COVID-19 VACCINATION STRATEGY IN SPAIN
This document is under permanent revision according to the evolution and new information
available on the infection by the novel coronavirus (SARS-CoV-2).
link to page 3 link to page 5 link to page 6 link to page 7
Table of contents
Introduction ........................................................................................................................... 3
Objectives of the stratagy ...................................................................................................... 5
Governance of the strategy ................................................................................................... 6
Development and availability of vaccines ............................................................................. 7
The COVID-19 pandemic is causing enormous human and economic costs in Spain and
the world. Having an effective and safe vaccine available in the short term, which can
be used for the population at large, will help to reduce the number of cases,
hospitalizations and deaths by COVID-19 and will help us to gradually return to normal.
The development of such a vaccine, its acquisition and administration is an
unprecedented challenge to the world. For this reason, the European Commission
presented a strategy to speed up the development, manufacture and deployment of
vaccines against COVID-191. The EU vaccine strategy aims to ensure the availability of
quality, safe and effective vaccines in the European Union (EU) as well as an equal,
rapid and equitable access to the available doses by all Member States and their
citizens. This strategy ensures that the entire purchase and distribution process is
conducted transparently and with equal standards of vaccine safety and efficacy
among all Member States. Joint action at EU level is the safest, fastest and most
efficient way to achieve these goals.
The Spanish Agency for Medicines and Healthcare Products (AEMPS) represents Spain
in the body that makes decisions about every advance purchase process. This body
monitors the development of vaccines and ensures transparency and good governance
in the process of purchase and distribution. Within this framework, advance purchase
agreements for vaccines have already been signed with five pharmaceutical
Pfizer/BioNTech and Curevac. Negotiations continue with Moderna/Lonza and
Novavax. This is a broad portfolio of vaccines that will ensure that, if the authorization
is granted, Europe and Spain will gradually have the necessary doses, at the same time,
and for the entire population, so as to face this unprecedented situation.
The effort that the world's scientific community is making to achieve a safe and
effective vaccine is unparalleled by any other before, and citizens should be aware that
the vaccines that will eventually be used in the EU against COVID-19 will have the same
levels of safety as any of those commonly used.
On October 15, 2020, the European Commission published a Communication on the
preparation of COVID-19 vaccination strategies and vaccine deployment2 which
identifies key elements to be considered within national vaccination strategies.
This European Commission document and the recommendations of other international
bodies have been taken into account for drawing up of the Vaccination Strategy for
Spain34. The main objective of the vaccination strategy is to reduce COVID-19
morbidity and mortality by vaccinating the population at large. Bearing in mind that
the availability of vaccines will be progressive, it is necessary to establish the main lines
that this vaccination strategy must follow, as well as the prioritization of different
The COVID-19 Vaccination Strategy in Spain has been devised with the information
available at this moment and aims to be a live, agile and flexible document, which will
be updated as knowledge increases on the results of the clinical trials being carried out
with candidate vaccines, on the information related to the logistics, storage and
administration requirements of the vaccines close to authorization, and on details
about the immunity generated after the disease.
This is a country-wide strategy, which is driven by an ethical framework based on
equity, with a solid technical base which will be coordinated on the basis of the
common European framework, and it is born with the conviction that better
acceptability results can be achieved if the vaccine is voluntary.
It should be noted that Spain has a great deal of experience in logistics, distribution
and vaccination, both in systematic vaccination and in specific campaigns. Indeed, in
the current flu vaccination campaign, in the context of a pandemic, vaccination levels
have significantly increased in all territories.
At the same time, lessons learned from the past 2009 influenza pandemic showed the
importance of having an international regulatory framework that would strengthen
global surveillance and response capacity, the inclusion of vaccines and antivirals in
preparedness and response plans, or the development of stronger information
systems. This experience ensures that the COVID-19 Vaccination Strategy can be
The current document describes the main lines for establishing a COVID-19 Vaccination
Strategy in Spain with the current knowledge, including the aspects described below.
2 Objectives of the strategy
The global objective of the COVID-19 vaccination strategy in Spain is to reduce the
morbidity and mortality caused by this disease, protecting the most vulnerable groups
through vaccination in a context of progressive vaccine availability.
