The High Authority for Health recommended on Friday the generalization of the third dose to the population over 40 years of age in France.
An increasingly wide extension for a booster dose initially intended only for those most at risk.
However, the idea of a generalized third dose is not unanimous, including at the WHO or among some doctors, who are wondering, among other things, about the benefit / risk factor.
First reserved for people over 65 and immunocompromised, the booster dose of vaccine against the coronavirus - commonly called the third dose - was extended to over 50s by Emmanuel Macron in his speech on November 9.
Barely implemented, this extension could still be modified.
On Friday, the High Authority for Health (HAS) recommended a booster dose for all French people from the age of 40.
The scenario is classic and has already been seen in several countries that have started booster doses: the age of the eligible population is falling more and more, before affecting all adults.
This is notably the decision of the United States, where the American Medicines Agency (Food and Drug Administration, FDA) authorized the generalization of the third dose to any adult vaccinated more than six months ago.
Too many doses?
These continuous extensions are not, however, unanimous. Starting with the World Health Organization (WHO), which deplores that countries already predominantly vaccinated (89.5% of eligible people are vaccinated in France for example) use additional doses of vaccine for booster shots, while poor countries are very poorly immunized. Only 16.2% of the African population has received a dose of the vaccine, and the rate is even lower in some specific nations (0.2% of the population in the Democratic Republic of the Congo for example).
"In absolute terms, if I had only one dose, I would not use it as a booster dose", recognizes Mathieu Molimard, head of the medical pharmacology department at the Bordeaux University Hospital.
Doctor Christian Lehmann notes that, even from a selfish point of view, rich countries have every interest in giving their excess doses to poor countries in order to avoid too much viral circulation, and therefore the appearance of new variants.
Don't overplay caution
Even if we imagine keeping the doses to ourselves, the third dose is no more consensus. Already, because France has 10.5% of eligible people who have not received any dose, including 500,000 individuals over the age of 80, particularly fragile in the face of the coronavirus. "All vaccination efforts in France should focus on the first doses to fragile people not yet vaccinated, instead of launching large general recall campaigns", deplores Christian Lehmann.
If it is little debate for the elderly or immunocompromised due to a rapid drop in their immunity, the value of a booster dose in the general population leaves skeptical. Even at six months, there is no notable drop in the efficacy of the vaccine against severe forms in the general population, an argument often used to justify the booster in the elderly. What interest then of a third dose for all? "There is an increase in immunity and protection against severe forms and death, but it is already 90% and more against severe forms," recalls Mathieu Molimard.
For Christian Lehmann, nothing says for the moment that the contribution is significant for populations not at risk, to the point of launching a generalized reminder: "There is a little the same speech as with hydroxychloroquine," we do not don't know too much but it can't hurt, and we don't have time to wait with the crisis ".
No, you have to calculate and verify the benefits / risks, instead of playing the game in haste.
"
What side effects?
The question of adverse effects arises for the third dose. If the balance of benefits / risks had been conclusive for two doses, the debate is relaunched for the booster dose, due to the poor improvement in protection against hospitalizations, and the risks of myocarditis linked to RNA vaccines - particularly Moderna - among young populations, mainly boys. "Studies tend to show that a third dose has adverse effects comparable to a second dose," notes Mathieu Molimard. It is therefore largely beneficial for the elderly, for example. "
“It is of course not a question of entering into an anti-tax discourse, specifies Christian Lehmann.
But it should not be taken for granted to overdose the vaccine without asking questions.
What is the rationale for recalling a 41-year-old and not a 39-year-old?
"With the booster vaccination for all already started in other countries, notably Israel, and the third dose for the populations most at risk (diabetes, obesity, etc.), more data in real conditions should make it possible to know the true value of recalls for non-at-risk populations.
In the meantime, skepticism remains.
Health
Coronavirus: The High Authority for Health recommends a booster dose from 40 years old
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Coronavirus in the United States: A third dose of vaccine authorized for all adults
epidemic
Covid 19
Vaccination
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