Why is Madrid the only region in Spain delaying Covid vaccinations?

Madrid is postponing appointments of first and second Pfizer vaccines by days or even weeks, claiming hold ups caused by Spain's national government are to blame. What’s really behind the problem and when will Madrid residents get their vaccines?

Why is Madrid the only region in Spain delaying Covid vaccinations?
The WiZink Centre in Madrid, one of the main places where residents are being vaccinated in Spain's capital. Photo: Javier Soriano/AFP

“What happened to my second dose?,” is the question on the minds of tens of thousands of Madrid residents in July 2021.

Regional authorities in Spain’s capital have decided to delay the second Pfizer vaccine for countless madrileños, past the initially stated and recommended 21 days after the first jab.

The wait could be 28 days or even 42 days after the first jab for those waiting to complete their Covid inoculation with the BioNTech/Pfizer vaccine.

Madrid has a system similar to Catalonia whereby citizens don’t get their appointment for the second dose in advance but rather receive a notification via text message 24 to 48 hours before it’s their turn, meaning many people in the capital have been waiting in vain after three weeks to be called up, unsure about how to plan their summer holidays around it. 

Hundreds of disgruntled residents have even decided to go to Madrid’s public hospitals to demand their second dose, or called up the 900 102 112 health hotline, but none have succeeded. 

Why is this happening?

The regional government headed by the divisive Isabel Díaz Ayuso links the problem to the “strategy of (Spain’s national Health) Ministry” and the “shortage of vaccines”, although no other region in Spain has reported similar incidents.

Madrid’s regional health director Enrique Ruiz Escudero on Tuesday told journalists that the lack of vaccine deliveries has meant that the region can’t “move forward” in terms of administering first doses, having stopped offering new appointments the previous week. 

“We received fewer vaccines than what we needed to complete our objectives,” he claimed.

“Pfizer vaccine stocks are being reserved for already confirmed second doses,” Escudero later tweeted.

But now there are apparently not enough vials to complete second Pfizer vaccines for everyone else that’s waiting either. 

Escudero indicated that the region has 350,000 doses from Pfizer allocated for the first vaccine, 120,000 from Moderna for first and second doses, about 120,000 from the single-dose Johnson & Johnson inoculation and 32,000 from AstraZeneca for second doses (after returning 200,000 to the Spanish Health Ministry due to a lack of target population).

Madrid opposition leader Mónica García has said it was a “joke” for Ayuso’s party to claim there was a shortage of vaccines in the region when there is a higher percentage of unused vials in Madrid than anywhere else in Spain except Melilla. 

READ MORE: Spain to receive no more AstraZeneca vaccines and donate remaining doses

Second dose delays are affecting the 40 to 49 age group in particular, with only 40.6 percent having received their full vaccination treatment in Madrid compared to 59 percent on average across all of Spain.

But the pause in first doses also means many young people, who are the main group affected by the fifth wave of the coronavirus in Spain, are not getting the partial immunity needed to curb infections.

Madrid’s health director called for “patience” and argued that delaying the second dose of the Pfizer vaccine past 21 days “doesn’t reduce the efficacy”.

He also stressed that Madrid has administered more first vaccines than most other Spanish regions – 75 percent to its eligible population – but according to Spain’s National Health Ministry this is where part of the problem may lie, stating that Ayuso’s government gave too many first doses and now has a shortfall of second doses as a result.

“All the regions knew that in June we achieved with great effort an advance of the Pfizer doses and they all made the correct planning of how to administer the first doses, being aware that in July vaccine availability would return to the previous levels,” Spain’s Secretary of State for Health Silvia Calzón said in response to criticism from Madrid.

“They shouldn’t be having problems administering second doses with the stock they will receive in the coming weeks”.

There’s also the fact that back on April 14th Escudero wrote to the national health department headed by Carolina Darias to ask for second doses of Pfizer and Moderna to “be completed 42 days” after the treatment started, suggesting it’s been part of Madrid’s vaccine plans all along. 

Spain’s national Health Ministry bases its recommendation on second doses on what the European Medicines Agency states – 21 days for Pfizer and 28 days for Moderna – but the US’s Centre for Disease Control has previously reported that “the second dose can be received up to six weeks or 42 days after the first dose, if necessary”.