There are four operational objectives:
1. To establish an order of priority of the population groups to be vaccinated,
taking into account scientific, ethical, legal and economic criteria, in a context
of progressive availability of vaccine doses. It is necessary to prioritize the
protection of the most vulnerable groups and those for which our legal system
has assumed a specific and reinforced duty of protection.
2. To arrange the fundamental aspects related to logistics, distribution and
administration of the vaccines that will be available for Spain in the coming
3. To establish the priority lines for the monitoring and evaluation of the
vaccination, including the coverage, safety and effectiveness of the vaccines, as
well as their impact on the epidemiology of COVID-19, which will allow the
strategy to be assessed and adjusted in order to achieve the maximum benefit
for the population.
4. To arrange the key aspects for the development of a communication strategy
aimed at health personnel and the general population, which will give access to
adequate and truthful information, increasing the population’s trust in the
process of authorization and use of the vaccine(s), and ultimately achieving
The main objective of the COVID-19 vaccination strategy in Spain is to reduce the
morbidity and mortality caused by this disease through vaccination against COVID-
19, in a context of progressive availability of doses, and protecting the most
3 Governance of the strategy
The preparation of the COVID-19 Vaccination Strategy in Spain is a mandate from the
plenary session of the Inter-territorial Council of the National Health System (CISNS), a
collegiate health body in which the health councilors of the autonomous communities
and cities and the Minister of Health participate.
On 9 September the CISNS plenary session approved a declaration of Coordinated
Actions in the field of Public Health which agreed:
• The implementation of a common vaccination strategy for all territories, drawn
up jointly taking into account the opinion of experts in bioethics and scientific
societies, approved by the CISNS plenary session.
• The provision by the Autonomous Communities of the equipment, resources
and materials necessary for the administration of the vaccines provided by the
Ministry of Health.
• The creation of a COVID-19 State Vaccination Register by the Ministry of Health
in collaboration with the autonomous communities and cities, which will be fed
with information from the vaccine registers and information systems, or any
other system with information of interest on the autonomous communities and
To this end, a COVID-19 Vaccination Technical Working Group (GTV) was created,
depending on the CISNS Programme and Registry of Vaccinations Report (or
Vaccination Committee), coordinated by the Ministry of Health, and which includes
eight members of the Committee itself, specialists from scientific societies, experts in
bioethics, sociology and methodology, as well as experts from the Carlos III Health
Institute, the Spanish Agency for Medicines and Healthcare Products (AEMPS), the
Health Alerts and Emergencies Coordination Centre (CCAES) and the Ministry's
Occupational Health and Vaccination Programmes areas.
The GTV has elaborated a document of Basis for the Strategy of COVID 19 Vaccination
, validated by the Programme and Registry of Vaccinations Committee.
The CISNS Vaccine Committee and the GTV are the technical bodies that will review
and update the Basis of the Strategy as new knowledge on the characteristics and
availability of vaccines and the implementation of the Strategy advance.
In addition, with the aim of supporting inter-sectoral coordination and promoting the
effective planning and implementation of the Vaccination Strategy in the various
priority groups, an inter-ministerial advisory group will be set up with the participation
of technical teams from the Second Vice-Presidency and the Ministry of Social Rights
and 2030 Agenda, the Ministries of Territorial Policy and the Civil Service, Defense,
Home Affairs, Inclusion, Social Security and Migration, Labour and Social Economy,
Education and Vocational Training, Industry, Trade and Tourism and Agriculture,
Fisheries and Food.
The Ministry of Health will acquire the corresponding doses for Spain within the
framework of the European strategy. Once the availability of doses authorized and
purchased by the Ministry of Health is known, the final prioritization of the vaccination
of certain population groups and the allocation of doses to each of the Autonomous
Communities will be agreed upon in the plenary session of the CISNS, after discussion
in the Vaccines Committee and the Public Health Commission. The vaccines will be
administered free of charge through the National Health System (SNS).
• The COVID-19 Vaccination Strategy in Spain is based on the recommendations
of the COVID-19 Vaccination Technical Working Group and the Vaccine
Committee, and will be coordinated by the Inter-territorial Council of the
National Health System (CISNS).
• The vaccines will be administered free of charge through the NHS.
4 Development and availability of vaccines
Finding a safe and effective vaccine is a key element of the exit strategy from the
pandemic. That is why an unprecedented collective effort is underway involving
countries, institutions, researchers and companies around the world to make vaccines
available at short notice.
