The pandemic hits nursing homes again. Again the positives increase again week by week. Again the isolations, the anguish to stop the infections, stressed templates after the casualties of infected colleagues. Again living with risk. Since the beginning of the epidemic, about 30,000 older people who lived in these centers have died, they are the population most vulnerable to the virus. Vaccines have radically changed the scenario compared to past waves, they have managed to drastically drop mortality.
The reception has been majority, but a small percentage of workers refuse to be punctured. For this reason, a debate begins to make its way in the sector. Should vaccination be an essential requirement to be able to work in these centers? The four large residency employers ask for it and other countries, such as France and Italy, have already approved it.
There is no national figure of how many employees have rejected the vaccine, the Ministry of Health does not have data. Not even all communities have that figure. The panorama is very changing depending on the autonomy, some report on all social health centers (not only for the elderly, also for disability, etc.), others, such as Castilla y León, do not register the number.
In regions such as La Rioja or Madrid they say they are a minority, but they do not specify how much. In Murcia and Catalonia, 5.8% and 7.8% of workers, respectively, do not have the first dose. In Valencia, the figure for those not vaccinated is 4.7%. In Andalusia, 2.7%. Neither in Galicia nor in Extremadura do they reach 1%.
The highest percentage is registered in Aragon, where 10.4% of nursing home employees have rejected the puncture, which is equivalent to about 1,300 people. This is a figure for April that the Government is updating and sources from the Department of Citizenship assure that it has decreased.
Sara gives a fictitious name. He is 36 years old and has been working for two in a residence in Guadalajara. From December to February they dealt with an outbreak in the center. When they offered him the vaccine, he rejected it: “I didn’t trust anything. They put us first, like guinea pigs ”. He says that, “although it sounds bad,” his fear outweighed his concern about the risk it could pose to the elderly.
“You have to look out for yourself, if I’m not well, I can’t work. First I thought about my body and then I thought about my future. I ended up putting it on because if I want to work on this they will end up demanding it from me, “he continues. Right now she is infected, although she is well and has not spread the virus to anyone in the residence.
She assures that they pressured her “a lot” in the center. The same tells Fatima, who works in Catalonia and has not been vaccinated either: “They ask you from the management, from occupational risk prevention …”. This 27-year-old is pregnant with her second child and, until she gives birth, does not want to put it on. “At the beginning, half of the workers were reluctant, now only I am left.”
There are three vectors of contagion in residences: visitors, exits and employees. There is no data to know how many of the outbreaks are caused by the latter or how many by unvaccinated workers. What is clear is that in the last month the situation of the centers has worsened again. From July 26 to August 1, 71 older people died after being infected,double that of the 36 of the previous week, according to data from the Imserso.
The positives have multiplied in the last month. Between July 26 and August 1, 1,150 new cases were recorded. However, the rate of increase in infections has slowed compared to previous weeks. And the fatality in the centers has fallen compared to previous waves (it is 6% between March 8 and August 1, compared to 20% between January 4 and August 1).
Experts disagree on the measure. In the current scenario, the rejections of these drugs “do not pose a public health problem”, say, bluntly, José Martínez Olmos and Alberto Infante, two experts in the field. Both emphasize that acceptance in Spain is very high. The first, a professor at the Andalusian School of Public Health, maintains that “in these centers practically 100% of the elderly are vaccinated, as well as the vast majority of the staff, and the vaccine does not guarantee that they do not become infected.”
“It would be convenient for everyone to get vaccinated, but I am not in favor of forcing, focusing on professionals would be wrong. The key is for everyone to have the necessary caution and adopt preventive measures ”, he says.
Jaime Jesús Pérez, a member of the board of directors of the Spanish Association of Vaccination, replies that, no matter how few, they pose a risk. “Someone vaccinated has less chance of becoming infected and, therefore, of transmitting the disease,” he says. “The residences are very special places, where we have prohibited visits for months, outings…
To protect a supreme good, his health, we have had to condition his life very hard. It does not seem to me to be professional, ethical, or morally acceptable. I think it should be a requirement in social and health institutions ”, he adds. “They are very few, but would we accept that one in 100 surgeons does not wash their hands, no matter how few they are?”
The four large residential employers agree that vaccinations should be mandatory. Jesús Cubero, general secretary of the Association of Dependency Services Companies, explains: “It is a question of healthcare ethics. The right of the weakest party to protect their health prevails ”. Juan Vela, president of the Lares Social Group, which groups together residences managed by non-profit organizations, considers that “only with the vaccine and prevention measures can we fight this disease: vaccine, masks, personal hygiene and distancing” .
