Should the 4th dose be opened to all French people?

“Some thought it was enough to say it for it to stop,” quips Benjamin Davido, infectious disease specialist. Between the war in Ukraine and the political sequence, we had almost forgotten (with delight) the pandemic, but the Covid-19 remembers our good memories.

For several weeks, the indicators have been panicking in France. Last week, there were an average of 80,000 new cases every day, with a 50% increase over seven days. More worrying: the number of critical care admissions has increased by 20% in one week, according to Covidtracker. In this context, many wonder about the interest of making a fourth dose of vaccine.

Only French people over 60 are eligible for the 4th dose

Since March 14, 2022, French people over the age of 80 have been invited to carry out a second booster shot of the vaccine. And since April 7, the authorities have extended this possibility to all citizens over the age of 60. Without making it mandatory. And there is no question of updating a vaccine pass, according to Olivia Grégoire. Problem: for the moment, these recommendations have not found their audience. According to Santé Publique France, on June 20, “only 26.5% of 60-79 year olds and 30.1% of 80 year olds and over eligible for the second booster dose actually received it”. Hence the recommendation of the health authority to increase efforts to accelerate the recall campaign among these eligible people.

What Brigitte Bourguignon, still Minister of Health, hastened to do last Thursday: “There is a more intense circulation of the virus in European countries, therefore also in France”, under the effect of “a variant , BA.5, highly transmissible but whose symptoms are less severe than those of historical variants”. She called for “intensifying vaccination”, “the most useful weapon”. While excluding new constraints.

A more effective vaccine expected in the fall

Should this fourth dose therefore be extended to all French people? For the moment, the government is not taking the path. “This is not the problem today, slice Benjamin Davido, infectious disease specialist and vaccine referent at the Raymond Poincaré hospital in Garches (Hauts-de-Seine). This risks slowing down the process: if you vaccinate people in their forties, it limits access to those over 80 years old. We should focus on the 10 to 15 million French people who are elderly or with comorbidity rather than the others. Especially since we arrive, for many fragile people, at six months after the last injection or infection. »

Second info that explains the current dilemma: the laboratories promise a vaccine adapted to Omicron in the fall. Moderna assured last Wednesday that its bivalent vaccine protected both from the original strain and against Omicron mutations, including BA.5. Will this vaccine be effective for longer? Will it have an effect on transmission? Will he arrive in France before winter and a possible new wave? These questions remain unanswered. “If we said today “we are going to vaccinate all French people”, we would waste time, precious cartridges. We are going to discourage citizens who could have gone there in the fall, ”pleads the infectious disease specialist.

An organizational problem?

For Gilles Pialoux, head of the infectious and tropical diseases department at Tenon hospital, “this calculation is risky. We have to put the package because the 7th wave is now, and it causes a lot of absenteeism, especially in the hospital. No one knows what will happen in the fall. It is not because we are going to extend the 4th dose that we are going to slow down the vaccination of the 8 million French people most at risk. We have sufficient doses to do both, especially since the citizens are not going to rush. In some families, there can be a ripple effect. This is why he thinks that the authorities should give the possibility to those who wish to be able to do this second reminder, whatever their age.

But (re) vaccinating all French people requires organization and infrastructure that we no longer have. “It will not escape anyone that this summer, caregivers are going on vacation,” continues Benjamin Davido. We know the difficulty that emergencies encounter in filling schedules. It is therefore impossible to ask them to vaccinate and ensure permanent care. In addition, many vaccination centers have closed. “But some vaccinodromes are reopening and between pharmacies, liberals, paramedics, there are many other solutions”, nuances Gilles Pialoux. The other difficulty is that in the middle of summer, citizens leave, especially abroad, so far from their homes. So that organizing a massive campaign would not be easy. “If we vaccinate everyone all the time, beyond being fed up, it has a cost: you need doses, arms to sting and to receive! “, annoys Benjamin Davido.

Targeting the most vulnerable, elderly and with comorbidity

This is why many doctors are stepping up, once again, to encourage the most vulnerable to take their fourth dose. At the forefront of which Alain Fischer, the president of the Council of orientation of the vaccine strategy, which multiplies the interventions in the media. “Despite the cumulative effect of the injections, the level of protection [de ces populations] is no longer optimal, pleads the government’s “Mister vaccine” in the Sunday newspaper. Moreover, the vaccines remain safe: there are no more side effects during a fourth dose,” he said. “The data shows that with a fourth dose, the level of neutralizing antibodies rises to the same level as after the third. Protection against severe forms is therefore restored to more than 90% for a certain number of months. Frankly, a shot twice a year, it’s not so terrible! “.

“If we remain in this immobility, the 4th dose will not take”, regrets Benjamin Davido, wishing a communication targeted on the most vulnerable. “By telling them that the Covid-19 is coming back, and that if you do your second reminder now, you are going on a quiet vacation, you will be better off with your grandchildren or on a hike than looking for a general practitioner in the middle of summer ! Above all, it must be said that there is no contraindication to doing a booster in the fall with the bivalent if you are vaccinated today. »

Another emergency according to him: prepare this summer the infrastructures to work twice as hard as of September. “We should give a timetable, with objectives, opening dates before the fall, he warns. And quickly target those under 60 with comorbidity. »