Sixty-six days after the sequencing of the SARS-CoV-2 genome, a human was first
injected with a candidate vaccine against the pandemic virus5.
At present, more than 250 different COVID-19 vaccine candidates6 are being
developed worldwide, based on different technological platforms, ranging from the
most common (inactivated viruses or purified protein sub-units of viruses), those
based on more recent technologies and for which vaccines are already commercialized
(replicative and non-replicative viral vectors), but also very new platforms that have
never been commercialized until now (DNA and mRNA).
The Spanish government is also promoting research and production of vaccines,
providing resources for the development of projects and programmes through the
Carlos III Health Institute and the Spanish National Research Council (CSIC). There are
currently 11 candidate vaccine projects.
The development of any vaccine covers different phases. Initially, an exploratory and
pre-clinical phase is developed with studies on laboratory animals. Then, clinical trials
in humans phase I, II and III are initiated to determine the optimal dose, explore initial
safety and characterize the efficacy and safety profile. Finally, data are evaluated by
the drug agencies, so that only if they prove to be effective and safe do the agencies
grant marketing authorization and pharmacovigilance activities begin, which are
maintained throughout the life cycle of the drug.
It is not yet known which of the more than 250 candidate projects will successfully go
through pre-clinical and clinical studies until approval, nor when these vaccines will be
available in sufficient quantities to allow their use in the population at large. For this
reason, work is underway at the European level on a broad portfolio that includes
vaccines from all platforms, thus maximizing the chances of having an effective and
safe vaccine as soon as it becomes available and is authorized by the competent
The criteria for including vaccines in the portfolio include the solvency of the clinical
development project and the consequent probability of being assessed for
authorization and commercialization, the capacity and solvency of the company to
manufacture it in a significant quantity, that can be produced in European territory or,
for example, have the possibility of distributing vaccines as soon as they are
5 Callaway E. The race for coronavirus vaccine
. Nature. April 2020. 580 no. 7805: 576-577. Available at:
https://doi.org/10.1038/d41586-020-01221-y [accessed 10 November 2020] 6 https://vac-lshtm.shinyapps.io/ncov_vaccine_landscape/
At the moment, there are eleven vaccines on different platforms that have already
started phase III of the clinical trials. Of these, five7 are in the European portfolio.
Table 1 lists the main characteristics and current state of development of the COVID-
19 vaccines that are part of the European Vaccine Strategy.
Table 1: Summary of European SARS-CoV-2 vaccine candidates and current status of development (results published
in peer review or preprint as of November 2020), subject to change.
Phase III: UK,
0-28 days dose
that carries the protein S
South Africa, USA,
mRNA encoding S protein
Phase III: USA,
encapsulated in lipid
0-21 days dose
Non replicating Ad26
Phase III: USA,
vector carrying S proteing doses:
0-56 days IM
Protein S purified with
Phase I/II: USA.
the adjuvant AS03
RNA encoding S protein
Phase III: USA.
encapsulated in lipid
Phase III: UK.
with Matrix-M1 saponin
as an adjuvant
mRNA encoding a
Phase I: Belgium
stabilized form of S-
protein encapsulated in
Phase II: Peru,
7 BioNTech/Pfizer, Moderna/Lonza, Johnson&Johnson/Janssen, Astra-Zeneca/Oxford y Novavax.
8 J&J/Janssen está llevando a cabo un gran ensayo fase III en Estados Unidos con una sola dosis (que en
principio será la dosis seleccionada para la autorización inicial) y otro gran ensayo fase III multinacional
con la misma vacuna, pero a dos dosis.
Within the framework of the European Vaccine Strategy, which provides for advance
purchase agreements, four contracts have already been signed: with Astra-Zeneca /
Oxford, Sanofi / GSK, J & J / Janssen and Pfizer / BioNTech. In addition, there is already
an agreement with CureVac and the contract will be signed shortly, other agreements
are still being negotiated with Moderna / Lonza and Novavax. If all the agreements are
completed, the EU will have secured, should vaccines be licensed, around 1.4 billion
doses (or immunizations for around 800 million people) available from various
manufacturers for the EU population, but also outside of it.
