Covid-19: challenges of the vaccination campaign in Cordoba

Each year, more than three million doses of the 20 vaccines listed in the national schedule are administered in Cordoba. The number is high, but most of these vaccinations are received by children under the age of 2, and in many cases up to four are given together.

Therefore, the vaccination campaign against Covid-19 is a historic health challenge. The province’s bet is to vaccinate 2.7 million people (all from Cordoba over 18 years old), without neglecting the population, in particular children, who will continue to receive the rest of the vaccinations.

The priority is to reach 1.1 million people in January and February, focused on health workers, over 60 and patients with hypertension, diabetes or cardiovascular disease. These are the groups most likely to generate severe symptoms or die from coronavirus.

The province already has a network of 786 vaccinations. Sandra Belfiore, coordinator of the vaccination program of the Ministry of Health of Cordoba, assures that this capacity should be expanded not only to face the intense campaign against the coronavirus, but also to continue to guarantee access to 20 other vaccines of the calendar.

“We work on the planning and logistics depending on the vaccines we receive. Perhaps we will add more vaccinations, especially in large cities, and we will also lengthen the hours to ensure social distancing and that it is not saturated, in the midst of a pandemic, ”he explains.

Belfiore is also making sure that more vaccinators will be added to the 1,300 activated in the province. “We must not neglect the other 20 vaccines and we must strengthen the vaccination network inside,” he insists.

In this sense, the Faculty of Medical Sciences of the National University of Cordoba has confirmed that 4,500 university students will participate in the vaccination campaign.

“The volunteers are already working and have participated in the flu shot. But not all will be concentrated in the city of Cordoba since we have students from all over the country ”, explains Rogelio Pizzi, dean of medical sciences at UNC.

And he adds, “We are already working on care training with each type of vaccine we receive.”

Program

Argentina has opened negotiations with five vaccine manufacturers. The one who would arrive fastest, at the end of the year, is Sputnik V, of the Gamaleya Institute of Russia. This would be around 10 million doses (25 million are being negotiated), of which Córdoba would receive between 800 thousand and one million.

There were also promises that Pfizer will deliver one million doses to Argentina by December. For its part, the AstraZeneca vaccine, whose active ingredient is manufactured in the country, would not be available until March. In this case, the agreement, already signed between the company and the national government, covers 22 million doses.

Other vaccines in development are Chinese Sinopharm and Janssen-Johnson & Johnson. Argentina is hosting the clinical trials of both projects, although the Asian project is more advanced and is already applied in its home country.

In addition, Argentina has paid to access the Covax mechanism of the World Health Organization. It is a united system of global access to vaccinations.

According to the Minister of Health, Ginés González García, our country will have access to nine million doses through this route and will be able to opt for one of the vaccines among a portfolio of six. They would be added in the second half of 2021.

Oiled logistics

Everything indicates that the first vaccine to arrive will be Sputnik V, which must be stored at minus 18 degrees below zero. Hugo Pizzi, public health expert and plenary professor at UNC, understands that the vaccine should arrive in Buenos Aires in a refrigerated plane from the country in which it was manufactured and from there be distributed by air and land, always to minus 18 degrees.

If there is not a large storage capacity at this temperature, Pizzi understands that the logistics should be oiled. “The refrigerated trucks have to arrive at the vaccination site and that’s only where it thaws. For this reason, the teams of vaccinators at the health points and the people who are going to be vaccinated must be prepared. If the vaccine loses its cold chain, it is neutralized and loses its effect, ”he explains.

In case there are people who cannot reach the place, they can go home, as has already been done in Cordoba with the flu vaccine, Pizzi says. “Cordoba is very well prepared and it would be a source of pride if the entire population proposed by Governor Juan Schiaretti were vaccinated,” he adds.

In February, Córdoba inaugurated the mass storage center for vaccines with a storage capacity of 3.5 million doses. Belfiore explains that this infrastructure will continue to be used to maintain the stock of the rest of the vaccines, although it could be used to store the AstraZeneca vaccine, which is kept at refrigerator temperature (two to eight degrees).

“It is not suitable for storing the Russian vaccine, which is why we are contacting Cordoba companies that work in the cold chain at sub-zero temperatures,” he said.

And he warned of another downside: “Once thawed there is only a 30 minute window to apply Sputnik V, while if Pfizer requires lower temperatures (-70 degrees) there is has a five-day window that can be maintained between two and eight degrees ”. The nearly 800 provincial vaccinations have the certified cold chain, but only in the two to eight degree range.

Safe cold

The cold chain is not a minor issue. “The challenge is that you can’t change the temperature even by half a degree, not even for a minute or a second,” Oleg Baykov, director of Biocard, a Russian logistics company, told Reuters.

For this reason, the government of Córdoba called for a reverse auction to acquire 100 special freezers. There are 50 units of 250 liters of capacity and another 50 of 360 liters, both with the dual mode of cooler and freezer up to 25 degrees below zero. The reference price per unit is 330 thousand and 500 thousand pesos.

This high cost is due to the fact that it has special features such as ensuring uniform temperature throughout the space and digital temperature programming.

It is expected that a batch of 50 teams will be available in a month and the rest 20 days later.

Sanitary glaciers ?. The Russian Sputnik V vaccine should be stored at a temperature of 18 degrees below zero. The Province has already started talking to companies in Cordoba that work with low temperature cold chains.

Immunity only 40 days after the first dose

All vaccines that will be available in this first stage require two doses and it takes on average about 40 days from the first injection to achieve effective and stable immunity.

The Gamaleya Institute clarified that it is possible to contract Covid-19 between the first and the second dose of the Sputnik V vaccine. Between the first and the second dose, 21 days must pass (those of Pfizer and AstraZeneca require 28 days) and immunity stabilizes three weeks after the second, said Alexander Gintsburg, director of the institute.

Russia has already recorded positive cases of people who had given only one injection of the vaccine.

“The human body begins to develop immunity after the first injection, but stable immunity to the new coronavirus emerges about three weeks after the second injection,” Gintsburg said.

And he added: “During the period between injections, it is possible to contract the infection, but the Sputnik V vaccine itself cannot be a source of infection in any case, because it does not contain the coronavirus. “

Russian authorities have also said they are preparing a freeze-dried formulation of the vaccine that will not be available until February. It is a white powder that should be stored between two and eight degrees and then diluted for injection.

Although it has already been proven that the immune response of this formulation is the same as that of the liquid version, efficacy testing has only been performed with the latter, so further testing may be required. to check whether freeze-drying (very convenient for application logistics) affects the effectiveness of the vaccine.