The public ministry of El Salvador has applied 11,289,175 vaccines against covid-19, but only 438,382 people have completed the scheme with the four doses.
By: Nancy Hernandez
In a small stream, Mrs. Berta Alicia López, 63, was making a living washing other people’s clothes.
– Are you going to get vaccinated?
– No, I do not need it, in our place; thank God it did not arrive (Covid-19) -, he answered the question.
In this way, the woman from the San Ignacio community, east of Puerto de La Libertad, in the department of La Libertad, is part of the statistics of thousands of Salvadorans who have not been vaccinated against the Covid-19 virus.
See the report here:
According to official data, the vaccination plan in El Salvador against covid-19 began on February 17, 2021, with the arrival of the first batch of 20,000 vaccines from the pharmaceutical company AstraZeneca.
In the third week of February 2021, thousands of doctors, nurses and support staff, working on the front lines against the virus in the hospital network, voluntarily received the first of two doses of the AstraZeneca vaccine, the government reported.
the purchase of vaccines
El Salvador entered the list of the first countries to start vaccination against the virus, which had already caused 2.5 million deaths worldwide. In the first year of the pandemic, 111 million people were infected.
Before the arrival of the vaccine, the number of deaths in El Salvador from this cause amounted to 4,000 people and a total of 113,109 positive cases of the virus were reported, according to official data, reported on the official website.
Vaccination plan in El Salvador
The vaccination strategy in El Salvador contemplated the immunization of 4.5 million people, out of the 6.7 million inhabitants that the country has, among front-line personnel made up of doctors, nurses, police and military, people with chronic illnesses, citizens over 60 years of age and, finally, those over 18 years of age.
The vaccines that are applied are those of AstraZeneca, Sinovac, Pfizer-BioNTech, Moderna, and Sinopharm.
To launch the immunization plan, the Government opened 162 vaccination centers in those months, including the Megacentro del Hospital El Salvador, which was built to specifically care for patients with covid-19.
Also read: Colombia, a country where young people refrained from vaccinating against Covid.
According to the study Monitoring vaccination against covid-19 in El Salvador, presented in February 2022 by the Central American Institute for Fiscal Studies (Icefi), this country closed the year 2021 with the cumulative acquisition of 15.6 million vaccines. .
If the target population group is taken into account, that is, the one that can be vaccinated based on their age, as well as the fact that for people over 18 years of age there is the possibility that a third dose can be given, the number of vaccines that the country needs are around 17.1 million, without considering the foreign population, Icefi explained.
Also read: Intensive care units: advances and consequences in a stressed health system.
Vaccine procurement
“This means that as of that date El Salvador had acquired 91.2% of the total doses it needs and only needed to acquire around 1.5 million doses, under the assumption that it will continue with the two-dose scheme for ages between 6 and under 18 years of age, and three doses for those of legal age, and assuming that a fourth dose will not be necessary, ”the study detailed.
President Nayib Bukele announced on Friday, March 18, 2022, the fourth dose was enabled in the Vaccination plan in El Salvador against Covid-19 for all people over 12 years of age. Which will also be available to foreigners regardless of their situation. Migratory.
In addition, the president explained through Twitter, his favorite social network, that, like the other doses, «This is totally voluntary and is available to all Salvadorans and foreigners.»
The same Icefi document affirms that the state has invested more than $170 million in vaccines against the virus, whose purchasing process is, according to the Office of Information and Response (OIR) of the Ministry of Health, confidential information for five years.
purchase reserve
December 3, 2021, was the last time the Ministry of Health (Minsal) reported on the entry of vaccines against covid-19; With the last batch, the country accumulated a total of 15,480,090 immunizing biologicals.
Currently, according to official data from the Government of El Salvador, 11,289,175 vaccines have been applied; that is, there are 4,190,915 doses stored for a year.
On March 11 of last year, the Government decreed, backed by the Law on Access to Public Information (LAIP), as «reserved information» all the data on the vaccination plan in El Salvador for a period of five years, this it means that information about the immunization process will not be able to be obtained.
To date, Salvadorans do not know how much the government invested in the purchase of vaccines, where the funds were obtained from, or when the expiration date of each batch, age, gender, and place of residence of the people vaccinated.
The Ministry of Health supported the decision in paragraph D of article 19 of the LAIP, which details that it is reserved information «that which clearly endangers the life, safety or health of any person.»