Advance Purchase Agreements within the European Vaccine Strategy reserve or grant
Member States the right to purchase a specified number of doses of vaccination at a
price stipulated at the time the vaccine in question is available. All Member States will
have access to COVID-19 vaccines at the same time and according to the size of their
For a vaccine to be available to the population, it must be previously authorized by the
European Commission after a positive scientific and technical opinion from the
Committee for Medicinal Products for Human Use of the European Medicines Agency
(EMA) and based on the usual criteria with which the quality, safety and efficacy of the
drugs are guaranteed. The authorization granted in this way is identical and valid
throughout the EU.
The time frame for the development of a vaccine is shortened for several reasons.
First, because the companies develop the vaccine by performing several phases in
parallel that would normally be carried out sequentially. Secondly, because companies
begin to manufacture "at risk" –supported by advance payments of purchase
agreements– so that they can have doses from the very moment they are authorized.
Finally, because to speed up the evaluation process in a health emergency situation
like this, the EMA has launched the rolling review process, whereby its Committee for
Medicinal Products for Human Use reviews the data as soon as they are available, in a
ongoing review that enables applications for authorisation to be quickly assessed while
ensuring sound scientific advice. In this way, the vaccine evaluation process is
accelerated to a great extend without compromising the safety requirements for its
authorization at any time.
Citizens should know that the vaccines that will ultimately be used to get immunized
against COVID-19 will have the same levels of safety as any other that are commonly
used. And that the levels of effectiveness will comply with the standards required for
its use to be authorized.We are relying on more teams and more resources. And all the
initiatives underway to obtain vaccines are undergoing the same procedures followed
by all the vaccines authorized so far.
Based on all established reviews, some vaccine manufacturers have announced that
the first deliveries of vaccine doses to EU Member States would be available possibly
before the end of 2020, provided the vaccines have a marketing authorisation in the
In addition, to facilitate early access to the vaccine, aspects such as the labeling of
medicines or actions at the national level have also been simplified to the maximum,
so that when a vaccine is authorized by the European Commission, the Spanish Agency
for Medicines and Medical Products (AEMPS) will grant the national code immediately
so that the vaccination can begin.
Table 2 summarizes the status of negotiations with the different companies, for which
marketing authorization is being requested in the EU and for which early availability
may be possible or a sufficient number of vaccine doses could be available to initiate a
nationwide vaccination campaign for priority groups.
Table 2: Status of the negotiations and approval schedule expected to November 2020, subject to change.
Pharmaceutical EU agreement
Total number Number
Contract signed 300M (+100M 31,555,469
in August 2020
Contract signed 300M
phase I / II
Contract signed 200 M (+100 M 20.873.941
Contract signed 200 M (+200 M Pending*
Contract signed 225 M (+180 M Pending*
in October 2020
Very advanced 80M
*Spain represents 10.57% of the population of the EU without the countries of the European Economic Area (EEA)
and 10.44% including the EEA countries (Norway, Iceland and Liechtenstein).
• Countries, institutions, researchers and companies around the world are making
an unprecedented effort to develop a safe and effective vaccine in a short period of
• If the agreements are completed, the EU will have secured 1,400 M doses or 800
M of immunizations and all Member States will have access to it at the same time to
a quantity according to its population.
• Citizens should know that the vaccines that will ultimately be used to immunize
against COVID-19 will have the same levels of security as any of those commonly
5 Prioritization of vaccination
The objective of the vaccination of the population is to prevent the disease and reduce
its severity and mortality, in addition to reducing the impact of the pandemic on the
health care system and the economy, especially by protecting those groups with
Given that the first vaccines against COVID-19 will be available in limited quantity, and
will increase progressively, three stages have been identified according to availability
at any particular time:
o First stage. Initial and very limited supply of vaccine doses.
o Second stage. Progressive increase in the availability of vaccines will alow to
increase the number of people to be vaccinated.
o Third stage. Increase in the number of doses and vaccines available to cover all
Due to the gradual availability of vaccine doses, it is necessary to prioritize the
population groups to be vaccinated in each of the stages set out. To this end, an ethical
framework has been established where prevail, in this order, principles of equality and
dignity of rights, necessity, equity, protection of disabilities and minors, social benefit
and reciprocity. In addition, the following more procedural principles have also been
taken into account: participation, transparency and accountability.
The evaluation of the different population groups is based on this framework, also
taking into account the applicable legal regulations and international
To set out the prioritization of the groups to be vaccinated in each of the stages, an
evaluation has been carried out based on the following criteria: risk of severe
morbidity and mortality, exposure, socioeconomic impact and transmission, in
addition to feasibility and acceptance.
