He himself says he waited impatiently for the government’s announcement. After issuing a favorable opinion on March 31 for access to the second booster dose for 60-80 year olds, Professor Alain Fischer, indeed wanted to be able to obtain this fourth injection as soon as possible “in this age group” . It is now possible, for the president of the Vaccine Strategy Orientation Council (COSV) as for all those over 60, since the public authorities announced on Thursday April 7 that they were now there. eligible, subject to having received the first reminder for more than six months. In the short term, 500,000 people are affected, in addition to the 2.3 million French people over the age of 80 or immunocompromised who could already benefit from it since March 13.
The timing of this announcement, however, is puzzling. The day before, the European Medicines Agency (EMA) had indicated in a press release “that there was for the moment no evidence that protection against a severe form of Covid decreased significantly in adults aged 60 79 years old with a normal immune system, so there was no clear evidence to recommend a fourth dose immediately.” Even if the member countries of the European Union are not required to follow the opinions of this body, how to explain that France takes such a radically different position? “We have a divergence in the interpretation of the available data”, slice Professor Alain Fischer.
“No risk of fearing an exhaustion of the immune response”
Already, the High Authority for Health and the Scientific Council had come out in favor of this new injection. Five arguments finished convincing the COSV. First, the very high level of viral circulation in France: with 140,000 cases per day, 1,500 hospitalizations and around a hundred deaths daily, the epidemic is still far from over. Then, a study by the statistics service of the Ministry of Health (confirmed by British and American studies) showed that at a distance from recall, protection against hospitalization in people over 60 decreases.
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“In addition, we have enough data to confirm that an additional dose is safe, and that there is no risk of fearing an exhaustion of the immune response induced by the repetition of vaccines”, underlines the Pr Fisher. Finally, an Israeli study, showing a very significant reduction in deaths among the over 60s after a second booster, has just been made available in pre-publication (not peer-reviewed): “This is an important result, which justifies to allow people who wish to protect themselves, while modeller projections show that the risk of infection will still be very high in the coming month”, adds Alain Fischer.
However, this study does not present “a very high level of evidence, because it is observational work, and not a randomized clinical trial against placebo”, notes an observer. This could explain why, this time, the authorities did not choose to make this new dose almost compulsory through the health pass, as they had been able to do in the past.
No 4th dose for caregivers under 60
In addition, the government did not follow the advice of the COSV which also recommended an additional reminder for caregivers. It was above all, for the members of this body, to protect the health system by reducing staff absenteeism for Covid, and by reducing, even marginally, the risk of transmission of the virus to patients. For their part, the public authorities have obviously not been convinced of the need to revaccinate young people, especially since this proposal was based “on a low level of evidence”, as the Council specifies in its opinion.
It now remains to convince the eligible French people to reach out again. What is not obvious: of the 2.3 million aged 80 and over and the immunocompromised, only 375,000 answered the call. “It’s not dazzling, but it’s a bit early to draw conclusions,” says Professor Fischer. On the side of the Ministry of Health, we are reassured by looking retrospectively at the success of the first reminder: “98% of eligible people have returned for the third dose. We hope that they will continue, because they know that they are at risk” .
Should we see in this announcement a first step before, once again, a generalization to the entire population of this reminder? Absolutely not, insists Professor Alain Fischer: “For the moment, we are going to stop there. There is no indication for young people to take a fourth dose. topic”. For people under 60 at risk (obese, diabetics, etc.), the question should be discussed with the attending physician. On the other hand, it is not at all certain that this fourth dose will exempt seniors from another booster in the fall. On the contrary, it seems “plausible” to the president of the COSV that there will again be a vaccination campaign at the end of the year, at the same time as that against the flu, at least for the most fragile audiences.
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