So, what is the vaccination plan and how is it going in Portugal?
If you have already received a vaccination shot- or better yet, two – congratulations!! The rest of us are hoping to do the same as soon as possible. It will be a relief to start reversing the mental, physical, and economic damage this scourge has wreaked on the world. The staggering number of people lost to this disease is heartbreaking beyond comprehension and my heart goes out to anyone who has suffered such a terrible loss. For the rest of us, quarantines, lockdowns, closed businesses and schools, and restrictions on movement are no fun and pale in comparison to the loss of a loved one, but they are burdens we all must shoulder in order to help each other beat this thing. Sigh…it feels as if no one has been left unscathed in some way or another. It’s kind of funny that the “vilified” pharmaceutical companies everyone likes to criticize are going to be the ones who will ultimately get us out of this awful situation.
As I’ve mentioned in the past, Portugal was lauded last year for taking quick and decisive action to contain the virus early on and had been doing a great job – up until December. That’s when restrictions were lifted allowing people to gather and travel around, as well as in and out, of the country to see their families for the holidays. Tragically, we paid a heavy price for that. Infections, hospitalizations and deaths skyrocketed.
The spike in cases was compounded by the high transmissibility of the more contagious UK variant due to the return of Portuguese immigrants for Christmas and tourists from the United Kingdom. The UK variant represented just 8% of infections in early January, jumped to nearly 25% of all cases by the third week of that month, and now represents 48% of all cases.
In an attempt to address the situation, the government ordered another severe lockdown just after the new year began. The good news is that compliance with that decision has had a positive impact on getting the numbers to drop quickly. I’ve pasted a screen shot below of a dashboard the Direção-Geral da Saúde (Directorate-General of Health or DGS) provides. It summarizes key stats as of Thursday, February 25. Click here to access the dashboard directly and see the most up-to-date information.
Here’s a close up of one of the charts above which shows how effective the lockdown has been. What is particularly interesting is that you can see how the numbers began to shoot up as the weather cooled and everyone started to prep, plan, and move about for the holidays as well as how it has precipitously dropped after the lockdown was ordered.
Due to the way the government is organized here, the president of the country can only request restrictions on the population in two-week increments. It was announced yesterday that the current lockdown will be extended another two weeks, until March 16, when further analysis will inform if it is to be lifted or extended. Since March 18 of last year the president has ordered 12 lockdowns. (I just realized that that is 24 weeks of lockdown since arriving in Portugal. Yikes!)
Portugal created and published a vaccination plan last year. Through the EU, the Portuguese government has purchased at total of 22 million vaccine doses from six manufacturers (Pfizer-BioNTech, Moderna, Janssen (J&J), AstraZeneca, Sanofi/GSK and CureVac); enough to inoculate the entire population of roughly 10 million people. The plan, which was put into action when the first Pfizer-BioNTech vaccines arrived in late December, is summarized below and outlines how vaccines will be administered and in what order. The vaccines are free and not mandatory, but health officials strongly recommend vaccination as a means of controlling the pandemic.
- Started on December 27, 2020 and includes:
- Health professionals involved in patient care
- Professionals in the armed forces, security forces and critical services
- Professionals and residents in Residential Structures for the Elderly (ERPI) and similar institutions
- Professionals and users of the National Integrated Continuing Care Network (RNCCI)
- To start April 1, but may need to be adjusted due to vaccine delivery delays. This phase includes:
- Persons aged 65 years and over (who have not been previously vaccinated)
- People between 50 and 64 years of age with at least one of the following pathologies:
– Active malignant neoplasm
– Chronic kidney disease (Glomerular Filtration Rate> 60ml / min)
– Liver failure
– Arterial hypertension
– Other pathologies with less prevalence that may be defined later, depending on scientific knowledge
Phase 3 will begin after the completion of Phase 2. This phase includes the rest of the eligible population, including foreign residents. The vaccine will be available to anyone present in Portugal, as long as the vaccine is clinically indicated for that person.
It is anticipated vaccinations will take place throughout 2021. Because Portugal has a centralized health system called the Serviço Nacional de Saude (SNS), anyone who is registered with the SNS will be proactively contacted when it is time to receive a vaccine (Won and I both are in the system even though we have private health insurance – this was a conscious decision we made last year). This means there is no stress associated with trying to schedule (or reschedule) an appointment. It is not possible to request an appointment. There is a site to help people understand which phase they will be in. If someone is not in the SNS (i.e. they only rely on the private healthcare system), they have to contact their doctor who will help coordinate a vaccination depending on their specific needs.