Based on this evaluation, the following group prioritization has been established for
the first stage:
1. Residents and health and social care personnel in care homes for the elderly and the
2. Front-line health personnel.
3. Other health and social health personnel.
4. Dependent people with disabilities who require intensive support measures (non-
institutionalized highly dependents).
Once the availability of one or more of the authorized and acquired vaccines by the
Ministry of Health is known, the final prioritization of vaccination to certain population
groups will be agreed in the Plenary of the CISNS, after discussion in the Presentation
of Vaccines and Vaccination Registry and in the Public Health Commission, • Due to the gradual availability of vaccine doses, it is necessary to prioritize the
population groups to be vaccinated based on to an established ethical framework
and risk criteria.
• The Plenary of the CISNS will agree on the final prioritization of vaccination of the
various groups of population.
6 Logistics, distribution and administration
The vaccination program against COVID-19 entails several critical points different from
the usual vaccination programs. These have to do with the requirement of
extraordinary cold conditions in the transport and storage of some vaccines, their
distribution in multi-dose vials that require planning of appointments to avoid dose
loss, the possible coincidence of use of different vaccines with different formats and
specific handling instructions and that to complete vaccination coverage may require
one or two doses, the need to maintain physical distance and preventive measures
during the process (for which the experience during the influenza vaccination
campaign serves as a reference), the special characteristics of the Immunization
Registry or the need to consider possible vaccination sites in addition to the usual
To facilitate the correct functioning of the vaccination process, it is therefore
paramount to ensure that the storage, distribution and administration of each vaccine
are carried out in optimal conditions that guarantee the quality of the vaccines
throughout the process. The COVID-19 Vaccination Technical Working Group has
evaluated the fundamental aspects to take into account from the authorization of the
use of vaccines to their administration, as outlined in Figure 1:
A. Financing, Authorization
authorization for use of vaccines; labeling FT; Contract, Financing; Allocation and traceability
B. Reception, Storage, Distribution, Control
Reception, storage and distribution; Different logistics depending on the vaccine; Distribution points
Autonomous Communities (type of vaccines); Registration/Traceability (stock, dose availability)
C. Information, Training
Continuous information; Administration; Different vaccines; Protocols, guides, instructions (training
platform); Vaccination card
D. Communication, Coordination
Manufacturers; Ministry of Health; AEMPS; Autonomous Communities
The Ministry of Health is working with the autonomous communities on different
alternatives of vaccination centers, taking into account the experience of Primary Care.
As information on the availability of vaccines becomes available, it will be necessary to
update the processes and establish where, who and how the vaccination will be
Vaccine distribution will require full collaboration and coordination between public
institutions, authorized distributors and pharmaceutical companies so that supply
chain logistics are carried out in an efficient and orderly manner in a process validated
at all times by the Ministry of Health. To this end, protocols will be developed to
control the traceability of distribution, assign process managers and define clear
The administration of the vaccines will be carried out initially with confirmed
appointment to avoid the waste of doses and following the safety protocols. The
vaccine doses administered will be included in the registration systems and the date
and data of the vaccine received will be included in the clinical history of the
All vaccinated persons shall receive adequate information on the vaccine administered
and a vaccination card, or similar, which shall state the type of vaccine administered
and the lot number, date of vaccination and date for the administration of the second
dose, if applicable, as well as how to proceed with any suspected adverse reaction.
- The logistic, distribution and administration processes of the vaccines against COVID-
19 are complex and associate several critical points that are being technically prepared
in advance of the arrival of the first vaccines.
- The distribution of the vaccines will require full collaboration and coordination
between public institutions and pharmaceutical companies so that the logistics of the
supply chain are carried out in an efficient and orderly manner in a process validated at
all times by the Ministry of Health.
7 Monitoring and Evaluation
Adequate records to ensure that vaccination data is properly collected and to assist in
surveillance and follow-up activities are essential for monitoring the vaccination
The National Health System's COVID-19 Vaccination Registry aims to keep track of the
doses and types of COVID-19 vaccines administered to different population groups.
This registry will be used to calculate the vaccination coverage achieved and will
include the entire target population that is being prioritized.
