Mexico’s challenges for vaccinating
Health workers conduct quick COVID-19 screening tests outside a metro station in Mexico City on December 4, 2020 (Photo: ALFREDO ESTRELLA / AFP)

Expectations are growing for the arrival of the Covid-19 vaccine in Mexico. This is the only real option available to overcome the pandemic, but there are many challenges facing the country in acquiring, storing, and guaranteeing universal access to it.

Tec Review consulted epidemiologists who explained the challenges that federal authorities will have to overcome in order to access the vaccine in order to control the virus that, according to official figures, has already claimed the lives of more than 108,000 people in the country.

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The agreement with Pfizer

On December 2nd, Health Secretary Jorge Alcocer signed a Covid-19 vaccine manufacturing and supply agreement with the pharmaceutical company Pfizer. This ensures that Mexico will acquire 34.4 million vaccines.

The first 250,000 doses will arrive in December. Health personnel will be given priority and begin to get immunized.

Although the news gave a breath of hope, there are still several problems.

“We have three main challenges. The first is the budget, having enough money to buy the necessary vaccines. The second is infrastructure, having everything we need to get the vaccine distributed everywhere (…) and the third is people accepting getting vaccinated because you already hear a lot of people saying, ‘I’m not going to get it’ before we even have the vaccine,” said Rodrigo Romero Feregrino, President of the Mexican Vaccination Association.

The expert explained in an interview that although there’s been speculation about the cost to the government of each vaccine dose, a significant amount of resources will need to be added to ensure its distribution, application, and storage.

For example, the UNAM has already called up students and academics in Medicine, Nursing, and Dentistry to join vaccination teams on university campuses, with a view to participating in the National Vaccination Campaign announced on December 8.

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The cold chain network

Mexico has a cold network for vaccine storage, although it has some deficiencies. So far, the infrastructure has worked and operated properly.

However, this network won’t be useful for storing the Covid-19 vaccine developed by the pharmaceutical company Pfizer specifically because it needs to be frozen at an ultra-cold temperature of -70 degrees Celsius in order to preserve it.

“mRNA-based vaccines incorporate a less harmful protein and need greater cooling conditions than do vaccines with viral vectors (those with a live attenuated virus) with easier storage conditions,” said Francisco Oliva Sánchez, epidemiologist and professor at UAM Xochimilco.

“We need to adapt the cooling systems in the cold chain network. We have people with experience in the operational management of vaccines, so we would only need to redesign it to the needs of this vaccine,” he added.

To dispel any doubts and because this deals with a global concern that no nation has the infrastructure for storing the vaccine, the Undersecretary for Multilateral Affairs, Martha Delgado, stated that the agreement signed with Pfizer provides for the pharmaceutical company to deliver the vaccine to points of vaccination identified by the Mexican authorities.

“We have Pfizer’s commitment to deliver this vaccine, which needs to be transported at an ultra-cold temperature of -70 degrees, to points of vaccination,” she explained in a television interview on December 3.

“The Mexican government will accompany the import and transfer (of the vaccine) to these points, but it’s very good news that it’ll be the company’s responsibility to transport it and handle the cold chain to the points of vaccination.”

As the official states, once the vaccine reaches the points identified by the Department of Health, the management of the vaccine is very similar to that of other vaccines, so it can last up to five days in refrigeration of 2 to 8 degrees Celsius, and up to 20 days with dry ice.

While it’s true that once it’s delivered to the points of vaccination, the Mexican authorities will need to find alternatives to store the vaccine. Delgado stressed that the goal is not to store it but to administer it as quickly as possible.

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Trial by ordeal

The fact that vaccines are in Phase 3 and pharmaceutical companies have started offering batches in advance to governments doesn’t mean the battle has been won, as the real test is yet to come: their application en masse.

According to experts, in addition to ensuring the resources and vaccine storage, the country will also need to carry out a very timely pharmacological monitoring process.