The ministry is reluctant
The Ministry of Health has been reluctant since the beginning of the pandemic to impose vaccination of the population, but six communities are in favor of making it a requirementfor health workers and residences, such as Murcia or Andalusia. In Murcia, in fact, the autonomous government has identified outbreaks that have been started by unvaccinated workers. In Álava, where between 5% and 6% of the staff have rejected the puncture, the general deputy, Ramiro González, has asked his legal services if there is legal protection to make the vaccination mandatory.
Faced with the increase in infections, the autonomies have been imposing measures in these centers. In Aragon, for example, non-inoculated employees have to pay out of pocket for a test every three days. In Catalonia there are three screenings a week compared to just one for those who are inoculated. In Andalusia they have established a weekly test for those who have not accepted the puncture.
Towards a new model of residences: Government and communities agree to establish a system of evaluations that are made public
The department headed by Carolina Darias, concerned about the rise in infections, is considering adopting measures for the entire territory. The report on alerts from the Interterritorial Council of the National Health System, a technical body that brings together the ministry and the communities and advises on public health matters, is studying doing two weekly PCR or antigen tests on unvaccinated workers or transferring them to their jobs. are not in contact with the elderly.
Cinta Pascual, president of the Círculo Empresarial de Attention to People, another of the employers’ associations, believes that any preventive measure seems “totally necessary.” Ignacio Fernández, president of the Business Federation of the Unit, argues that “referring non-vaccinated farmers to activities without contact with the elderly is not a viable or sustainable activity.” His job is precisely to serve them on a day-to-day basis. Both affirm that vaccination is taken into account in new hires.
Mariví Nieto, a member of Marea de Residencias, which groups together family members, residents and workers, defends vaccination, but believes that it should be chosen to do pedagogy, that “to force would even be discriminatory.” On the Platform, which brings together associations from most of the autonomous regions, they do believe that it should be an essential requirement.
“There are residences with 30% unvaccinated workers, so there is no way to adopt organizational measures, and the outbreaks end with savage restrictions for the residents”,says María José Carcelén, from the 5 + 1 Coordinator, which is part of the Platform. Another member, Miguel Vázquez, president of Pladigmare, ditch: “There is talk of a collision of fundamental rights.
But what is the right of an employee whose job it is to take care of the health of the elderly in nursing homes? What gets ahead? It is a complex issue, but after everything that has happened, the obligation should not be questioned by anyone. That their right is respected, but then they cannot work in a residence ”.
José Manuel Ramírez, president of the Association of Directors and Managers of Social Services, regrets that “they continue to abandon residences .” “We must legally study the mandatory nature of the vaccine,” he claims. He defends that it is a requirement to work in these centers.
“But we also ask for periodic screening of all workers, not only those who are not vaccinated, and that the COVID certificate or at least an antigen test is required on visits.” “We also request an immunity study of the vaccinated elderly, we do not understand how Public Health has not launched it at the national level,” he explains.
In Spain vaccination is voluntary.Therefore, it cannot be imposed on the workers. The centers have no margin to demand it. Jesús Cruz Villalón, professor of Labor Law at the University of Seville, maintains: “It is a matter of public health and not of prevention of occupational hazards.
The government would have to make a legislative change to be able to demand it. Currently, you cannot fire someone for not having the vaccine, nor can it be published in a job advertisement, for example, because it would be considered discriminatory in a court ”.
A technical guide from a few years ago for the prevention of biological risks at work, which is not binding, specifies that vaccination is voluntary, but that non-acceptance in certain types of employment and for certain diseases may lead to the consideration of “no suitable”, based on the need for third party protection. Cruz Villalón points out that as of today there is no regulation that specifies which positions are unsuitable for those who are not immunized against covid.
There are communities that are beginning to make a move. The Balearic Government Council approved in May a decree to modify the Balearic Public Health Law that allows the option of “subjecting to prophylactic measures” for the prevention of coronavirus, including mandatory vaccination for groups that are not specified.
The Ministry of Health insists, however, that at the moment the possibility of immunizing health or social health workers is not being considered, but it has this open path. The professor of Constitutional Law at the Carlos III University Elviro Aranda believes that, since the autonomous communities are competent in social services, “they have to regulate how the service is provided and the conditions under which it is done.”
Alberto Infante, emeritus professor of International Health at the National School of Health in Madrid, states that “most likely the Government would appeal” the regional laws to the Constitutional Court, as has already happened in the case of Galicia.”They could request authorization from the courts, in specific cases, in a circumscribed and limited area, for reasons of public health, such as the curfew,” he adds.
He does not believe that we are in the scenario of the Government issuing a norm for the entire State, “what would have to happen to establish compulsory vaccination”, and points out that, if it happens, it is likely that it will end up resorting to the Constitutional Court. He does not agree with imposing the vaccine, but with convincing that it is the best protection tool, as well as non-pharmacological measures (such as limiting visits and doing them remotely and outdoors, daily tests on staff, etc.).