The Ministry of Health is working with the Autonomous Communities on the
standardized and structured confluence of information systems and regional records
into a single registry that will house COVID-19 vaccination data for the entire country
and will be interoperable with other registries implemented during the pandemic.
The Spanish Pharmacovigilance System, coordinated by the AEMPS, has developed a
specific Plan for the safety surveillance of COVID-19 vaccines that will continuously
analyze the reports of suspected adverse reactions made by both health professionals
and the vaccinated citizens themselves, sharing information with the rest of European
agencies and the WHO.
The Strategy contemplates the development of different studies of vaccine
effectiveness in the vaccinated population that complement the data of the studies
carried out by the pharmaceutical companies, as well as studies of the effect of the
introduction of the vaccine on the epidemic wave.
Spain will participate together with seven countries in the European project ACCESS
coordinated by the European Medicines Agency on coverage, effectiveness and safety
of vaccines through the BIFAB Program, a computerized database of the clinical history
of Primary Care for pharmacoepidemiological research.
The Strategy also foresees studies of the acceptability of vaccination and processes of
continuous evaluation of the Strategy that allow monitoring and dynamic adaptation
of the same.
- The Strategy foresees different tools and studies that will allow monitoring and
evaluation of the coverage, safety and effectiveness of the vaccines.
• The Spanish Pharmacovigilance System, coordinated by the AEMPS, has developed
a specific Plan for the safety surveillance of COVID-19 vaccines that will continuously
analyze the reports of suspected adverse reactions made by both health
professionals and the vaccinated citizens themselves, sharing information with the
rest of the European agencies and the WHO.
The development of a communication strategy must contribute to effective, equitable,
and ethically sound access to vaccination, and be developed with full respect for
transparency, as the fundamental axis of all public decisions and policies, especially
those adopted in the field of public health, as set forth in the General Law on Public
It is considered a facilitator of these objectives that the communication is carried out
preferably by technical personnel and that it is focused on the transmission of the
criterion of solidarity, that is, to inform that the vaccination will be prioritized to the
population that needs it the most, taking into account the safety of the vaccines.
Health personnel play a fundamental role in informing the public.
In short, it is a matter of generating a high level of confidence that will translate into
This communication strategy will be governed by the application of the following
- Veracity: information based on available scientific evidence on the benefits and
risks of vaccination.
- Transparency: truthful information shall be provided at all times in a clear and
accessible manner that also includes uncertainties.
- Participation: the doubts of the population and health personnel will be heard in
order to direct the communication strategy to respond to existing needs.
- Equity: messages will be adapted to the audience to ensure that it is accessible.
Specific attention will be given to people with disabilities.
- Evaluation: information will be periodically re-evaluated.
The communication strategy will create a framework of truthfulness, transparency and
trust with differentiated objectives for health personnel and the general population.
1.Healthcare personnel must be informed about the development, authorization,
procurement procedures, distribution and use of COVID-19 vaccines at the different
stages of availability of the vaccines, establishing synergies with key actors in the
vaccination and transmission of accurate information (participation of professional
associations). The following objectives have been established:
a) To ensure confidence in the evaluation, authorization and surveillance process after
the administration of the vaccines (continuous evaluation in the benefit-risk
b) To help understand the difference between the usual vaccine authorization process
and the one used in the current situation by the regulatory agencies (EMA and
c) Raise awareness of the need to prioritize vaccination as a criterion of solidarity and
in line with the safety and efficacy data of the vaccines.
d) Raise awareness on the deontological commitment towards vaccines, so that they
transmit to the population the example of protecting their health to protect others.
e) Remember the importance of reporting adverse events that may occur after
2. The general population should be informed about the development, authorization,
distribution and use of COVID-19 vaccines, with the participation of population
associations (patient associations):
a) Communicate about the process of evaluation, authorization of the vaccines and
continuous surveillance after their authorization, as well as answering questions.
b) Explain the reasons for prioritization as a criterion of solidarity
c) Inform about the scientific evidence of the vaccines, their history and the scientific
characteristics of the vaccines to be distributed.
d) Inform about the adverse reactions of the vaccines identified before and after their
authorization. In this sense, to have data on the adverse reactions that occur in other
- The development of a communication strategy should contribute to the effective and
equitable access to the vaccination, complying with ethical principles and developed
with full respect to transparency. - The general objective of the strategy is to generate
a high level of trust that translates into better coverage, and for this purpose health
personnel play a fundamental role.