The costs
Given the lack of information, Icefi used the average prices per vaccine to carry out said exercise. Based on this, the value that other countries have paid per dose for Sinopharm is $20.48, for Sinovac $17.85, $13.78 for Pfizer-BioNTech and $4.77 for AstraZeneca.
Using these prices, it can be concluded that the Salvadoran State has paid around $171.3 million, without considering commission or transportation costs.
For dimensioning, this amount represents 17% of the total budget of the Ministry of Health for 2021, three times the budget of the Ministry of Agriculture and Livestock (MAG) or 13 times the budget of the Ministry of Environment and Natural Resources (Marn), according to the study.
Vaccination strategy in El Salvador
To obtain the vaccine, Salvadorans must schedule an appointment through the three modalities that the Government has enabled: entering the digital site, sending the Unique Identity Document (DUI) number in a text message (MSM) to 6055- 5555 and wait for a response; Finally, going to the health units of the municipalities or waiting for health promoters to arrive in the communities, if these are difficult to access.
In the case of Doña Berta, she explained that in her community, San Ignacio, whose access is difficult due to the terrible conditions of the street, the health promoters did not come to administer the vaccines to the neighbors.
The Port of La Libertad is the closest city to the community of Doña Berta, but he affirms that walking takes an estimated three hours to get there and only «those who have possibilities» pay for a pickup to go to the place, obtain health services and vaccines.
“Here you did not hear about vaccines, they told me, but just as a joke, but not that long ago. They only said where they were vaccinating, at least there, in El Puerto. I’m not going to get the vaccine, it scares me, I don’t need it, I feel,» he stressed.
Who is missing to get vaccinated?
According to the report, Vaccination Study 2021, from the Salvadoran Foundation for Economic and Social Development (FUSADES), Doña Berta is among the population group between 56 and 65 years of age who have decided not to get vaccinated for «fear of reactions and because they do not consider it necessary”, this group represents 22% of the population.
“Regarding the information of the unvaccinated in rural and urban areas and by sex, there is fear of reactions to the vaccine, work schedules do not allow them to go to the vaccines, they are confused with the information or they do not deem necessary,» the document says.
And furthermore, he adds: «The reluctance to vaccinate at different ages is variable, from 18 to 45 years old they mention work schedules, fear of reactions and because they do not consider it necessary, are the prevailing reasons, and of 56 to 65 years or more, the prevailing reasons are fear of reactions and not considering it necessary.
Likewise, it concludes that: “It is striking that people over 65 years of age are not strongly associated with the category “Yes, two doses”., that is, it may be happening that they have not wanted to be vaccinated”, it concludes.
Vaccination in El Salvador of the population with chronic diseases
On the other side of the coin, is Angélica de Jesús Pérez, 41 years old and a resident of the San José Las Mesas community, in the municipality of La Libertad, in the department of the same name in El Salvador, who stated that three of the four doses that Consider the immunization strategy.
“Yes, here in the community 100% have gone to be vaccinated, even children 7 years of age and up. Here we are going to vaccinate the Port of La Libertad; there they were putting the doses. They did not come here, but they enabled transportation; when someone did not go the promoter came to ask why and managed to convince, but most of us have vaccines ”, he details.
The woman is diabetic and her father suffers from kidney failure. They are part of the citizens who are a priority for the government in its vaccination plans in El Salvador. However, they had to travel more than ten kilometers to receive the vaccine doses.
“In my case, I am diabetic, so it is difficult for me to go to medical appointments and pick up the medicines they give me to take, as well as more people. In the case of my dad, he is also a patient who suffers from kidney failure. They suspended his medical appointments,» said Angélica.
«There is a political background»
Continuously, the Government announced vaccination campaigns in El Salvador inviting Salvadorans to get vaccinated, but infectologist Jorge Panameño warned that the management in general has been with a political propaganda background, which exceeds all health criteria.
“Now, there are aspects that should be highlighted; for example, the fact of vaccination because there was a vaccine in this country before in others, that must definitely be recognized”, he said.
In addition, he explained that vaccination in El Salvador has also had an impact on mortality in recent waves, among other factors.
“Regarding the vaccination strategy, we (the Medical College of El Salvador) never agreed with the way it was carried out; different strategies should have been planned from the beginning so that the vaccine would have been taken to the community. ”, he added.
The expert affirmed that El Salvador has more than 50 years of experience in vaccination and faces diseases that have been a real problem, such as poliomyelitis, measles, whooping cough, tetanus, all controlled, not eradicated but controlled.
