4TH DOSE. The High Authority for Health decided on Friday, March 18, 2022, for the opening of a second booster dose, or fourth dose, for people over 65 who are most at risk.
[Mis à jour le 18 mars 2022, à 18h56] While the figures for the Covid-19 epidemic have been on the rise for several days, the recommendations of the High Health Authority (HAS) were published this Friday, March 18, on the fourth dose. The HAS recommends a second booster dose for people over the age of 65 “at very high risk of severe form” or “those who are polypathological”. “For those who wish”, this new dose can be administered within “at least six months” after the first booster.
In a press release, the HAS evokes the evolution of the epidemic which “seems to be stagnating today or even starting to rise again, in particular with the spread of BA 2, a new sub-variant of Omicron”. “A new peak in cases could occur soon, although lower than in January,” she said. The various indicators “also show that it is always people aged 65 and over who remain the most at risk of developing a serious form of the disease and of dying”, she underlined before adding that “As of March 10, 2022, the over 60s thus represented 80% of patients hospitalized with Covid-19”.
On the effectiveness of the fourth dose, the Haute Autorité de Santé states, according to data from the United Kingdom and the United States, that “the protection conferred by the booster dose begins to decrease after 3 months in people aged 60 years and older”. On the other hand, “due to the still limited data on the protection conferred by infection with Omicron, there is no reason to consider a second booster dose in people who have recently contracted a SARS-CoV-2 infection with this variant, regardless of their age,” she said. It remains to be seen whether the government will decide to follow this advice or not. Since March 14, people aged 80 and over have been eligible for a second booster dose against Covid-19. It is now possible to make an appointment since Monday, as announced by the Prime Minister in the columns of Le Parisien.
As a reminder, the last notice of the Vaccine Strategy Orientation Council (the COSV, a body whose executive follows the advice), published on January 19, was unfavorable to the generalization of a fourth dose of vaccine. The health authority indicated that “with the exception of severely immunocompromised people, a second booster dose of vaccination would not bring any significant individual benefit” – it had, as a reminder, advised the second booster to people “severely immunocompromised” in its opinion of January 6. The Council also feared that forcing the French to receive a fourth dose of vaccine would have “a counterproductive effect as regards the continuation of the current vaccination campaign”.
The French government in favor of a 4th dose?
After making the third dose of the vaccine against Covid-19 compulsory, the question arises of the use of the fourth dose. The government is considering this possibility and has been making more announcements since the beginning of the year. In all the statements, however short, one can understand that the ministers are in favor of the use of an additional booster dose, certainly encouraged by the countries which have already made the fourth injection compulsory, such as Israel, Belgium or Denmark. On January 6, on BFMTV, the Prime Minister stated bluntly that “dAs soon as our health authorities have said yes, […] we will go” to the fourth dose. The government has since been hanging on the lips of the various health authorities while waiting for a green light for the generalization of the fourth dose.
If all French people could be affected by the use of a new booster dose, the question originally arises especially for fragile people and more at risk of developing serious forms of Covid-19. Also, if the fourth dose becomes necessary, it should be a priority for immunocompromised people and the very elderly. But the additional injection should not take place before the fall according to the last speech by Olivier Véran, on February 2 on BFMTV. However, once the decision is made, the resumption of the vaccination course could be rapid. On January 13, Brigitte Bourguignon, Minister Delegate in charge of Autonomy let it be known that France has the necessary doses. Between now and the fall, France will continue to observe the effectiveness of the fourth dose in Israel, which has opened it since the beginning of the year to over 60s as well as to medical personnel. Beyond the hypothesis of a fourth dose, the government also plans to use the anti-Covid vaccine regularly as is the case for the flu vaccine for example. “If we have a vaccine which is safe, effective and which should protect us over time, we would unfortunately get into the habit of having reminders from time to time”, warned Oliver Véran in particular.
Do health authorities recommend the 4th dose?
The Scientific Council, which is scrutinizing the evolution of the epidemic with a magnifying glass, put forward the idea of a fourth dose at the beginning of December 2021. The chairman of the council, Jean-François Delfraissy, had also put the subject on the table before the Senate Social Affairs Committee: “It is possible that at some point we will need a fourth dose”. But the organization acts as a consultant and can only make recommendations.
The Vaccine Strategy Orientation Council issued an opinion on the question of a fourth dose in January. “The available data do not currently call for the implementation of a second vaccination booster”, could we read in its report to the government. Recognizing that “the question is made legitimate by the current context of strong viral circulation”, the COSV is formal: the fourth dose is not relevant or rather not for everyone. Thus, it is specified in the opinion that: “With the exception of severely immunocompromised persons, for whom the COSV has already recommended the systematic injection of a second vaccine booster dose, a second booster dose vaccine would not bring any significant individual benefit.”
The Council of orientation of the vaccine strategy estimates that the generalization of the fourth dose, as of today, could have “a counter-productive effect as for the continuation of the vaccination campaign in progress”. Especially since, according to him, “in the current context of very high circulation of the Omicron variant, the population could have developed sufficient protection to fight against future variants, which would attenuate the need for a second vaccine booster dose. in the general population.” The most important thing for the COSV is to focus on the third dose, or booster dose: “From an epidemiological point of view, the proper conduct of first-time campaignsvaccination and booster vaccine would provide greater effects than the implementation of a second booster dose.” more generally, the Council admits that it will need more hindsight and new data concerning this fourth dose, before being able to recommend it .
What effectiveness for the 4th dose of vaccine against Covid?
If several scientific studies show the loss of effectiveness of doses of vaccine against Covid-19 over time, would the benefits granted by a fourth injection be real? A first study was conducted in Israel in early January, in a hospital center, with 150 caregivers. All had received their third dose at least four months ago. On Tuesday January 4, 2022, the first results were announced: “antibodies increased fivefold, indicating that the vaccine is working and offers protection against serious complications”. Initial encouraging data which, for the time being, does not indicate the lifespan of these antibodies. Because new results, reported by the television channel i24News Thursday, January 6, evoke a “disappointing” effectiveness, also arguing that the Israeli government is still waiting before opening this second reminder to the entire population. The study must still be carried out for six months.
According to an Israeli hospital that has started one of the first clinical trials on the fourth dose of the Pfizer or Moderna vaccines, the booster antibodies would be “less” effective in fighting the Omicron variant of Covid-19. The administration of a fourth dose of the Pfizer or Moderna vaccines makes it possible to multiply the antibodies but proves to be “less” effective in combating the Omicron variant of the coronavirus, he indicated on Monday January 17. “We find that many people infected with Omicron received the fourth dose. Admittedly, a little less but still a lot of infections”, recognized Professor Gili Regev-Yochay, co-author of this study.