In Portugal there is practically no one left to vaccinate

Portugal’s health system was on the verge of collapse. The hospitals in the capital Lisbon were overcrowded and the authorities urged people to treat themselves at home. In the last week of January, nearly 2,000 people died from the spread of the virus.

The country’s vaccine program was in tatters, so the government turned to Vice Admiral Henrique Gouveia e Melo, a former submarine squadron commander, to get the ship back on its feet.

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

“We believe we have reached the point of group protection and near herd immunity,” he said. “Things are looking very good.”

Portugal lifted almost all of its coronavirus restrictions on Friday. There was a sharp drop in new cases to around 650 per day and vanishingly few deaths.

Many Western nations fortunate enough to have ample vaccine supplies have seen a plateau in vaccination rates, with more than 20 percent of their populations still unprotected. Therefore, other governments are looking for possible intelligence in Portugal and are closely watching what happens when almost every eligible person is protected.

False dawns in the coronavirus pandemic are just as common as new nightmarish waves of infection. So Portugal could still face a setback as the delta variant spreads further around the world.

There have been worrying signs from Israel and elsewhere that vaccine protection may deteriorate over time, and a global debate is raging about who and when to offer booster vaccinations.

Portugal could soon start offering boosters to the elderly and those considered clinically at risk, Admiral Gouveia e Melo said, and he was confident they could all be reached by the end of December.

But now that bars and nightclubs are bustling with life, infections are waning and deaths are falling, the country’s vaccination campaign is thriving, even after overcoming many of the same hurdles that stalled others.

The same barrage of misinformation about vaccines has filled the Portuguese’s social media accounts. The country is ruled by a left-wing minority government, reflecting its political division. And, according to opinion polls, there were widespread doubts about the vaccines when they first hit the market.

The turning point is attributed to Admiral Gouveia e Melo. With a background working on intricate logistical challenges in the military, he was appointed head of the National Vaccination Commission in February.

The admiral was 6 feet 3 inches tall and made a point of wearing only his combat uniform on his many public and television appearances as he sought to essentially turn the nation into a collective pandemic fighting force.

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

While politicians around the world conjure up similar martial rhetoric, he said it was critical to his success that he be widely viewed as politically distant.

Updated

Oct. 1, 2021, 1:47 p.m. ET

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

When asked what other countries can do to boost their own vaccination efforts, he did not hesitate to offer his best advice.

“You have to find people who are not politicians,” he said.

Before the pandemic, Portugal was fortunate to have a robust national vaccination program in place. It grew out of the country’s devastating experience in the fight against polio, which continued to shape the country even after the birth of Admiral Gouveia e Melo in 1960. He remembers when the daughter of a family friend fell ill with the disease and the ailments it caused.

Manuela Ivone da Cunha, a Portuguese anthropologist who has studied anti-vaccination movements, said that “vaccine doubters and anti-Vaxxers are in the minority in Portugal and are also less loud” than in many other countries.

Leonor Beleza, a former Portuguese health minister and now president of the Champalimaud Medical Foundation, said Portugal’s rollout clearly benefited from the discipline that comes from the nomination of a military officer.

“He formulated a communication policy about what was happening that gave credibility and confidence,” she said.

When the Task Force developed the most efficient system to get most people safely through vaccination centers, they deployed troops to build trust in the system. People could see that the vaccines were safe when soldier after soldier was shot.

The state of vaccine mandates in the United States

• • Vaccination rules. On August 23, the FDA granted Pfizer-BioNTech’s coronavirus vaccine full approval for people aged 16 and over, paving the way for mandates in both the public and private sectors. Such mandates are legally permissible and have been confirmed in legal challenges.
  • College and Universities. More than 400 colleges and universities require a vaccination against Covid-19. Almost all of them are in states that voted for President Biden.
  • Schools. California has become the first state to enact a vaccine mandate for all educators and has announced that it will add the Covid-19 vaccine as a requirement for school attendance as early as next fall. Los Angeles already has a vaccination mandate for students 12 years and older who will attend classes in person from November 21st. New York City has introduced a vaccination mandate for teachers and staff, but due to legal challenges, it is still in effect. On September 27, a federal appeals court overturned a decision that temporarily suspended that mandate.
  • Hospitals and medical centers. Many hospitals and major health systems require their employees to be vaccinated. Medical mandates in California and New York state appear to have forced thousands of objecters to receive injections.
  • New York City. Proof of vaccination from workers and customers is required for indoor dining, gyms, performances, and other indoor situations. City education staff and hospital staff also need to be vaccinated.
  • At the federal level. On the 9th of September President Biden announced a vaccination mandate for the vast majority of federal employees. This mandate applies to members of the executive branch, including the White House and all federal agencies and members of the armed forces.
  • In the private sector. Mr Biden has ordered that all companies with more than 100 employees mandate vaccinations or weekly tests to drive new company vaccination policies. Some companies, such as United Airlines and Tyson Foods, had mandates prior to Mr. Biden’s announcement.

At the same time, the task force made a point of showing doctors and nurses how to get their vaccinations to bring home the message of vaccine safety.

While other countries have included doctors, nurses, police officers and soldiers in their vaccination campaigns, Admiral Gouveia e Melo said message consistency is critical.

However, when the campaign shifted to younger age groups in the summer – less than half the population was vaccinated – there were signs that resistance was building.

In a submarine, said the admiral, you are in a slow ship trying to catch faster ships.

“You have to position yourself and act wisely,” he said, “and use the opportunity when it presents itself.”

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

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

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

While the television cameras rolled, the admiral stood still.

“I said the killer was the virus,” recalled Admiral Gouveia e Melo. The real killer, he said, would be people living like they were in the 13th century, with no idea of ​​reality.

“I have tried to communicate all doubts and problems very truthfully and honestly,” he said.

But not everyone welcomed his approach.

“We don’t really have a culture to question authorities,” said Laura Sanches, a clinical psychologist who criticized Portugal’s mass vaccination as being too militaristic and called for the exclusion of younger people.

“And the way he always presented himself in camouflage suits the army – as if he was going to war – along with the language of the media and politics has contributed to a feeling of fear that also makes us more susceptible to obey and not to do. “Question,” she said.

Still, the public messaging campaign – including an aggressive television and media flash – made steady strides.

“In the beginning, about 40 percent were unsure,” said Admiral Gouveia e Melo. According to surveys, only 2.2 percent now do not want the vaccine.

When he stepped down from the task force this week, the admiral said he felt he was well on his way. But as a submarine operator, he warned that vigilance would remain essential to ensure this war was won.