“For decades work has been done and the experience was there available and was ignored. The scientific and academic aspect of the pandemic was ignored and replaced by political propaganda criteria. Today we have the fact that, for example, the vaccination center in El Salvador is closed, which was never necessary. It closes due to lack of demand; the population is no longer demanding a vaccine,» he stressed.
On the other hand, Panamanian warned that due to the lack of demand, «the vaccines that are being used are about to become obsolete because new vaccines and new vaccination strategies are coming.»
In this sense, he said that he is going to start vaccinating with a product that is the equivalent and has the presence of antigens. but today he should bring a second component against the Omicron variant, which is what he is going to start doing in the whole world.
“We have not been taught what is being thought, what is the strategy. This is organized beforehand because you have to place orders, go find where there are offers, you don’t wait until January has arrived and I’m going to start because when this is accomplished, several months will have passed and time here is extremely important”, he pointed.
Other outputs
The government reported that it acquired 4 million tablets of the antiviral drug molnupiravir last February to be used in the recovery treatment of patients infected with covid-19.
This strategy includes an investment of approximately $12 million between the medicine and the logistics for the delivery of this medicine, which will be brought to the door of the house of the positive patients.
The antiviral tablets are sent, according to official information, to patients confirmed by means of PCR (Polymerase Chain Reaction) or antigen laboratory tests.
According to the Minister of Health, patients are sent two kits: one in blue with the treatment for patients with suspected disease and another in light blue that contains treatment for five days with molnupiravir, for positive people. to covid-19.
“There is international scientific evidence that molnupiravir reduces patient admissions to hospitals by up to 50%,” Alabi reported.
Current situation of vaccination in El Salvador
According to data from the Ministry of Health, posted on the page set up by the Government, until November 24, a total of 11,289,175 Salvadorans have been vaccinated against the virus; of these, 4,634,978 have a dose; 4,329,694, with two doses; 1,847,442 with three doses; and only 438,382 Salvadorans have chosen to apply four doses of the vaccines against the virus.
More than 38,000 foreigners have had access to the vaccine, of these. 918 have applied for the fourth dose of the biological.
According to the Health authorities, 4,230 people have died from the disease in the country and there are 201,785 confirmed cases at an average rate of 300 daily cases at present.
“We have come from having 10 to 20 positive cases on a daily average, and now we are registering between 150 and 300 patients for covid-19. We are facing a situation in which there will be a greater number of patients, who are going to require some hospital management,» declared the Minister of Health, Francisco Alabí, in a television interview.
new variants
The official pointed out that the country presents new variants of the SARS-CoV-2 coronavirus, which causes covid-19, which could be BQ1 or BQ1.1, subvariants of Omicrón, with the highest incidence internationally, and it is likely that they are the origin of the virus. rise in infections
The latest report released by the health entity indicated that between October 30 and November 5, El Salvador registered 411 new infections of covid-19. However, since last November 10, the statistics have not been updated.
Regarding the query if this is a sixth wave of the virus in the country, Alabí replied that «what we are observing at the moment is an increase in cases that has been the expression of the arrival of a new variant or subvariant in this case to the territory ”.
He warned that these new variants have a greater ease of transmission compared to Delta or Alpha variants. “They even talk about 30% more transmission than previously known variants. Omicron could have a greater possibility of transmission than measles,» he said.
For Jorge Panamanian, one of the most representative voices on the covid issue, El Salvador is going through the beginning of a sixth wave of the virus.
“In my opinion, we are at the beginning of the sixth wave, and in the coming weeks this will become clear; but at this time there should already be free sales of tests as in other countries. The isolation period must be a minimum of seven days, studies have shown that Omicron will stop being contagious between the seventh day of the onset of the disease and even on the seventh day with 19 percent there is a possibility that one is still spreading the virus”, he expanded
But there are other problems, said Panamanian, who affirms that parallel to the increase in covid cases, there is a phenomenon that has been taking place for almost two months, associated with the Respiratory Syncytial Virus (RSV).
“We have an emergence of a virus called respiratory syncytial, it is a virus that mainly attacks children and causes an attack in a very particular structure of the lungs, called bronchioles and produces a disease called bronchiolitis, whose main manifestation is which increases the secretion of mucus and can flood the lungs of children, frequently carrying a secretion and causing an inflammatory reaction that requires intubating and ventilating children and has a very high mortality in neonates”, he stated.
Virus combination?
In the same way, Emilio Salazar, an intensive care surgeon, said that El Salvador could be facing a triple Mia due to the rise in cases of covid-19, RSV and influenza because in some people up to two of the three viruses are being combined.
