In Portugal, there is hardly anyone left to vaccinate

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The Portuguese healthcare system was on the verge of collapse. Hospitals in the capital, Lisbon, were overflowing and authorities were asking people to take care of themselves at home. In the last week of January, nearly 2,000 people died as the virus spread.

The country’s vaccination program was in shambles, so the government turned to Vice-Admiral Henrique Gouveia e Melo, a former submarine squadron commander, to right the ship.

Eight months later, Portugal is among the world leaders in immunization, with around 86 percent of its population of 10.3 million fully vaccinated. About 98% of all people eligible for vaccines – that is, anyone over the age of 12 – have been fully vaccinated, Admiral Gouveia e Melo said.

“We think we’ve reached the point of group protection and almost collective immunity,” he said. “Things are looking very good.”

Portugal ended almost all of its coronavirus restrictions on Friday. There has been a sharp drop in the number of new cases, to around 650 per day, and very few deaths.

Many western countries lucky enough to have abundant vaccine reserves have seen inoculation rates stabilize, with more than 20 percent of their populations still unprotected. So other governments are looking to Portugal for possible information and closely monitoring what happens when almost everyone who qualifies is protected.

False dawn in the coronavirus pandemic have been as common as new nightmarish waves of infection. Portugal could therefore still suffer a setback as the Delta variant continues to spread around the world.

There have been worrying signs from Israel and elsewhere that the protection offered by vaccines may wane over time, and a global debate rages on over who should be offered booster shots and when.

Portugal may soon start offering reminders for the elderly and those deemed clinically vulnerable, Admiral Gouveia e Melo said, and he was confident they could all be affected by the end of December.

But for now, as bars and nightclubs teem with life, infections decline and deaths plummet, the country’s vaccination campaign has succeeded even after encountering many of the same obstacles that have plagued others. .

The same flood of vaccine misinformation has filled Portuguese social media accounts. The country is ruled by a left-wing minority government, a reflection of its political divisions. And, according to opinion polls, there was widespread doubt about the vaccines when they first arrived.

Admiral Gouveia e Melo has been credited with turning the tide. With experience working on complex logistical challenges in the military, he was appointed in February to lead the National Immunization Working Group.

Standing at 6ft 3in, the Admiral made it a point to wear only his combat uniform during his numerous public and television appearances as he essentially sought to unite the nation into one collective fighting force. the pandemic.

“The first thing is to make this thing a war,” Admiral Gouveia e Melo said in an interview, recalling how he approached the job. “I use not only the language of war, but the language of the military.”

While politicians around the world have invoked similar martial rhetoric, he said it was essential to his success that he was widely seen as detached from politics.

He quickly assembled a team of around three dozen, led by elite military personnel, including mathematicians, doctors, analysts and strategic experts from the Portuguese Army, Air Force and Navy. .

Asked what other countries can do to strengthen their own immunization efforts, he was quick to offer his best advice.

“They need to find people who are not politicians,” he said.

Before the pandemic, Portugal was fortunate to have a strong national vaccination program. He was born from the country’s devastating experience in the fight against polio, which still affected the country after the birth of Admiral Gouveia e Melo in 1960. He remembers the moment when the daughter of a family friend fell ill with the illness and the suffering that followed.

Manuela Ivone da Cunha, a Portuguese anthropologist who has studied anti-vaccination movements, said that “skeptics and anti-vaccines are in the minority in Portugal, and they are also quieter” than in many other countries.

Leonor Beleza, former Portuguese health minister and now president of the Champalimaud medical foundation, said the deployment to Portugal clearly benefits from the discipline that comes from the appointment of a military officer.

“He formulated a communication policy on what was going on which gave credibility and confidence,” she said.

As the task force worked out the most efficient system to safely move the largest number of people through immunization centers, it used troops to build confidence in the system. People could see that the vaccines were safe as a soldier after the soldier got vaccinated.

At the same time, the task force made a point of showing doctors and nurses getting vaccinated to get the message out about vaccine safety.

As other countries have featured doctors, nurses, police and soldiers in their vaccination campaigns, Admiral Gouveia e Melo said consistency in the message was essential.

Still, as the campaign shifted to younger age groups over the summer – with less than half of the public vaccinated – there were signs that resistance was building.

In a submarine, says the admiral, you are in a slow boat trying to catch faster boats.

“You have to position yourself and be smart about how to do it,” he said, “and seize the opportunity when it presents itself.”

In July, Admiral Gouveia e Melo seized such an opportunity.

Protesters were blocking the entrance to a vaccination center in Lisbon, so he put on his combat uniform and went there without any security details.

“I’ve been through these crazy people,” he said. “They started calling me ‘murderer, murderer’.”

As the television cameras rolled, the admiral calmly stood his ground.

“I said that the murderer is the virus,” recalls Admiral Gouveia e Melo. The real killer, he said, would be people who live like they did in the 13th century with no notion of reality.

“I have tried to communicate very real and honestly about all doubts and issues,” he said.

But not everyone liked his approach.

“We don’t really have a culture of questioning authorities,” said Laura Sanches, a clinical psychologist who has criticized the deployment of mass vaccination in Portugal as being too militaristic and called for excluding young people.

“And the way he always presented himself in military camouflage suits – as if he was fighting a war – as well as the language used by the media and politicians, contributed to a sense of fear that also makes us more inclined to obey and not question, ”she said.

Still, the public messaging campaign – including an aggressive TV and media blitz – has made steady progress.

“At the start, we had about 40 percent who weren’t sure,” Admiral Gouveia e Melo said. Now, according to polls, he said, only 2.2% don’t want the vaccine.

As he left the task force this week, the admiral said he believed the country was on the right track. But, still a submariner, he warned that vigilance would remain essential to ensure this war was won.


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