Booster dose, bivalent vaccines, child protection: update on Covid vaccination in France

Booster dose, bivalent vaccines, child protection: update on Covid vaccination in France

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For a few days, the curve of reported cases of Covid-19 has begun to rise. Associated with a spawn rate greater than 1, this may herald an eighth wave. However, apart from vaccination, nothing is done in France to prevent this possible new uptick: no specific protocol in schools, no masks (FFP2) in closed public places, no aeration and ventilation protocols for closed spaces open to the public.

It seems that everyone has given up. 30,000 covid deaths reported since the start of the year isn’t even enough to roll up our sleeves; The public, the media, the authorities have decided to turn the page on this pandemic, almost reproaching it for seeking to invite itself to quite rich news today.

To limit the damage, that is, to reduce the risks of prolonged covid, hospitalizations and death, full vaccination remains a fundamental measure promoted by public authorities, at least among adults.

Let us first return to the figures relating to vaccination: they are far from being as negative as could still be feared a little over a year ago. To date, 94.6% of eligible French people have received at least one dose of vaccine, 93.1% have received two, 64.9% an additional booster dose (the third dose, therefore) .

These figures are, to say the least, revealing that the anti-vaccines constituted a minority, certainly noisy, but very little representative of the population and that the bovines, who were much more numerous, saw their doubts dissipate over time. The latter will probably have found adequate answers to their questions, in particular with the accumulation of scientific evidence on the effectiveness of the vaccine in protecting against severe forms of Covid.

There remains some difficulty in getting people to complete their booster doses. Is it the result of a certain tiredness? The result of overly reassuring policies that tempered the risk of infection as vaccine immunity waned? Or maybe just the fear of going unconscious again for two days like the first few doses? In fact, some report symptoms of reactogenicity related to the vaccine: a kind of quite strong flu syndrome that can occur the day after and the day after infection.

reminder time?

However, all the data we have today reminds us of the safety of vaccines and the importance of booster doses to avoid hospitalizations -and therefore serious cases, often with serious consequences and sequelae- and deaths. In addition, and although the etiology and semiology of long-term Covid have yet to be refined, vaccination seems to have a protective effect against these post-infectious syndromes, which is a great asset. This pathology seems to attack infected people randomly; it can be very disabling for months after infection, if not longer, and cause long-lasting damage to various organs.

In the face of a further increase in the power of Omicron and its sub-variants, we can only advise those who haven’t yet to get their booster dose, be it a third or fourth dose, sometimes even a fifth for the most vulnerable. The relationship between benefits and risks of these reminders is clear.

While the vaccine arsenal should be topped off in the fall with bivalent vaccines, you may be wondering if it’s best to wait for these new vaccines to become available for your booster dose. Frankly, it’s hard for us to say right now.

These bivalent vaccines that the EMA Committee for Medicinal Products for Human Use (CHMP) has just recommended are bivalent messenger RNA vaccines, that is, they target both the Omicron, BA.1 or BA.5 subvariants depending on the type of vaccine and the original strain of SARS-CoV-2, known as Wuhan. The idea is to have a vaccine that is more effective against severe forms, but also more effective against transmissions; we have seen this second effectiveness decrease as variants of the Wuhan strain are developed.

lack of hindsight

If we remain absolutely positive for vaccines and in favor of booster doses, we now have some questions about the enthusiasm around these new bivalent vaccines. Its good tolerance has been evaluated, but on the other hand, the pressing time, it has not been decided to evaluate its efficacy through clinical trials. To justify it, the authorities wield a precedent, that of flu vaccines, which are also not tested in real life before going on the market. But we don’t have the same hindsight with Covid as we do with the flu, and this argument remains unconvincing.

First, we pose a theoretical question. Different articles have referred to Omicron and its sub-variants as “stealth variants”, that is, capable of going unnoticed by immunity radars. If Omicron is able to evade the immunity acquired by the infection and leave no trace of its passage through our immune machinery (many people have been contaminated several times with this variant), we wonder how the immunity acquired by bivalent vaccination can be protective.

These vaccines bet on the persistence of the circulation of Omicron, although it is not certain that it will continue to be dominant in the coming months.

The only data provided by the manufacturers refers to elevations of neutralizing antibodies (for the bivalent BA.1) and tests in mice (for the bivalent BA.5), which still seems a bit poor to us. At the risk of sounding like St. Thomas, it is true that we need to see theory confronted with clinical observations.

Do you think the authorities are right to make that bet, because we are running after variants and time is running out? Do you also tell yourself that it cannot be less effective than current vaccine formulations, that they are not very effective in preventing contamination? Even on these points we express some doubts.

In particular, we fear that the reduction in the dose of messenger RNA against the original strain will cause the vaccine to pass below the threshold of clinical efficacy, which, it should be remembered, has not only been re-evaluated for these bivalent vaccines. Although the United States is vigorously using the vaccines in question, we hope to have our questions answered soon and our doubts on these points cleared up, as we will benefit from their clinical experience.

pediatric emergency

These bivalent vaccines also bet on the persistence of Omicron’s circulation in Europe, although it is not certain that it will continue to be dominant in the coming months. Recall the Omicron eruption, which chased away the Delta variant in a few weeks last winter. However, Delta had been installed for several months and had caused two waves in Europe. We find it difficult to applaud these new bivalent vaccines before the results of the clinical efficacy data are before us.

On the other hand, we can only recommend those who have not taken their booster dose to do it quickly, whatever the formulation, monovalent or bivalent. If the upward epidemiological trend is confirmed and an eighth autumn wave, whose scope we do not know, sweeps through the territory, it will be better to be well protected.

We ask the public authorities to launch a clear and committed information campaign for the vaccination of children between 5 and 11 years of age.

The other emergency concerns children (5-11 years), insufficiently vaccinated to date. This is precisely the age group in which most of the new pollution occurs in this month of September. However, although they are eligible from the end of 2021 according to the joint positive opinions of the High Authority for Health (HAS) and the Council for the Orientation of the Vaccine Strategy (COSV), children aged 5 to 11 years are only vaccinated in less than 5%. . This situation is worrying to say the least, and France is almost the red light in Europe for vaccination of children, despite the fact that it presents a more than favorable relationship between benefits and risks. Switzerland is ranked just behind in this area.

Recent studies show that if children are less prone to severe forms, those who were hospitalized had been vaccinated even less frequently than the population of the same age. However, children are not spared severe cases of pediatric multisystem inflammatory syndrome (PIMS) and severe myocarditis induced by Covid-19 infection. They are also not immune to the risk of prolonged Covid.

Given these risks, vaccination has proven its effectiveness, and it is unacceptable not to offer protection to the youngest when an effective and safe vaccine is available. This massive hesitancy about vaccines, focused almost exclusively on children, can be attributed to French-speaking learned societies of pediatricians. It is the result of a long consistent tradition, without solid scientific foundation, in stating – as with chicken pox or formerly with measles – that it would be better for children to build their own immunity through natural infection than through vaccination.

In the United States, activism in favor of vaccinating children has made it possible to achieve much higher coverage, and there are now many studies that quantify the benefits of this Covid vaccination in children. Today, and although the fall may be complicated in schools where the virus is already circulating, we ask public administrations to launch a clear and committed information campaign for the vaccination of children between 5 and 11 years of age. Protecting children’s health and schooling will be one of the challenges for Brigitte Autran and hers, the new Health Risk Monitoring and Anticipation Committee, which is taking time to set up.

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