Monday, September 20

Reasons for the third dose fever in rich countries: fear for the vulnerable and pressure from pharmaceutical companies

The third dose of the COVID-19 vaccine has passed in two weeks from being questioned by scientists for being rushed to be approved by countries with just half of their population vaccinated with the full schedule. Austria, France, Germany and the United States have followed in Israel’s footsteps and will give the booster dose (or booster) to its most vulnerable.

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Viruses are not the only thing spreading at high speed around the world. There are controversies or debates that start in a residual way and spread until giving rise to a collective fever as in the case of the third dose in the West. The third puncture is not only a decision already taken in several states, but also debated. In Spain it frequently comes to the fore when the measures to be taken with the small percentage of people who have not generated a good immunity are considered. Above all, among the immunosuppressed and inmates of residences. This last month there has been an increase in the incidence among older people already immunized, but health workers and geriatricians warn that the conditions are much less serious and that most of those admitted are among the unvaccinated. Still, reducing the death curve remains the pandemic’s priority. This is also why some countries have decided to prevent with the third dose.

“If the protection of the elderly is declining, it is necessary to monitor them very closely because we are not going to wait for more people to die. We must make decisions in anticipation of that,” believes instead Isabel Solá, a virologist at the CSIC and director of one of the Spanish vaccines. “But I would not say that you have to start giving them a third dose tomorrow, I think it is still premature,” he admits. The Community of Madrid has spoken openly of the need to administer it to the “immunosuppressed” and, although the Minister of Health, Carolina Darias, advanced that it would surely be necessary, the Government has not endorsed it yet.

Health has decided to wait until there is no more scientific evidence of the duration of immunity and the benefits of the booster. “The organizations that make these decisions are not the ones that are obsessed with it, rather the pharmaceutical companies, which have already started with the trials. Another thing is that this is used as a defense for the third dose,” says José Martínez Olmos, former secretary of Health and expert in Public Health. In fact, the WHO ordered to delay the booster dose in the rich part of the world until the immunization of the most impoverished one was guaranteed. Only 1% of the population in developing countries have received a dose.

“The third dose cannot be ruled out for the future but it is not scientifically confirmed or endorsed by regulatory bodies for the present. So, a third dose in developed countries now or a first in poor countries right now?” wonders Amós García Rojas, president of the Spanish Society of Vaccination (AEV). But some have already chosen. “Israel is not comparable with the European countries. I am not in favor, but the information that comes from Germany or France can be useful to us”, recognizes Martínez Olmos. “Although if we want to end the pandemic, the key is vaccination with universal access,” he concludes.

Which countries will administer the third dose and when?

The United States on Thursday authorized the administration of a third dose of the Pfizer and Moderna COVID-19 vaccines to immunosuppressed people, that is, with weaker immune systems. It is, according to this regulatory body, a “small group” of people, made up of organ transplant recipients or “those who are diagnosed with conditions that are considered to have an equivalent level of immunosuppression,” according to the FDA, the US Food and Drug Regulatory Agency.

The rate of vaccination in the US, where denial groups have taken over the debate, is not the fastest. According to data from the Center for Disease Control and Prevention (CDC), 59.2% of Americans have received at least one dose and 50.2% the full regimen. Returning to Europe, the three countries that have already announced that they will inject it are Germany, France and Austria. The first has 56.2% of the population fully immunized, the second 53.2% and the third 55%.

Austria will begin in October to refresh the immune protection of people who received the second injection nine months earlier. “The plan is to start with October 17,” announced Austrian Health Minister Wolfgang Mückstein. French President Emmanuel Macron said that in September vaccination will focus on “people over 80 years old and particularly vulnerable.” In Germany, also in September, the third dose will be given to people who meet age and risk criteria, and who have received the last dose more than six months ago.

“A third dose only seems reasonable to me if it is endorsed by the European Medicines Agency (EMA) and if it is a specific group and not in a general way”, defends José Martínez Omos. “A policy coordinated and ordered by Europe means that there is no inequality. We are going to finish doing what we have to do first and if we have an immunity problem among the most vulnerable, we raise it. But eight months are hardly any experience,” he thinks the expert. However, a week ago the European Commission stepped aside and expressed that the decision to put a dose or not booster it corresponded only to the member states.

A fever generated by the pharmaceutical companies?

Pharmaceuticals were the first to talk about the third dose months ago. The CEO of Pfizer / BioNTech, Albert Bourla, gave it a glimpse last April and even launched into pointing out when it was supposedly needed. Its global clinical study has been in phase III since last July, so the results will not wait. The third dose, the company advances on its website, “has the potential to preserve the highest levels of protective efficacy against all currently known variants.” Moderna, too, announced months ago that it was immersed in booster vaccine trials against upward variants.

José Antonio Forcada, secretary of the Spanish Association of Vaccination (AEV) describes as “unquestionable” that the message has been placed on the agenda by pharmaceutical companies, which have exponentially increased their economic benefits with the sale of vaccines. For the expert, it is “obvious” that these are private companies that “have their interests, which are based on making money”, but he regrets even more than governments and politicians buy so easily the speech and help to amplify it strongly.

When the CEO of Pfizer leaves and begins to talk to us about the third dose, some concern is generated, but when the Minister of Health also leaves, the fever, which they have created themselves, increases. We cannot get carried away by gimmicky messages.

Jose Antonio Forcada
– President of ANENVAC

“When the CEO of Pfizer comes out and begins to talk to us about the third dose, a certain concern is generated, but when the Minister of Health also comes out, the fever, which they have created themselves, increases. We cannot get carried away by gimmicky messages, we must let science and experts speak, “says Forcada, who celebrates the statements of the Minister of Science and Innovation, Diana Morant, qualifying Darias’s words and ensuring that Spain does not think of a third dose “as long as the scientific community does not have clear scientific evidence that it is necessary.”

It is currently a possibility that is being studied. What will have to be known to make the decision is how long immunity lasts, and not only based on the production of antibodies, but also on other possible protection mechanisms such as cellular immunity. “As we collect more data and studies, we can then decide whether or not it is necessary. Probably, rather than an indiscriminate injection of the third dose, it should be limited to certain populations at risk, for example immunosuppressed people ”, explains Forcada. We must not lose sight of the fact that immunity can be lost and it is better that we anticipate now that things surprise us in three months, “adds Solá.

In this scenario, experts agree that the debate on the third dose cannot cloud what has already been scientifically proven: that those people who are not immunized should still get the two pricks in a context of still important community transmission in Spain, and even more so. in impoverished countries, which see the pressure growing to inoculate the third while only 1% of their population has received one. Hence, the WHO has requested a pause in the third dose to the countries that dominate the supply, but which for now has been ignored by both the European Union and the United States.