4TH DOSE. In accordance with the recommendations of the High Authority for Health, the government is extending the administration of a fourth dose of vaccine against Covid-19 to all adults at risk of a serious form. Who is concerned ?
[Mis à jour le 20 juillet 2022 à 18h44] This is a new step for the vaccination schedule against Covid-19. This Wednesday, July 20, the government decided to extend the use of a 4th dose of vaccine (equivalent to a second booster dose) to all adults with comorbidities and therefore at risk of contracting serious forms of the disease. With this decision, the executive chooses to follow the recommendations made a week earlier by the High Authority of Health (HAS). Three new categories of people are eligible for a 4th dose of vaccine: adults aged 18 to 59 suffering from comorbidities (obesity, renal or respiratory failure, severe disabilities, psychiatric disorders, etc.), people living in contact with vulnerable individuals and pregnant women. Around 5 million French people are affected by government recommendations, in addition to people over the age of 60, immunocompromised people and high-risk children for whom the injection of a 4th dose is strongly recommended.
As with all booster shots, Pfizer-BioNTech or Moderna messenger RNA vaccines must be injected within a minimum of three months after the last injection or after contamination with Covid-19. As a reminder, this period is extended to six months for people over 80 years of age. The Ministry of Health invites all French people concerned to “get vaccinated now, without waiting for new vaccines, to be protected from the risks of a serious form” notes The Parisian July 20. A statement addressed to those who would try to wait until the arrival of new vaccines created from the latest variants of Covid-19. It must be said that the 4th dose of vaccine does not shine by its popularity: only 26.5% of people aged 60 to 79 and 33.7% of people over 80 received the second booster shot, a coverage well too weak to ensure the protection of the most vulnerable.
The government’s decision to expand the use of a 4th dose of vaccine comes as the peak of the 7th wave of Covid-19 appears to have passed. Still, the epidemic has not said its last word according to the Scientific Council which alerted in his last opinion on “a possible rebound of the epidemic during the fall or next winter”. However, good vaccination coverage is, according to Public Health France, the means to “spend a serene summer and autumn” despite the virus.
What is the 4e dose of vaccine against Covid-19?
1st, 2e3e4e, booster dose… So many terms that are often mentioned when it comes to vaccination against Covid. But how to find your way there without getting lost? The 1st and the 2e dose were the starting point of the vaccination campaign, making it possible to complete its initial vaccination schedule. Then, for the most fragile and oldest people, a 3ethen a 4e dose of vaccine can be injected into them. On this subject, we also speak of 1st and 2e booster dose.
A 4e dose of vaccine against Covid-19, for whom?
On July 13, the High Authority of Health recommended opening the 4th dose of vaccine against Covid-19 to pregnant women and people living in the environment or in regular contact with immunocompromised or vulnerable people. A notice followed a week later, on July 20, by the government. People over the age of 60 and immunocompromised people – individuals with solid organ transplants, or bone marrow recently, patients on dialysis, patients with autoimmune diseases undergoing aggressive immunosuppressive treatment such as anti-CD20 or antimetabolites, or even patients with rare forms of primary immunodeficiency – are no longer the only ones who can receive a second booster dose. For them, the use of the 4th dose of vaccine has been possible since mid-March but in four months “only 26.5% of eligible 60-79 year olds and 33.7% of 80 and over” have received their second dose. reminder, informed Public Health France July 7th.
“The vaccination effort must be increased” in order to improve the vaccination coverage which remains “insufficient in certain territories such as the Antilles and Guyana and among the oldest”. The health agency also specifies that even though the latter had “the highest hospitalization rates”, only “a third of eligible 80 and over had received the second booster dose”. The government keeps the same speech: on July 5, the new Minister of Health Francois Braun insisting on the importance of getting vaccinated “when you are fragile”: “You have to do it now”, he said, at a time when “we have not reached the peak”. And to add: “50% of contamination occurs when the curve drops”.
There must be a delay since your last injection before you can claim to receive a new dose of vaccine: three months for immunocompromised people and those aged 80 and over; six months for people aged 60 to 79. The deadlines to be observed after the previous dose, in particular in the event of a Covid infection occurring after the last injection, have been clarified: “The fourth vaccination is active within 5 to 7 days therefore it is immediately effective” reminded the president of the Scientific Council and immunologist Jean François Delfraissy on France Inter on July 11 before confirming that this dose could protect “still a little more infection and transmission and especially in a “very clear way against the occurrence of serious forms”. Responding to those who are worried about receiving a more deleterious dose for the body, he reassured: “In terms of distribution and repertoire of the immune response, this 4th dose does not modify our immune response capacity so we can do and it’s time to do it for the oldest and most fragile right now”. This 4th dose can thus be made without waiting for next fall.
For the time being, however, the 4th dose of vaccine against Covid is not compulsory. But highly recommended for these at-risk populations. PFor the epidemiologist Antoine Flahaut, there is also “no reason to procrastinate to receive your vaccine if you are eligible for a booster” which specified to our colleagues from the HuffPost that there is “strong scientific data today showing that hospitalizations for severe forms of Covid-19 as well as mortality by Covid-19 are largely prevented by complete vaccination regimens (3 doses) associated with a second booster in the most vulnerable people”. Alain Fischer, the president of the orientation council for the vaccine strategy, assured that this reminder represented “no danger”, trying to reassure the population about this “safe” vaccine and in his eyes necessary to “catch up with the level of protection obtained after the first reminder in terms of protection against infection but especially against serious forms” (comments made on France 2 at the end of June).
A 4e Will the dose of vaccine against Covid-19 be generalized?
This is the big question. The 4th dose allowing the increase in the rate of neutralizing antibodies, it allows a reinforcement of the immunity which can prove to be necessary for the elderly and more fragile for whom the protection guaranteed by the vaccine decreases after six months, against twelve months for the general population. While in its vaccination strategy, the government has gradually opened up access to vaccines by age group, will it be the same with the 4e dose (2e booster dose)? “We will probably come there” replied Brigitte Bourguignon on June 27, without however, at this stage, mentioning a precise timetable, criteria or even constraints on this subject. Remember that in January, the validity of the vaccination pass was conditional on the injection of a booster dose.
Another problem remains: territorial disparities in the vaccination process. At the dawn of the summer holidays, franceinfo noted, Friday, July 8, that obtaining an appointment was now a feat for a certain number of departments. In the short term, it is not uncommon to no longer have any vaccination slots available. If in large cities or in departments, such as Seine-Maritime, Pas-de-Calais, Var or Haute-Corse, it is not complicated to make an appointment, it is another pair sleeves in Drôme, Tarn, Landes or even Haute-Savoie and Côtes-d’Armor. In particular, the closure of vaccination centers and the departure on vacation of certain pharmacists and doctors, explains franceinfo.