Vaccination to blood donors

Dear Editor:

"I cannot imagine that an example of philanthropy more noble and broader than this is provided in the annals of history".

Edward Jenner (on the Royal Vaccine Philanthropic Expedition or Balmis Expedition)

We have read with interest the editorial by Drs. Dal-Ré and Camps.¹ We share with the authors the 3 procedural principles they advocate: "fairness in prioritisation, transparency and evidence-based". The decision to prioritize one population group over another to receive the SARS-CoV-2 vaccine is neither easy nor straightforward and must take into account scientific evidence, ethics, and deliverability. From an ethical perspective, prioritisation should maximise benefits and reduce harm, be fair and transparent, and address health inequalities. Most Western countries, including our own, should have developed phased vaccination plans based on these principles.1, 2 These authors, taking into account 4 allocation criteria, propose 4 allocation phases.¹ According to them, in phase 1a, high-risk health and social care workers, transport and environmental services at risk should be vaccinated; then, in phase 1b, high-risk patients and people over 65 years of age who live with many people.¹ In this sense, it is in line with the Consensus Document of the Spanish Society of Preventive Medicine,³ which has been endorsed by more than 45 Spanish scientific societies, which, through FACME, have asked the Ministry of Health to use it as a basis for strategic decisions on the SARS-CoV-2 vaccination campaign in Spain.

In this regard, the US Immunization Practices Advisory Committee, with maximum transparency, applying the ethical principle of "maximizing benefits and minimizing harms" asked: Which groups are most at risk of SARS-CoV-2 infection, symptomatic COVID-19 disease, hospitalisation and mortality? Which groups are essential for COVID-19 response, and which groups are essential for maintaining critical societal functions? The first of the 4 groups chosen for preferential vaccination was the one that preserves health care services essential to the COVID-19 response and the overall health care system 2. Indeed, the World Health Organization (WHO) has warned of the risk of neglecting other non-communicable diseases (NCDs).⁴ “COVID-19 is interacting with NCDs and inequalities to form the 'perfect storm' of avoidable death and suffering". It thus states that: "Taking appropriate action on NCDs now can save lives and reduce health disparities, strengthen resilience to COVID-19 and future pandemics, and help restore progress in achieving the sustainable development goals (SDGs) broadly. Opportunities for scaling up action on NCDs should be taken both immediately and as part of longer-term efforts to strengthen systems for health”.⁴ WHO has recommended prioritizing essential health services and adapting to changing contexts and needs. To avoid indirect morbidity and mortality and prevent acute exacerbation of chronic conditions when services are disrupted, countries should define which essential health services will be prioritised according to the context so that they continue to function during the acute phase of the COVID-19⁴ pandemic.

The WHO's high priority categories include, among others, “auxiliary services, such as basic diagnostic imaging, laboratory services and blood bank services” and "the provision of medicines and supplies and the support of health workers for the uninterrupted treatment of chronic diseases", such as blood components and plasma derivatives.⁴ Already in 2009, in the case of the A/H1N1 influenza pandemic, the Ministry of Health recommended encouraging donors to receive regular seasonal influenza vaccine and helping them to have priority access to a pandemic vaccine when it becomes available.⁵

However, in our country's national plan, the essential services, with the exception of health and social-health professionals considered to be the first line, were left in a second or third phase. Thus, health workers are classified into first-line workers, who are vaccinated in the first phase, and second-line workers. Second-line health and social care workers will either be vaccinated in a second phase when their risk of exposure is high or will be moved to a third phase to be included alongside other essential personnel. However, blood donors are not currently covered by any of the priority vaccination phases.³

This is why we believe, in agreement with Drs. Dal-Ré and Camps, that priority should be given to vaccinating vulnerable and high-risk groups of patients in phase 1.¹ In line with the philosophy of the H1N1 influenza pandemic coordination plan and WHO recommendations,4, 5 workers in transfusion centres and services should be included in this initial phase to ensure the supply of blood components and derivatives. Then, in phase 2, we encourage the inclusion of non-immunized active blood donors, especially apheresis donors. We also propose that blood donations from vaccinated donors be scheduled 7 days after the second dose of mRNA or non-replicating adenovirus vaccines, not only to reinforce the safety of donors and Transfusion Centre workers but, above all, to ensure that the humoral immunity present in the plasma of their donation has an "extra" benefit by providing passive immunity to the recipients.

Funding

Without funding.

Conflict of interests

The authors declare that they have no conflict of interest in relation to the present paper.

The corresponding author has received conference grants and fees for courses, lectures and/or teaching material from Uriach-Vifor, Sandoz, Zambon, Jansen. The first author has received conference grants or fees from GSK, Pfizer, Sanofi-Pasteur.