COVID-19 cases and deaths have been rising in the past few weeks, with vaccination rates
plateauing.
Here in Germany, the slowing pace of inoculations has forced authorities to find creative ways
to get things back on track.
It’s in our hands, it depends what we do on where this pandemic goes.
It's the most urgent public health challenge of our time.
The COVID-19 pandemic has killed nearly 5 million people around the world.
Vaccines can slash mortality rates - but only when people have their jabs.
And that's not always a given.
Some governments don't give people a choice.
Others try to nudge citizens by restricting where the unvaccinated can go.
Some have even offered bribes.
But what if I told you that there's a country that didn't do anything like that - and yet
has one of the highest vaccination rates in the world?
When you take countries with more than 10 million people, Spain is the only big one
where nearly 80 percent of people are fully vaccinated.
As of October 7, Italy only is at 69 percent, France at 67 percent and Germany at 65 percent.
So how did they do it?
And what can others learn from the Spanish success story?
As we'll see, some reasons are specifically Spanish, but others might work in other places.
For Spain, the factors we're going to look at created the perfect storm together.
I have 100%, 200% confidence in the Spanish public health system.
I think we have an incredible system, they have treated us well.
That confidence - that trust - is one of the cornerstones of Spain's successful vaccine
drive.
There has always been a close relationship of the population with their family physicians,
with health centers.
And this reflected in the dynamic of vaccination.
And in Spain, it's all free, and has been for decades.
Universal health care is even enshrined in the constitution.
Trust is absolutely not something that's normally sort of delivered via text message or from
a single infomercial.
It's built up over time from seeing that systems are working for people, that they're generating
good outcomes.
This confidence in the health system translates to trust in the vaccines it offers.
A study by the Imperial College London found that 79 percent of Spanish people trusted
COVID-19 vaccines, compared to 62 percent in the US and 56 percent in France.
Another factor that pushed people to trust the vaccines was the devastating first wave
of the pandemic - and the way Spain got out of it.
That first wave killed nearly 50,000 people.
Most of them were elderly.
Almost everyone has a relative or a friend or someone they know that experienced this
kind of problem, who died in the hospital, in the corridor of the hospital or even before
going to the hospital.
And this is in the mind of everyone.
So I believe that no one wants to have a similar experience this year.
Many of those who died had been infected by younger relatives.
Spain is a country of close family ties and different generations often live together.
More than half of Spaniards in their late 20s live with their parents or grandparents.
When older people got vaccinated, hospitalization and death rates dropped dramatically.
The success experienced in the nursing homes, in the geriatric places, was incredible.
Incredible!
To me as an infectious disease doctor the results were better than expected.
People saw the vaccines working - and the fact that so many had seen elderly relatives
die, meant they knew what was at stake.
I’m getting vaccinated for my family, who are already a bit older, they are 60 years
old and it's to take care of them and to be able to have the guarantee of going home,
coming back and not infecting them, or at least that it's less strong.
This kind of more collective value is very important when deciding to be vaccinated and
is part of the communication strategy on vaccination in Spain.
The authorities made protecting older people part of their messaging to Spanish teenagers.
Nearly 90 percent are vaccinated.
For German teens, the figure is only at 35 percent.
There have been very targeted campaigns to the youngsters for promoting the vaccine:
TV, sports advertisement organized by the Ministry of Health and engaging youngsters
in telling all youngsters that it's important to be vaccinated.
Science suggests that when I see that most people, particularly people who I identify
with, if I see that a lot of them are doing something, it changes attitudes because then
I start to think, oh, well, maybe they know something I missed, and I sort of don't want
to be left out, either.
But it wasn't just the message which played a role in getting young people jabbed.
Authorities helped by making it easy to do.
People are often dissuaded when they hear about hassle factors or aren't absolutely
sure this is recommended for them.
And so research shows that if, for instance, you give people an appointment and simply
say, you know, we've scheduled you at this time and date in a convenient location, that
can dramatically increase vaccine uptake.
There were personalized phone calls to call for the vaccination, a follow up by the family
physicians in the primary health care centers.
There is now an active search for the rest of the people to try to ensure that those
who were not able to be vaccinated because they were traveling or they were sick or they
have had COVID recently are identified, are reached by the system and we complete the
vaccination.
Another factor that helped Spain's jab rate was the low level of anti-vaccine sentiment.
I think all in all, there was very little receptivity or tolerance to the discourse
of conspiracy or anti-vaccine.
Spain's newspapers and television stations also played a role.
Critical and science-based discussion is vital to build trust, experts say.
In all the media there was a constant scrutiny of how well we were progressing with the vaccine,
and it was not just general information, but the granular analysis of how we were advancing
with each population group in each region and how the vaccine was being distributed
and whether or not it was being applied.
And that region-by-region analysis led to a race between traditional rivals.
Catalonia and Madrid, for example, they compete and they compete not just in soccer, in football.
They compete in many different things, political issues.
And once the government bought and supplied the vaccines to every autonomous community,
everyone wanted to be the first to vaccinate more people.
And that brings us to the issue of access.
Spain was part of the EU common purchasing system, so getting hold of the vaccines was
never a major issue.
But for other countries it was - and remains – a huge problem.
Many smaller and poorer countries were stuck at the back of the line for vaccine contracts.
Africa is the continent with the lowest rate of vaccination.
Sierra Leone, Nigeria and Cameroon have fully vaccinated less than 1 percent of their population.
The factors we've mentioned don't matter if there's no vaccine available.
But Spain was lucky - and did sensible things in that lucky situation.
So it's a happy alignment of planets or a combination of factors: trust of the population,
a reliability on the health system by the population and on the population by the health
system, good responsiveness to the calls for vaccination and a real concerted effort of
prioritizing the vaccination.
Of all the factors we've considered, experts say trust is one of the most important - and
it will be trust that makes all the difference the next time a killer virus strikes.
I don't know of a quick switch we can flip in societies where trust is lower to make
it higher, but I do think this points to the hard work we need to do in the years and decades
ahead because this is not going to be our last pandemic or our last crisis where trust
in science matters.
And I think we need to invest more in building that trust and making sure it's earned.