“There is an underreporting of covid-19 cases and let’s remember tripledemia, we are not only fighting covid-19, but there may be cases of influenza, with acute respiratory infections, it may have respiratory syncytial or even a combination of both. There has been an increase in cases of influenza, there has even been a couple of patients who combined influenza with covid-19, who have infection with both viral agents, both pathogens,» he declared.
In this regard, Alabí ruled out both phenomena, but he did acknowledge the rise in cases of respiratory diseases and SARS-CoV-2, but downplayed the importance, arguing that covid is already an endemic disease, like the Spanish flu.
“Frankly, we are seeing an increase in cases, obviously a respiratory disease like Covid will continue to be, because it is already an endemic disease, like influenza, which always has increases and decreases. The previous pandemic was the Spanish flu, and the Spanish flu is now the flu,” he explained.
The Ministry of Health registers this year 1,132,179 cases of acute respiratory infections; 0.6% more than in 2019 and 20,446 cases of pneumonia; 38.7% less than in 2019.
In his latest statements, Alabi indicated that the El Salvador Hospital has 94 admitted patients, some in serious condition, due to covid-19.
He also assured that in the private health system some institutions have the conditions to care for patients with the disease. but due to the reduction in infections that occurred this year, many have disabled the service.
monkeypox
Almost seven months after the first monkeypox infections in the world became known, El Salvador has reported 21 confirmed cases, Health Minister Francisco Alabi said in a television interview.
The first reported case was a 28-year-old woman who had contact with people from the United States.
“On the issue of monkeypox, we already have 21 confirmed cases to date. At the international level, there are close to 80,000 cases,” said Alabí, who added that 18 contacts have been vaccinated and are being monitored.
In addition, the official indicated that cases were being reported «scarcely.» “Monkeypox cases continue to rise at a fairly slow rate,” he said.
Of these 21 cases, the head of Health reported that one case was female and the rest were male, between the ages of 30 and 50. adding that this is a new disease that has not had rapid growth, but has the potential for complications. that “can lead to death”.
El Salvador prepares
The minister said that the health system is prepared to deal with the new virus. «It is a disease for which the health system of El Salvador has the necessary tools to be able to take care of your health, we already have the vaccines,» he added.
El Salvador received the first batch of 1,400 doses of the monkeypox vaccine on October 24. The Government reported that the biological cannot be used in people under 18 years of age, in pregnant women and in immunocompromised patients.
The vaccines will be applied to the health personnel who manage or analyze the tests, the teams that have contact with the positive patients or the links in the confirmed cases.
“In this case, it is not like the covid-19 vaccine that was applied massively, why? Because if it does not have a medical indication, it is not necessary to apply it to a disease that has a rather slow growth rate and is due to its very particular characteristics, unlike other diseases that monkeypox has had”, explained the Minister of Health.
Is El Salvador prepared for a new pandemic?
The Health system of El Salvador is prepared for a new wave of Covid-19 or a new pandemic, according to the words of Minister Alabi
“Yes, they have (the capabilities). It is very important to see how, through the capacities that the health system was trained in the pandemic; specifically the national reference laboratory, which not only has the capacity to run polymerase chains in real time for covid 19, but also It incorporated the power to have a molecular biology laboratory in the eastern, western, and central areas,» said the public official.
In this sense, he affirmed that now the tests can be run much more easily because previously respiratory panels were carried out to be able to detect influences and what type of influenza.
With this technology, Alabi said that «not all covid-19 patients are going to have a respiratory panel that rules out almost seven viruses, it is like doing a similar number of covid-19 tests in parallel, so it is very important to take this into consideration because it is reserved for the epidemiological analysis of what is circulating in the territory, but it can also become important to use in those people who have very important risk factors and who are in severe symptoms”, he said.
Regarding the tests, the official pointed out that «there are enough tests, there is always a stock of everything for possible increases and the standard is being made based on the requirement.»
divided opinions
The Salvadoran Government explained that there is availability of hospital beds, hospital supplies, medicines; in addition, there are enough doses of vaccines to immunize 100% of the population.
However, this has been questioned by the Panamanian on several occasions, first because it ensures that the vaccines acquired in 2021 are no longer entirely useful for immunization, because they do not contemplate a response to the different mutations of the virus.
Also because it considers that government elections have a propaganda electoral approach and the decisions are not based on the scientific and academic experience that exists.
