Vaccination Commission: There is no technical support to eliminate compulsory vaccination against covid-19

“Based on the information available, it is not possible to recommend, from a technical point of view, to eliminate the mandatory vaccination.”

With this forcefulness, the National Commission for Vaccination and Epidemiology (CNVE) responded to the request of the Minister of Health, Joselyn Chacón, to give the technical and scientific criteria of why inoculation against covid-19 should be maintained for public employees and workers of health.

“All the measures taken by the country’s health authorities, including the CNVE in its sphere of competence, pursue a collective protective effect that far transcends the individual right to refuse to follow them,” they assured.

“The mandatory vaccination of the adult population is not a merely scientific criterion, it is also a strategy that contributes to increasing the coverage of vaccines in the population in groups of workers identified as at risk and those who provide public services, in order to to protect the health and safety of the entire population,” the document added.

The Commission is the technical entity in charge of giving the guidelines on the application of all the vaccines against the different diseases in Costa Rica. The minister asked to review the issue of vaccination in public officials first in a meeting on May 10 and later requested technical and scientific support in a letter on May 16.

“During the last extraordinary session of the CNVE, held on Tuesday, May 10, your esteemed person requested the reconsideration of the mandatory vaccination against covid-19 in public officials, arguing that this measure can generate more confidence in the population and would allow to increase the vaccination coverage, however, it did not present any support for this affirmation”, adds the answer.

The CNVE even proceeded to seek information on the scope of vaccination in Costa Rica to determine if it was possible to lift the obligation, but found no reason.

The response of this organ, of which The nation It has a copy and can be seen at this link, It was sent on May 19, three days after the formal request made by the hierarch. The document includes copies of the agreements that were made to establish the obligation with their respective foundations. In addition, it contains data proving that the measure led to an increase in people who came to protect themselves against the pandemic disease.

The drug has shown decrease hospitalizations and deaths in case of infection.

At this time, inoculation against covid-19 is mandatory for children and adolescents between 5 and 17 years old, health workers and public officials. Private companies can extensively demand it from their workers. For the other population groups, inoculation has always been voluntary and remains so.

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The inoculation was done Mandatory on state employees on September 28 and in minors on November 5. Last February, the third dose was also made mandatory in both populations.

Chacón, together with President Rodrigo Chaves, announced on May 8 the elimination of the compulsory nature of the vaccine and said they had signed a decree to that effect. The contrary reaction and the observation that such a measure could only be taken by the Commission coincided with the fact that the decree was not made public. Three days later, a regulation was released that only urged employers not to fire employees who did not get vaccinated.

In the request to the CNVE, the minister also argued that the obligation did not encourage people to go for third doses. However, the Commission does not share the view.

“In the course of executing the vaccination against covid-19 in the last 15 months, it was possible to observe that by announcing the compulsory nature of vaccination, the rate of vaccination was accelerated,” adds the document sent by the CNVE to the ministerial office.

Until now, it has not been possible to discuss this issue with Minister Chacón. The nation He had scheduled an interview with the hierarch and with the secretary of the CNVE, Roberto Arroba, for Friday, May 20, but it was canceled without a new date being given.

Justification for mandatory in health workers

The Commission’s response explains that the mandatory nature of health workers, both public and private, which was taken on February 16, 2021is based on the following points:

  • Which is personnel who directly or indirectly care for covid-19 patients or people at high risk to become seriously ill and die from it.
  • They have an occupational risk of getting sick with covid-19.
  • They subject the people who are going to attend to a risk of getting sick with covid-19.
  • By vaccinating the entire population of these institutions that do not have contraindications for vaccination, it is influencing the prompt reactivation of health services in general, reducing the costs inherent in the same situation.
  • By vaccinating health personnel, hospitals and health institutions are prevented from being a source of contagion for society.

