Daniel Ocaña does not find it surprising that some people are sceptical about the coronavirus and are opposed to a vaccine: "That happens with every health alarm," he says. This doctor, a member of the Vaccine Advisory Committee of Andalucía and the Andalusian Society of Family and Community Medicine, says people should "listen to professionals, not social media" and warns that it is essential to prevent flu and pneumonia, illnesses which can complicate the cases of Covid-19 patients and for which vaccines already exist.
Up to 40 per cent of patients who are admitted to hospital with pneumonia die. Have we underestimated the risk?
I think people underestimate the risk of infectious illnesses in general, maybe because they affect older people above all. Pneumonia is the tenth most common cause of death, higher than many tumors, traffic accidents and other pathologies. It's as if they have trivialised it. If there were a vaccine for cancer, it would be unthinkable not to use it. And for pneumonia, there is a vaccine.
It's the primary cause of death in children. Why is that?
Mainly because of the figures in developing countries.
But in Spain it is also the primary cause of death in children. Why is the mortality rate so high in children here?
Immunity is one of the functions of our body. It is not an organ, but it is a system. Just as with age there is a deterioration called immunosenescence, which is the ageing of the immune system and something that makes us more vulnerable to infectious agents; in children this system is still immature and not fully developed.
Then why does the coronavirus, unlike pneumonia, hardly affect children?
All viruses and bacteria need us as hosts; they need to coexist with us in order to survive. But the coronavirus gains access to the cells through an enzyme which has a lot to do with the cardiovascular system. That's why it affects people with cardiovascular pathologies: hypertension, diabetes, a history of cardiovascular accidents... the mortality is not so much due to the infection as the underlying conditions which can complicate the illness. And children do not present a cardiovascular risk.
What is the relationship between coronavirus and pneumonia? A lot of patients who are hospitalised with Covid have both.
The way these infectious agents enter and cause these illnesses is via the respiratory system. They colonise it. That's why the pulmonary tissue is most affected, and it leads to pneumonia.
Can the vaccine against pneumococcus minimise the impact of the virus?
From the data from the first wave of Covid-19 we know that up to 60 per cent of patients with coronavirus had pneumococcus in their airways. In other words, they had a double infection: coronavirus and pneumonia. They go hand in hand, just as occurs with the flu. When flu and Covid, or pneumonia and Covid, coexist it increases the risk and can lead to death.
So why has there not been a vaccination campaign for pneumoccus like there has been for flu?
In Andalucía we try to programme these things. The health system has its limits. Last year 1.2 million people were vaccinated against flu and another half a million against pneumococcus. But GPs have to carry on with their other work as well. Vaccination has to be organised by sector to avoid crowds and contagions. Flu is seasonal: from December or January to March or April. Pneumonia, not so much. With flu, because it doesn't create a permanent immunogenic memory, we have to vaccinate every year because the virus mutates, although the germ is the same. With pneumonia, you only need a vaccine once in your life.
Who should be vaccinated against pneumococcus?
The two most extreme age groups: children, which is why we have a vaccination calendar for them, and people over 65. Also people who are at risk from this, who are also high risk for the coronavirus, such as those with a depressed immune system or who have chronic illnesses such as diabetes, chronic obstructive pulmonary disease, cardiovascular pathologies, arrhythmia...
Does it worry you that so many people seem to be sceptical about vaccines?
That happens every time there is a health alarm, some people will be negative about it. But the main problem with regard to vaccination is that there is a lack of awareness about health and care. The coronavirus has reminded us what an infectious illness can do, what harm it can cause. There is a great deal of disinformation, and that leaves the door open to myths and conjecture.
So can a lack of resources be a risk factor?
It is for all health problems. That's why we are trying to empower people, make them aware of the importance of self-care, remind them that these vaccines are free... but not everybody has access to the information.
What do you think about the war between pharmaceutical companies over coronavirus, with different firms announcing that their vaccine is more effective than the others?
It's a war of figures. I think all the vaccines which are approved will be useful, because we are going to need so many doses.
Will there be different vaccines for Covid-19 at the same time, then?
Oh, yes. Production is difficult because of the amount needed. But that happens with the flu, too. In Andalucía, for example, we don't buy just one flu vaccine, we buy three or four, because if there is some type of production problem with one of them we might not have enough. And every vaccine will cover different groups of the population; some will be more effective among certain groups than others.
What would you say to someone who opposes vaccines?
We demand things from vaccines that we don't demand from any other medication. People happily take anti-inflammatories or antibiotics, but they can have more adverse effects and cause more organ damage than any vaccine. Vaccination, after water purification, is the health measure which has saved the most lives. I tell my patients that vaccines function like a Photofit portrait, the photo of the most-wanted criminal. The body will recognise the germ when it arrives. We give our bodies a defence system to fight against what harms us. I don't know why there is so much disinformation about vaccines. I recommend listening to professionals, not social media.