Chile’s Formula To Become The Leader In Vaccination In Latin America

“We have exceeded three million vaccinated in Chile. This should fill us with pride and we must thank primary care, mayors and the capacity of the State to carry out this feat.” With these words, the Chilean Health Minister, Enrique Paris, celebrated on Tuesday the good rhythm and operation of the vaccination program of the South American country.

According to data from the Department of Health Statistics and Information (DEIS), since the beginning of the campaign, at the end of December of last year, and until February 24, more than 3,123,000 doses have been administered. More than 20% of the target population (15.2 million) have received at least one of the two doses. Although only 55,500 people have received the double dose – 0.4% of the total -, the results achieved so far place Chile at the forefront of immunization in Latin American countries and among the most outstanding in the world.

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Statistics from Our World in Data from the University of Oxford place Chile as the fifth country with the most doses per 100 inhabitants, only behind Israel, the United Arab Emirates, the United Kingdom and the United States. Regarding the absolute number of doses applied, Chile occupies the eighth position in the world in a ranking led by the United States (65 million), China (40.5), United Kingdom (19.5), Israel (7.6 ), Brazil (7.3), United Arab Emirates (5.6) and Russia (3.9).

Although Chile has not stood out precisely for its good management of the pandemic (there are more than 20,000 deaths and 800,000 cases of COVID-19 infections), analysts and experts coincide in underlining, instead, the success of its vaccination process. The formula? A robust network of primary care, diversify providers and bet on the Chinese vaccine before those manufactured in the main laboratories in Europe and the United States.

“Chile is committed to a vaccine that is not the one chosen by most developed countries, which opt for traditional manufacturers,” says Cristóbal Cuadrado, an academic from the School of Public Health at the University of Chile. “Although initially this meant a greater risk because there was uncertainty about the efficacy of the Sinovac vaccine compared to other manufacturers, it has been a success that has allowed access to a greater number of vaccine doses,” he adds.

The Chinese remedy has reached Chile in large quantities also thanks to the clinical trials that were carried out through a collaboration with the Catholic University that strengthened Chile’s negotiating position and for which Sinovac promised early access to doses and better price. AstraZeneca, Johnson & Johnson and Chinese-Canadian CanSino also conducted phase 3 trials in the country.

“Some universities in the private world maintain networks with certain Chinese pharmaceutical companies and researchers linked to the development of the vaccine and that had an influence,” says Cuadrado. According to him, an early and early negotiation of the Sebastián Piñera government with different suppliers was decisive to guarantee supply. In May the authorities began to negotiate with different laboratories around the world, favored by an economic model open to foreign trade and the free market. The results came quickly: negotiators were able to close deals with four manufacturers: Pfizer-BioNTech, Sinovac, AstraZeneca and Johnson & Johnson. The first two are the current suppliers.

This week the second shipment of Sinovac, of almost four million doses, will arrive in the country. Pfizer’s sixth shipment was received on Wednesday, with another 189,150 more. Five million doses of Oxford / AstraZeneca are also expected to arrive in April or May and Janssen – which has committed another four million – is processing permits to become the fourth licensed vaccine in the country. The health authorities are also studying the possibility of buying eight million doses of Sputnik V from the Russians. According to what has transpired, if that contract is signed, the drugs would arrive in the second half of this year.

“Logistics has shown that some 200,000 people can be inoculated every day in Chile,” says Cristóbal Cuadrado. A figure that has been recorded for several days since February 3, when mass vaccination began, and behind which is the work of primary care teams throughout the territory, which reach even the most remote places. In the town of Laguna Blanca, for example, located in the extreme south, in the Magallanes Region, the entire target population (just over 200 people) has already been vaccinated with the first dose.

“The primary care network, which depends on the municipalities, has made it possible to offer equitable access to the population, not only in large cities, but also in more rural areas,” says Dr. Cuadrado. “It has workers from all over the country who have a long history and experience in vaccination campaigns,” he adds.

Chile has a tradition of more than 100 years in vaccination campaigns. The current National Immunization Program (PNI), which established the vaccination schedule, dates back to 1978. “We have had a very solid inoculation plan for many years and there is a culture of vaccinating,” says Dr. Claudia Cortés, vice president of the Chilean Society of Infectology. “Vaccination programs began to develop very early since smallpox started and the country’s public health system was structured based on vaccinations,” adds the academic. For the infectologist, vaccines “are one of the few – if not the only one – absolutely free, egalitarian and democratic act” of the Chilean health system, characterized by a strong inequality of access and coverage.

Despite the good results, a couple of controversies have marked the first weeks of the process. The first occurred when the Minister of Foreign Affairs, Andrés Allamand, denied the vaccine to foreigners who are in the country in an irregular situation. Amid the criticism, Allamand backed down.

The second took place when it emerged that 37,000 people had received the injection, although by age they do not belong to the risk groups prioritized by the Ministry of Health. Although it does not represent a violation of the regulations, the news drew criticism from the Medical College and a large part of the public. “No one was secretly vaccinated or there have been special lists [de personas vacunadas], but there were variations with respect to the technical recommendations of the Advisory Council on Vaccines and Immunization (CAVEI) and a group of ‘essential workers’ was incorporated under a qualification that is quite lax and that has generated noise “, explains Claudia Cortés. they point to the fact that young people or people who are teleworking have received the vaccine before people with chronic diseases.

Beyond the controversies, Chile could be the first emerging country in the world to achieve herd immunity against COVID-19. This is pointed out by a recent report by the New York investment bank JP Morgan. The process has attracted the attention of large investors who see possibilities in the country to reopen the economy and promote a stronger recovery. Piñera has been underlining this idea for weeks when he speaks publicly about the success of the vaccination process. An objective that, for the president, is essential to improve his image and overcome public approval that in recent months has sunk in the polls.

At the beginning of March, Chile will begin the second stage of mass immunization with the injection of the second dose, which will force to multiply the personnel to maintain the rate that has been achieved so far. In addition, the flu vaccination campaign will also begin in the middle of the month, which last year covered eight million people.

Dr. Cortés considers that one of the greatest pending challenges now involves “rescuing those over 60 who have not been vaccinated.” Although this group should have already received their first dose in its entirety, the figures show that it has not. “Some may not want to be vaccinated and we have to invest efforts in convincing them of it for their own good and that of the rest of the population,” adds the academic. It also stresses the importance of vaccinating chronically ill people as soon as possible and ensuring the arrival of supplies so as not to slow down the pace. “The main challenge is to ensure a sufficient stock of new vaccines because this is a complexity that exists at a global level,” agrees Dr. Cuadrado.

The Government set a goal to immunize 5.8 million people during the first quarter of 2021 and reach 80% of the target population, that is, about 15 million people, by the end of the first half of 2021.

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