municipalities, health centers, trying to reach these elderly people who are either isolated or bedridden, or who are info-excluded.

Ministers of Education and Higher Education have always insisted that schools are safe places. Despite this, 280 thousand teachers and staff were placed in front of thousands of patients of the first phase, such as cardiac and severe renal and pulmonary patients. The experts of the technical vaccination commission of the Directorate-General for Health (DGS) contest this decision. How is the inclusion of this new group in the first phase justified?
I find it strange that experts challenge this priority, because the priority comes from DGS. We carry out a plan according to priorities defined by the DGS. We need to gain resilience from the State, so that it is possible to respond during the pandemic, but, on the other hand, while vaccines are scarce, we must concentrate as much as possible on the most vulnerable and elderly population. We defined a simple rule: 90% of the vaccines available went to accelerate this process of saving lives and 10% to gain the resilience of the State. [Além disso], the large tranche of teachers and non-teachers, 200 thousand, is vaccinated on the weekend of [10 e] April 11, when phase 1 is practically closed, because we reached 100% of the other groups. We are preparing for a massive vaccination phase and we need to test systems [desse tipo].

Are teachers being used for this test, therefore?
Teachers also serve to test the entire system [de vacinação em massa].

What about resilience outside the state?
It will be won with vaccination by age groups. What is at stake for the second phase? We are currently discussing with DGS whether or not we should continue to [dar prioridade a] large groups, for example diabetics, hypertensive, which can be three million people. By vaccinating by age, we are also vaccinating for disease. Most diseases are associated with age. Diseases that are not associated with age should be given priority. We are fighting with a strategy with two things simultaneously, also [queremos] go to get less elderly people who would have to wait a long time, but who have diseases that can be very critical.

Like people who have had transplants, for example?
It seems to us that it is more fair. The sickest people are the oldest people. The exception should be for other small groups that have rare or very specific diseases and that, due to age, would have to wait months.

When will the decision be made to use the age criterion?
It is being taken at the moment, these are decisions that require some reflection. Plans have to change. There is a phase when there are very few vaccines and suddenly there is a tidal wave of vaccines.

Are you confident that what you call “the vaccine tidal wave” will same to arrive in April?
If there is no tsunami, the plan must be readjusted again. In the first quarter 2 million vaccines arrived and 4.4 million were expected. [No segundo] 9 million will arrive and we cannot be making filigree progress. We have to move on to another, in which the speed, the pace of vaccination is the most important. I must not create difficulties at this rate because [se o fizer] I keep accumulating vaccines. This is what is unacceptable. The process is complex and, if I have to look for so many disease codes and this and that, I can’t vaccinate 100,000 to 120,000 people every day.

Does group vaccination hinder the speed of the operation?
Of course, because the organization is very complex and full of rules hinders all the logistics and the efficiency of the process. And the difference between people being vaccinated using group criteria or being vaccinated by age criteria is a matter of days. Now, it is not a matter of days if you try to do the opposite. It does not make sense for most of the population to wait for all these small groups to be vaccinated and to accumulate vaccines in storage that could be giving protection to people.


I already said that a site for people to self-register. But won’t that make those with the most initiative, probably the youngest, sign up first?
No, because the self-registration will be done by age groups, from x to x time it opens an age group for registration. And the two methods will continue to exist, that of the central system that goes to the database and that is seeing who was not called and the self-scheduling. People will be able to choose the date and the location, because that makes the process a lot easier. I have 100,000 seats to fill every day, and instead of looking for 100,000 people to fill the seats, I want these people to step up and proactively try to fill them. The first test will be in the third week of April. Let’s start with the age group that is to be filled out. I assume it will be in the 70s, then 60s, then 50s, then 40s, until we’re done.

But you need staff to vaccinate. Are these accounts done?
We need about 2500 nurses, 400 doctors and 2300 assistants, roughly speaking. In primary health care there are about 9,000 nurses. It is acceptable to use up to 20% of these nurses for vaccination. But primary care must recover the care activity [que ficou por fazer]. So, what we are trying to do is have between 1,000 to 1,500 NHS professionals to frame the answer and then go and get others. Either people who are not employed or who are leaving nursing schools now, who are finishing their training, or nurses who work overtime.

Can they then be nursing students?
Not students, but people who are moving from the teaching stage to the professional stage. What is needed is to find solutions inside and outside the National Health Service.

How do you respond to patient organizations that claim priority?
They are all right, except that the number of vaccines does not allow everyone to be vaccinated. This hierarchy hurts a lot of people, but the indecision is that it cannot happen.

How many doses are ordered?
We have 35.8 million doses ordered and promised. The Government did not save and bought a different range of vaccines to avoid becoming dependent on one type of vaccine. In the second half of April we will receive 80 thousand doses of the Janssen vaccine, which can be reserved for logistically more complicated situations, as is the case with the bedridden.

In Canada and Berlin, it has now been decided to give only the AstraZeneca vaccine from the age of 55. Aren’t you worried?
There are many episodes about Astrazeneca… if they correspond to an actual health concern or something else, I will not comment, I leave it to the imagination and the interpretive capacity of people. There is a European regulator that has scientists and data and a capacity that no single country regulator has and that says it is safe and effective.

Is the risk of not getting the covid-19 vaccine higher?
I can make a very simple calculation: there is one thromboembolic event in every half million people vaccinated, and there is still no certainty that there is a relationship with the AstraZeneca vaccine. In Portugal, more than 16 thousand people have died with covid, that is, in every 600 Portuguese people one died. Not having the vaccine has a risk almost a thousand times higher.

The price of the AstraZeneca vaccine is much lower than that of Pfizer and that of Moderna. Some say there may be a trade war here.
I cannot comment, I leave that to the good judgment of the people. The reality is that this vaccine is cheaper, they have dispensed with the profit, it is what it is.

Let’s go same get to group immunity in August, as I said?
I like the concept of group protection more than group immunity. Group immunity means that the vaccinated person is not a virus transmitter, group protection means that that person is protected. If vaccinations arrive, by the end of the summer we will have more than 70% of the population with one dose, I do not mean the date a, b or c.

When will you be vaccinated?
I should have been vaccinated for my military duties, but I did not need the vaccine, because I think I have to set an example in these roles. I’ll take a chance and try to give my vaccine to those who need it most. In that position, it does not seem very curiously in ethical terms to be using my military function to vaccinate me.

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