Justification for public officials

mandatory for public officials, whose decision was made on September 23, 2021is based, according to the document, on the following points:

  • The number of registered cases of covi-19.
  • The increased circulation of the delta variant (at that time) in the national territory, which, being more contagious, spreads more quickly.
  • The high hospital occupation that is faced, impacted to a greater extent by patients who are not vaccinated.
  • The fact that at the time there was no approved vaccination for children under 12 years of age (and currently there is not for children under 5).
  • The fact that covid-19 became the leading cause of death in our country.
  • The need to continue opening the economy without collapsing the hospital system.
  • The need for workplaces to be safer spaces and work functions do not have to be interrupted by people who get sick and get complicated.
  • The worrying slowdown of first doses that was in those weeks.
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Analysis of the current situation

As these decisions were made months ago, the CNVE reviewed in light of the situation in May 2022 whether it is appropriate to continue with mandatory vaccination in the established groups.

“We are in a clear trend of increasing cases in three consecutive weeks. (…) Given the epidemiological risk of a fifth pandemic wave, which can be increased by not wearing masks and since the country maintains community transmission of the virus, it is essential that public officials have the maximum possible vaccination protection, to guarantee the continuity of services for the population. A large number of officials on sick leave due to disability or isolation can compromise critical public services,” the statement highlights.

The CNVE also indicated that there is a risk of a new saturation of hospital services. In the document, the specialists point out that there are concerns from the Directorate of Health Services of the Costa Rican Social Security Fund (CCSS) about what could happen in care services if the obligation were eliminated, especially in communities that are reluctant to inoculation.

Compulsory increased vaccination

The document records that when the compulsory vaccination decree was published in October, the rate of inoculation increased by 26.5% in the first week and continued to increase in the following weeks.

In addition, to combat resistance to vaccination, one of the recommendations of MDJ Peters, a public health specialist who has studied resistance to vaccination, does speak of mandatory strategy.

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“Mandatory vaccination or implementation of sanctions in non-vaccinated. If the mandatory covid-19 vaccine is established, it must be available and accessible. The CNVE highlighted that access to vaccination has been guaranteed in Costa Rica and recalled that it is not mandatory for the general population, only for the aforementioned groups.

The Commission also clarified that it is not within its regular jurisdiction over dismissals or labor sanctions for employees, both public and private, who reject the vaccine.

The Commission and its criteria

The CNVE is a technical group made up of eight specialists in Immunology, Infectious Diseases and Paediatrics. There are also health specialists, epidemiologists and health economists. Since 2001, they decide which vaccine is given, to whom, and when.

The Commission is in charge of reviewing and updating the official basic schedule and the special immunization schedules, based on the epidemiological reality and scientific-technical information. By law, it is also obliged, together with the Caja and the Ministry of Health, to identify the population groups that should be vaccinated; decide whether vaccination is mandatory or optional and have the conditions in which the doses must be given, so it is the only body in charge of making decisions on the mandatory nature of one or another vaccine and in what circumstances it is given.

This body is headed by the current minister Chacón, replacing Daniel Salas Peraza, former head of Health. It is attached to the Ministry of Health, but it is a decentralized body with instrumental legal personality, which means that it has independence in making its technical decisions.

None of its members receive commission or per diem. Their job, per the 2001 Vaccination Act, is to honor

In terms of vaccination against covid-19, they have had to define which products were going to be used, stratify the prioritization groups, define the distance with which the doses would be applied according to availability and epidemiological moment, include this drug in the basic vaccination scheme and determine in which cases it would be mandatory.

The Minister of Health heads the Commission, which is also made up of:

  • Roberto Arroba Tijerino, secretary and coordinator of the Commission, and the most visible face of this group.
  • Sandra Delgado Jimenez, Head of the Health Surveillance Unit of the Ministry of Health.
  • Oscar Porras Madrigal specialist in Immunology and representative of the Costa Rican Association of Pediatrics.
  • Dora Matus Obregon, Pediatrician specializing in Clinical Immunology.
  • Hugo Marin Piva chief physician of the Pharmacoeconomics Area, of the Pharmacoepidemiology Directorate of the Costa Rican Social Security Fund (CCSS).
  • Leandra Abarca Gomez, medical coordinator of the Expanded Program of Immunizations, of the sub-area of ​​Epidemiological Surveillance of the Fund.
  • Juan Villalobos Vindas, infectologist at Hospital México.

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