Chile’s secrets to having one of the best vaccination campaigns in the world

This interview was originally posted on Americas Quarterly.

In the race to vaccinate people against Covid-19, Chile stands out not only as a regional, but also global leader, and since February 3 vaccines at a rate of one million people per week. Before February 22, Chile vaccinated 15.66% of the population, according to the data collected by the project Our world in data from the University of Oxford. Compared to major economies in the region, and even other parts of the world, these numbers are enviable.

Chile’s current rapid success has its roots in actions taken last year, when the country has participated in several clinical trials and set out to build a diversified vaccine portfolio, negotiating contracts with AstraZeneca, Johnson & Johnson, Pfizer, Sinovac and other potential partners on the horizon. On February 15, Chile had ordered 88.4 million doses, enough to immunize twice its total population, assuming all orders arrive. The authorities are also participating in the World Health Organization’s (WHO) Global Vaccine Access Initiative (Covax), which aims to provide vaccines to countries in need.

The Chilean government has set itself the goal have 80% of the population fully immunized by mid-year. In this interview, the doctor Izkia Siches Pastén, president of Colegio Médico de Chile – a powerful union of doctors and surgeons – says she is convinced that Chile’s infrastructure will manage to maintain current impressive vaccination rate.

Siches is 34 years old and in April of last year the magazine Americas Quarterly reported that he was previously mentioned in international media as the face “of a new generation of emerging leaders during the coronavirus epidemic. He is a member of the Covid-19 social roundtable, which helped design Chile’s response to the pandemic. In February, the magazine Time included Siches in his list of the 100 future emerging world leaders. His name is even mentioned as potential presidential candidate.

—Chile has set a goal of vaccinating five million people by the end of March. Do you think your country will be able to achieve this goal?

“We are now two and a half million who received the first dose.” From a logistical point of view, the goal is fully achievable. We vaccinate a million people per week. The big question is whether we will have enough vaccines. But today, February 19, the president announced that four million more doses would arrive next week. With that, Chile is approaching eight million doses, enough to ensure that a significant percentage of the population receives both doses. If we continue to receive vaccine shipments, I think that in March we will be able to reach five million vaccinated.

– In your opinion, is there a factor that explains why Chile was able to vaccinate so many people in such a short time?

—One factor has to do with Chile’s primary health care system and the history of the Chilean immunization program. In Chile, vaccines are universal for both private and public sector beneficiaries and are provided by the National Immunization Registry. No matter where in Chile a person is vaccinated: everything is part of the same platform. This allows us to follow in real time and allows us to space the first dose from the second without confusion.

—Last year, Chile participated in several clinical trials of vaccines. Was it a strategic decision? Do you think that later it helped Chile get access to more vaccines?

– Yes, it was a strategic decision taken by the members of the Chilean scientific community who collaborated in the studies carried out by Moderna, AstraZeneca, CanSino, Pfizer and Sinovac, and it is these same scientific teams who concluded the agreements with the laboratories . Chile has not closed itself off to any vaccine strategy. In reality, Chile is currently evaluating purchase agreement for Russian vaccine Sputnik V, del Instituto Gamaleya.

– Based on your experience, what steps should other Latin American leaders take to achieve this?

—We already had platforms that helped us that other Latin American countries might not have, such as a national immunization registry. I think the biggest limitation that Latin American countries have encountered is limited access to vaccines. The medical community and the global political community should find a way to make the distribution more equitable.

“The first vaccinated in Chile mainly received the CoronaVac vaccine from the Chinese company Sinovac. Have you noticed any distrust of this vaccine and of vaccines in general?

– Public opinion in general is more favorable to vaccines from the United States and the European Union – two historical references for Chile – such as those from Pfizer, Moderna and AstraZeneca. However, due to the vaccine supply problem around the world, Chile decided to sign collaboration contracts with other countries, such as through the WHO Covax initiative. For us, buying from China was not complicated due to the nature of this vaccine – which inactivated viruses – since Chile was already purchasing vaccines from China. Chile was already purchasing the seasonal flu vaccine from the Sinovac company, which was reassuring, adding to the fact that the results of the phase 2 and phase 3 trials were published. However, doubts remained, mainly because there were not many phase 3 trials to scale published in international journals. But Chile’s public health institute has approved the vaccine’s use, and the medical and scientific communities are backing the government’s decision.

Does the Sinovac vaccine have any special characteristics to which part of the Chilean success can be attributed?

“Definitely the storage method.” Pfizer has to be stored in ultra-low temperature units of -70 ° C, which we do not have in Chile. The Chilean territory also imposes certain limits, because it is a geographically long country. The Sinovac vaccine requires a very simple storage method, between 2 ° C and 8 ° C, which allows it to be shipped without problem to any end of the country, from Arica to Magallanes and Tierra del Fuego. And all health centers in the country already had refrigerators for vaccines, thanks to our national immunization program.

– Do you think that the problem of inequalities, which has been such an important topic for Chilean society in recent years, has played a role in the vaccination process?

– This forces the Chilean authorities to be much more careful. I think that after the social uprising, our president understood, for example, that he could not be vaccinated before other Chileans. In fact, one of his actions, which I think is redeemable, is that the president did not receive a token vaccination, but rather had to wait like everyone else until the members of his group were vaccinated. , and not before.

– Has there been collaboration between the public and private sectors in the immunization process?

“Everything was very orderly.” When health workers began to be vaccinated, no distinction was made between public health workers and private health workers, unlike what was observed in Mexico, for example. There was some pressure from different sectors of the economy to become more involved in the immunization process, but so far the greatest burden of immunization has been borne by the Chilean public sector.

—What challenges will Chile’s immunization process face in the weeks or months to come?

“The first challenge is to get the shipments up to the rate at which we are vaccinating people, which is over a million per week. This requires a continuous flow of new batches of doses. And the second problem is to specify which groups have priority. In this sense, our perspective of the medical union is to ensure first the vaccination of people over 60 years of age and people with chronic diseases. From there, the way the general population is prioritized becomes more political. Who to vaccinate first? Transport workers, teachers, dockers, office workers, essential workers? It is a definition which, in our opinion, must be very transparent, so that we do not perceive that there are people who have privileges that allow them to access the vaccine. I think what happened in Peru caught the attention of leaders around the world. It is essential that people perceive that there is justice in citizens’ access to health care. If we all start to jump the line, it is very difficult to maintain a public vaccination policy.

Translation of Jaime Arrambide

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