2023-09-14 12:27:34
by Health Editorial Staff
The American CDC has opted for mass vaccination, recommending booster shots from 6 months and older while Europe aims to protect those at risk of serious illness
I Centers for Disease Control and Prevention (CDC) have recommended vaccination against Covid-19 with an updated vaccine for all people over 6 months of age who have not received a Covid vaccination in the last two months. In the United States, the new Pfizer-BioNTech and Moderna vaccines will be available as early as this week. In Italy, announced by the Minister of Health Orazio Schillaci, they will be available in fifteen days and will be reserved for over 60s, healthcare workers and fragile people. For now it is not known whether they will be offered free of charge to those who want to do them.
The CDC motivates the choice of mass vaccination in this way: «Vaccination remains the best protection against hospitalization and death linked to Covid-19 because it also reduces the possibility of suffering the effects of long-Covid», they explain on their website. Long Covid which affects the quality of life of an even younger segment of the population and consequently on productivity. “Receiving an updated vaccine – recalls the note – can restore protection and provide improved protection against the variants currently responsible for the majority of infections”. The safety of the vaccines has also been confirmed: «To date, hundreds of millions of people have received a vaccine against Covid-19 in complete safety thanks to the most intense safety monitoring in the history of the United States», they conclude.
The new vaccines
The new vaccines are designed against the Omicron XBB.1.5 variant, which was the dominant virus earlier this year, when health officials were forced to decide the composition of an upcoming fall vaccine. XBB.1.5 represents only 3% of cases today, but over 90% of the circulating variants are its close relatives. The new vaccines appear to be effective against all circulating subvariants in preventing serious infection. However, some experts in the United States fear that a generalized vaccination campaign could mislead the message that the vaccine is most necessary for the elderly and more vulnerable individuals. What pushes the CDC in the direction of offering vaccination to everyone is the fact that 70% of the American population is overweight or obese (and obesity is a risk factor for serious disease). Furthermore, after the over 75 age group, according to American data, the people at greatest risk of dying from Covid would be children under five years of age.
Who can be vaccinated in Italy
In Italy the campaign to immunize against Sars-CoV-2 will start in conjunction with the flu campaign for the 2023/24 season, as foreseen in the circular from the Ministry of Health, which should start in October. The vaccine is not mandatory but is strongly recommended for some categories: people over 60, people with high fragility, pregnant women and health and social care workers. These groups are recommended and offered a booster dose valid for 12 months with the new updated vaccine formulation. Vaccination may also be recommended to family members and cohabitants of people with serious frailties. For people with marked impairment of the immune system or with very serious fragility, it may be necessary, after medical evaluation, a further booster dose or an anticipation of the interval from the last dose.
Objective: limit hospitalizations and deaths
While in the United States vaccination is offered free of charge to everyone and a universal vaccination approach has therefore been adopted, in Europe (including Italy), despite the EMA having authorized the use of the new vaccines on all age groups, it has been opted for protect only the categories at risk of severe Covid: the objective is to limit hospital admissions and deaths as much as possible.
But what do Italian experts think about the two different approaches adopted? «Considering how the vaccination campaigns went last year, it is good to focus on where the impact is greatest, i.e. those who are most at risk of being hospitalized» explains Marco Cavaleri, head of “Health risks and vaccination strategies” at the EMA and head of the Emergency task force. «The most targeted line adopted by Europe aims to concentrate efforts on the people who are most at risk» adds Cavaleri.
Carlo Signorelli, professor of Hygiene and Public Health at the Vita-Salute San Raffaele University of Milan and president of the Nitag – National Advisory Group on Vaccinations, agrees: «I support the idea of the Ministry of Health to identify precise categories to be directed towards the autumn-winter references. I don’t agree with mass vaccination: we need to mediate costs and benefits and the organization of this prevention activity. Moreover, it has been said that on medical indication it is possible to leave those categories, so a small child with a disease that damages the immune system will still be able to get the vaccine.”
Matteo Bassetti, director of infectious diseases at the San Martino Polyclinic in Genoa, is critical of the American choice: «We must not repeat the same mistake already made two years ago by expanding vaccination to everyone from 0 to 100 years of age without any distinction. I remember that the fourth dose was taken by 8% of the population from 0 to 100 years old, so it seems to me that it was a total failure – Bassetti remarks – We must protect a population of fragile, ultrafragile and elderly subjects, for which I would even be of the idea of not starting with vaccination from 60 years of age onwards, but of targeting the very elderly, i.e. from 70-75 years of age onwards, plus the frail and ultrafragile with this booster. In these categories – he continues – we should be able to reach 100% coverage, because every person aged 70, 75, 80 who has Covid risks having a serious form of illness, having problems, having to go to hospital. These people must absolutely be protected.” Bassetti is succinct about his boys: «My children and my wife will not get vaccinated».
Maria Rita Gismondo, director of the Laboratory of clinical microbiology, virology and bioemergency diagnostics at the Sacco hospital in Milan, is on the same wavelength: «I say that vaccinating everyone aged 6 months and older is truly something that should not be accepted. A vaccine, like any drug, must be widely tested and known including its side effects, and some aspects of these vaccines still need to be considered and evaluated. Furthermore, a vaccine, like a drug, must be administered when the risk of a side effect is significantly lower than the risk of contracting the disease. And from 6 months onwards, up to old age, the risk of contracting the disease in a serious form is almost non-existent in healthy individuals.”
Pregliasco: the vaccine is free for all those who want to have it
A voice out of the chorus is that of Massimo Andreoni, scientific director of the Italian Society of Infectious and Tropical Diseases (Simit) and professor of Infectious Diseases at the Tor Vergata University of Rome: «The CDC recommendation confirms that a booster of the updated anti-Covid vaccine is always useful for everyone. It should be remembered that this is an annoying disease even in healthy subjects and in younger children and being vaccinated then reduces the risk of Long Covid. The more the population is protected, the less the virus circulates, perhaps affecting those who are very fragile or immunocompromised.”
Fabrizio Pregliasco, virologist at the State University of Milan, although believing that an autumn-winter booster campaign that focuses on the elderly and frail is correct, hopes that the vaccine can be an opportunity for everyone. “I believe that the vaccine should be free for everyone and it is obviously also necessary to relaunch the flu vaccine, perhaps in the same session.”
September 14, 2023 (modified September 14, 2023 | 12:27)
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