For many people in Madrid, their regional government’s claim that they’re pausing first doses to “avoid delays” for second doses isn’t credible, given that this isn’t what’s happening in practice.

This vaccine fiasco also represents the latest chapter in a year of political wrangling between the socialist-led national government and the right-wing Popular Party in charge in Madrid, constantly at odds over their handling of Covid-19 restrictions.

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Spain rules out EU’s advice on compulsory Covid-19 vaccination 

Spain’s Health Ministry said Thursday there will be no mandatory vaccination in the country following the European Commission’s advice to Member States to “think about it” and Germany’s announcement that it will make vaccines compulsory in February.

Spain rules out EU's advice on compulsory Covid-19 vaccination 
A Spanish man being vaccinated poses with a custom-made T-shirt showing Spain's chief epidimiologist Fernando Simón striking a 'Dirty Harry/Clint Eastwood' pose over the words "What part of keep a two-metre distance don't you understand?' Photo: José Jordan

Spain’s Health Minister Carolina Darias on Thursday told journalists Covid-19 vaccines will continue to be voluntary in Spain given the “very high awareness of the population” with regard to the benefits of vaccination.

This follows the words of European Commission chief Ursula von der Leyen on Thursday, urging Member States to “think about mandatory vaccination” as more cases of the Omicron variant are detected across Europe. 

READ ALSO: Is Spain proving facts rather than force can convince the unvaccinated?

“I can understand that countries with low vaccine coverage are contemplating this and that Von der Leyen is considering opening up a debate, but in our country the situation is absolutely different,” Darias said at the press conference following her meeting with Spain’s Interterritorial Health Council.

According to the national health minister,  this was also “the general belief” of regional health leaders of each of Spain’s 17 autonomous communities she had just been in discussion with over Christmas Covid measures. 

READ MORE: Spain rules out new restrictions against Omicron variant

Almost 80 percent of Spain’s total population is fully vaccinated against Covid-19, a figure which is around 10 percent higher if looking at those who are eligible for the vaccine (over 12s). 

It has the highest vaccination rate among Europe’s most populous countries.

Germany announced tough new restrictions on Thursday in a bid to contain its fourth wave of Covid-19 aimed largely at the country’s unvaccinated people, with outgoing Chancellor Angela Merkel speaking in favour of compulsory vaccinations, which the German parliament is due to vote on soon.

Austria has also already said it will make Covid-19 vaccines compulsory next February, Belgium is also considering it and Greece on Tuesday said it will make vaccination obligatory for those over 60.

But for Spain, strict Covid-19 vaccination rules have never been on the table, having said from the start that getting the Covid-19 jabs was voluntary. 

There’s also a huge legal implication to imposing such a rule which Spanish courts are unlikely to look on favourably. 

Stricter Covid restrictions and the country’s two states of alarm, the first resulting in a full national lockdown from March to May 2020, have both been deemed unconstitutional by Spain’s Constitutional Court. 

READ ALSO: Could Spain lock down its unvaccinated or make Covid vaccines compulsory?

The Covid-19 health pass to access indoor public spaces was also until recently consistently rejected by regional high courts for breaching fundamental rights, although judges have changed their stance favouring this Covid certificate over old Covid-19 restrictions that affect the whole population.

MAP: Which regions in Spain now require a Covid health pass for daily affairs?

“In Spain what we have to do is to continue vaccinating as we have done until now” Darias added. 

“Spaniards understand that vaccines are not only a right, they are an obligation because we protect others with them”.

What Spanish health authorities are still considering is whether to vaccinate their 5 to 11 year olds after the go-ahead from the European Medicines Agency, with regions such as Madrid claiming they will start vaccinating their young children in December despite there being no official confirmation from Spain’s Vaccine Committee yet.

READ MORE: Will Spain soon vaccinate its children under 12?

Spain’s infection rate continues to rise day by day, jumping 17 points up to 234 cases per 100,000 people on Thursday. There are now also five confirmed cases of the Omicron variant in the country, one through community transmission.

Hospital bed occupancy with Covid patients has also risen slightly nationwide to 3.3 percent, as has ICU Covid occupancy which now stands at 8.4 percent, but the Spanish government insists these figures are “almost three times lower” than during previous waves of the coronavirus pandemic.