According to the Department of Foreign Affairs (SRE), in addition to the agreement signed with the pharmaceutical company Pfizer for the acquisition of 34.4 million vaccines, the Mexican government has three additional alternatives to buy vaccines.

The first is the Covid-19 vaccine access mechanism called Covax, run by the World Health Organization (WHO), through which 51.5 million doses will be purchased.

In addition, 77.4 million doses will be purchased from the company AstraZeneca and 35 million additional doses from CanSino Biologics.

All this for a total value of just over 35 billion pesos. “Supposing the Pfizer vaccine is first and supposing it has adverse side effects, that would be, say, a Phase 4 clinical trial since the results may change in controlled environments. This is why I think the government’s strategy of having multiple contracts is appropriate in order to prevent that situation,” Oliva Sánchez said.

“It’s not about the government or pharmaceutical companies experimenting on people. It’s about finding out which of these vaccines will be most effective when they’re out in the population, and that can only be seen by putting them out there,” the academic emphasized.

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The challenges in Mexico

However, once a vaccine reaches Mexico, such as Pfizer’s, in addition to requiring transporting it at a temperature below -70 degrees Celsius, Mexico will have to solve three additional challenges at the moment of vaccination.

The first, as already stated by the Undersecretary of Health, Hugo López Gatell, will be having the human resources to not only distribute vaccines to the population but also administer them. So, the real option on the table is to have the Army, with the capacity that it has, vaccinate the population.

There will also be primary health care technicians, who have been taking vaccines to people’s homes for 40 years, to administer children’s vaccination programs across the whole country.

This is not to mention the efforts that universities and private organizations could provide, such as support from the UNAM community, as mentioned above.

Once the vaccine is at the points of vaccination, Francisco Oliva Sánchez, epidemiologist and professor at UAM Xochimilco, says that atypical vaccination campaigns should be promoted in a way that not only prioritizes the immunization of the most vulnerable sectors -health personnel, older adults, and people with comorbidities- but that also prevents chaos or large movements of people.

This should take into account the characteristics of Covid and how easily it spreads in very crowded places.

“Atypical vaccination strategies will need to be pushed so that people don’t congregate. By atypical, I mean that there should be a distribution that prioritizes needs.

“There should be governance in health. The government can’t impose this. There must be participation of the populace, and what we need are information campaigns to debunk misinformation on the negative effects of getting vaccinated,” the expert stressed.

And the last challenge -which would go hand in hand with the pharmacological monitoring of adverse effects vaccines might have- is to get the message out to the population of the need to get vaccinated and the need to get two doses.

The Pfizer and AstraZeneca vaccines and the Covax mechanism, at least, need two doses to be effective.

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Patience is the key

“We have to reduce skepticism a little bit and be patient because the fact that we have a vaccine today does not mean that Covid-19 will be over tomorrow. We have to go through this whole process and reach mass coverage to see a decrease in cases,” warns Rodrigo Romero Feregrino, President of the Mexican Vaccination Association.

According to the Association, he says, one of the biggest challenges that exists is the acceptance of the vaccine by the populace.

In recent years, immunization levels among the populace have dropped due to misinformation, and this trend must be reversed if the goal is to overcome the pandemic.

“For us at the Mexican Vaccination Association, one of the biggest challenges we are seeing -and that we have seen in recent years- is that the acceptance of vaccines has decreased, and it’ll be a very important challenge to get people to have confidence in this vaccine as well and to feel safe when getting it.

“We believe there needs to be transparency. All the decisions around the application of the vaccine and the information that is given out needs to be based on scientific evidence so that people will realize when they see this information that it isn’t something made up but that it’s scientifically proven,” he said.

So, health authorities need to begin a very strong information and communication campaign now to provide certainty to the population.

“Vaccination is beneficial. The only diseases that have historically been eradicated in Mexico, such as polio, have been eradicated through vaccination, and that’s what we should talk about here,” affirmed Francisco Oliva Sánchez, academic and doctor of epidemiology at UAM Xochimilco.