Vaccinations of individuals in Phase 1 will take place at more than 1200 SNS locations throughout the country. Residents in nursing homes and those hospitalized in long-term care units will be vaccinated in those locations by the nursing teams caring for them or by teams from the health centers. Sometime in April, when vaccine supplies are, hopefully, less problematic, pharmacies will also be used as vaccination sites. There are 2,924 pharmacies in the country so this should speed up the vaccination rate.
Documentation and Tracking
Because Portugal has a centralized health system, there is an easily accessible vaccine registration program which has been modified to record the details of each COVID-19 inoculation and ensure that whomever gets the first dose also receives the second.
The inoculation record will be made directly in the Vaccines system, which will automatically show the vaccine:
- in the user’s vaccination schedule
- on the VACINAS Platform (accessible to healthcare professionals)
- on the MySNS Wallet App (vaccine bulletin)
- in the Citizens Area of the SNS Portal
(I love how information here is so integrated and digitized!)
Due to the novelty of the vaccine, a clinical follow-up will take place and will include effectiveness studies. In terms of logistics, there is a command and control model of coordination and execution of the entire operation overseen by the Ministry of Health and supported by the Armed Forces and other security forces.
A communication plan was developed early on to generate confidence in the population. The Ministry of Health also created a website to provide relevant information and telephone numbers to support the general population and healthcare professionals.
With only 2.5 million doses received of the 4.4 million promised before the end of March, security forces (police and military) and firefighters have been removed from the Phase 1 priority list. The plan is to use 90% of available vaccines on two groups: those over the age of 80 and people between the ages of 50 and 79 with diseases most susceptible to COVID-19: particularly heart disease, kidney disease and COPD (chronic obstructive pulmonary disease). Security forces and firefighters will go back on the list as soon as more vaccines are received.
In the EU, vaccines, which are negotiated for and acquired by the bloc on behalf of its 27 member states, are sent ‘simultaneously’ with the distribution being proportionate to the number of inhabitants in each country.
If you scroll back up to the full DGS chart above, you will see that as of yesterday, Portugal has administered 752,317 vaccines with 497,040 receiving their first dose and 255,277 receiving their second. The original goal was to vaccinate 150,000 people per day, but that objective has been impacted by limited vaccine supply. I learned recently that Portugal is expecting to receive the J&J single-dose vaccine sometime in the 2nd quarter of this year once the European Medicines Agency issues an opinion on its efficacy and safety, which is great news.
Even with the limitations on vaccine availability, Portugal is the 6th European country with most vaccines completed and 22nd worldwide as of this week. Additionally, Portugal is planning to increase its testing protocol by offering tests to all contacts of people who have tested positive, not simply those deemed to be most likely to have been exposed to risk. Portugal remains the 7th country in Europe with the most tests conducted per million inhabitants.
For those of you who had asked me how the vaccination process was going in Portugal, you’ve got the most up-to-date information I could gather. I hope you found it interesting. Based on everything we know right now, Won will most likely be vaccinated in Phase 2 (because he has been diagnosed with hypertension) and I’ll be in Phase 3.
In other happy news, because the infection rate is dropping, on Tuesday evening of this week, the municipality of Cascais (our municipality) opened up the beaches and the paredão (seawall) that runs along the waterfront. Previously we were only allowed to be outside within 500 meters of our residence; the beaches and waterfront walkways were all closed. (You could also be out if you were going to work, which required having papers from your employer to prove you were allowed to be on the road, get food, go to the doctor or dentist, and get medicine or fuel. If you were caught being out when you weren’t allowed to be you could be fined a minimum of 200€, which must paid on the spot. The police carry handheld machines that can charge your multi-banco card and if you don’t have your card on you, they’ll drive you to the bank. They aren’t kidding around.)
We didn’t waste any time and were at the beach the next day. It was great fun to be able to frolic with Sweet Pea on what little bit of sand was still available with the tide so high. The ocean was very active that day. A portion of the seawall that protrudes into the water you will see in the video below is typically dry with people jumping off the end. It will give you an idea of how active the waves were.
Starting tomorrow, the weather is expected to be warm and sunny for the next week. You can bet we’ll be back at the beach as much as possible!!
As always, please stay safe, stay healthy, and stay in touch.
From Portugal with love,