Waiting for a universal vaccine (studies are underway but times do not seem very fast), the fourth anti-Covid dose is making its way not only in the collective imagination, because it enters the government’s agenda. Fourth dose that march sent to various European countries and even beyond the ocean. The executive will most likely decide within a week, aware of the fact that the reason for discussion, at this moment, is above all the need to standardize intentions by deciding who to do the second booster dose: whether only to fragile patients or to the entire category of the elderly, and from what age. Certainly, the Minister of Health Roberto Speranza has guaranteed in these hours, “we will not do it at all”.
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The Brussels decision
With regard to the fourth dose, the Council of Health Ministers in Brussels made it clear: Speranza announced that “in the conclusions, both the EU Commissioner for Health and the French President made a commitment within a week to make a proposal in this direction “to evaluate a European procedure on the criteria of administration. At the moment in Italy the “fourth dose” of the anti-Covid vaccine is given to severely immunosuppressed over 12, who are “subjects with marked impairment of the immune response, due to causes related to the underlying disease or pharmacological treatments and organ transplant”. Technically, however, it is not a fourth dose, but the booster, inoculated at the end of the primary vaccination cycle, consisting of two doses and an additional one.
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Maga: “It shouldn’t be extended to everyone”
“Surely one of the topics on the agenda is whether or not to extend the audience of subjects who could have the fourth dose – he premieres Giovanni Maga, virologist and director of the Cnr of Pavia -. In Italy, at the moment, it is administered only to immunosuppressed people, for whom it would be more correct to call it a booster, given that their recommended vaccination cycle already included three doses “.
And he continues: “The data on the true efficacy of the fourth dose are not yet definitive even for immunosuppressed people who have completed the first cycle of three. In reality, from the data coming from Israel, it seems that this further immunization in the general population, therefore without distinction by age group, is unable to provide significant additional protection from infection caused by Omicron 2 “. So at this moment it is not advisable to carry it out on the general population “.
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The crux of the fragile population
The crux of the fragile population remains, especially the elderly. “There are discrepancies – explains Maga -. At the European level, the age above which to recommend a further recall has not yet been established. From a strictly medical-scientific point of view it is clear that people over 70-75 years old may have a decrease in the immune response more rapid than in young people. And therefore, given that the fourth dose is still able to increase the levels of antibodies, this could be useful to restore a share of immune defense, even if we know not fully effective against Omicron and Omicron 2 “variants.
“In my opinion the most correct position – adds the expert – is to wait for the data deriving from ongoing trials, and from other countries, to consolidate, so as to be able to better define which categories can benefit from the fourth dose”.
The universal vaccine
And in view of autumn? What vaccination strategy should be implemented? “A recall could be planned for the general population, as I have always wished, but with a different vaccine – concludes Maga -. I am talking about a vaccine based on a different concept than the current ones. It is already under examination (Rolling Review by Ema) , the vaccine produced by Valneva, based on the entire SARS-Cov 2 virus, inactivated, therefore killed, no longer pathogenic.A vaccine that contains all the proteins of the virus, therefore able to give an immune response against many and different components. This could also increase its ability to protect us against Omicron and possible new variants. “
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Here are which countries are doing it, Israel and the US leading the way
But which countries are already administering the fourth dose? Israel led the way. The booster is given to over 18s with medical conditions that require it or are at great risk for the effects of the virus, at least 4 months after the third dose.
And even Israeli soldiers can receive it, always if they are over 18 and 4 months after the third.
The US is also moving in this direction. On March 29, the American Food and Drug Administration authorized the fourth dose of Pfizer-Biontech and Moderna vaccine for the over 50s, as well as for some categories of immunocompromised people.
The cases of Great Britain and Spain
In Great Britain, the resurgence of infections linked to the Omicron 2 variant could convince the government of Boris Johnson and the health authorities to anticipate the fourth dose campaign already announced for mid-spring. Campaign limited, at least for now, to an audience of 5 million people aged over 75, immunosuppressed aged 12 and over and guests of retirement homes.
In Spain, on the other hand, the fourth dose is administered – at least 5 months after the last – to frail people, such as patients receiving chemotherapy or radiotherapy, transplant patients or those undergoing immunosuppressive therapy. Germany has made the same choice: it administers the second booster to the most vulnerable and to medical personnel who have contact with groups at risk.
The other countries that say yes
Then there is France. On March 12, Prime Minister Jean Castex announced the start of the fourth dose “to those aged 80 and over and who have received the third for over 3 months”. And Denmark also offers it to vulnerable people.
Hungary, on the other hand, was the first country in the European Union to administer it to the entire population. The crisis unit has given a favorable opinion for the over 18s. Minister of Labor and Social Affairs Darija Kisic Tepavcevic specified that it can be obtained 5 months after the third one, with priority given to frail people with serious illnesses.
Finally, there is Brazil: here the recommendation of a fourth dose of the vaccine is already valid for the immunosuppressed population aged 18 and over. And, in at least five states (San Paolo, Espirito Santo, Mato Grosso do Sul, Amazonas and Parà), the administration has begun.