More than six months ago almost 4.1 million Spaniards over 70 years of age received the booster dose.

A time in which his artificial immunity has faced two variants, delta and omicron, and a sixth wave with more than six million infections.

Now it's time to decide if your shields against what is to come.

From Europe, Spain has already been singled out, together with France, as the countries in which there is a significant rise in cases in those over 65 years of age.

The European Medicines Agency (EMA) and the European Center for Disease Prevention and Control (ECDC) already recommend a second dose of selective reinforcement: only for those over 80 years of age and the most vulnerable population.

In Europe, to date, nine countries recommend the administration of the fourth dose in different types of vulnerable population, such as people living in nursing homes.

These are Cyprus, Finland, France, Germany, Greece, Hungary, Ireland, Holland and Sweden.

And what does Spain do?

Except for the population included in group 7 of the Health Vaccination Strategy (such as some cancer patients, transplant recipients, on dialysis or hemodialysis, over 40 years of age with Down syndrome or who take immunosuppressive drugs) it has not yet been decided what to do with those over 80 who have been 'losing' acquired immunity for a month, "they will not have antibodies in their blood, but we cannot rule out cellular immunity, memory to fight the virus," explains Marcos López Hoyos, president of the Spanish Society of Immunology (SEI).

The problem is that the rebound that places Spain before a new wave, urges many communities to protect those who need it most.

Murcia, Andalusia, Galicia and Asturias have asked in technical meetings on Public Health and in the Conference on Vaccines that a decision be made now to cover this group.

The answer has been negative.

In a draft of the Vaccine Report to which EL MUNDO has had access, they point out three drawbacks to administering a second booster dose at the present time: pandemic fatigue, a lesser impact of this new dose, overloading the health system and waiting for autumn due to a possible seasonality of the virus.

In fact, it is thus reflected in the document: "Effect on confidence and coverage; possibility of tolerance of the immune system (less response at shorter intervals, and at a greater number of doses) that could translate into progressively less effectiveness of the doses successive booster doses; cost of administering this second booster dose, especially in terms of overloading the health system that will have to dedicate resources to vaccination; no clear evidence of "seasonalization"

of COVID, respiratory viruses circulate more and cause more pathology in autumn and winter.

Therefore, it is highly likely that a booster dose in the fall would be appropriate to prevent severe disease."

This document, as this newspaper has learned, does not have widespread technical support, because there are epidemiological reasons to protect these specific population groups and immunological reasons for loss of immunity after six months.

In fact, the latest ECDC report notes that "with regard to a second booster, the modeling shows that its implementation in some vulnerable groups could also prevent a substantial proportion of COVID-19 deaths between now and mid-autumn 2022." ".

In addition to technical dissent, not all communities are in favor.

And there is little regional pressure, which on other occasions has served to promote initiatives.

Castilla-La Mancha believes that it is necessary to continue with the technical criteria that have always been debated in the Interterritorial Council.

Madrid believes that "at the moment we have to wait."

Antonio Zapatero, speaking to Onda Madrid, pointed out this week that "sometimes, by always stimulating with the same antigen, with the same vaccine, we don't get the answer and in that sense there is also evidence".

López Hoyos, like Zapatero, and the position indicates one of the reasons for waiting: "Perhaps it is better that new vaccines be administered, that are not the same as in the booster dose."

In this case, he is referring to the arrival of the new Spanish Hipra vaccine (under rapid review by the EMA and waiting for the green light before the summer) or the new formulations from Pfizer or Moderna.

"Heterologous patterns have been shown to enhance the effect of immunization because they force the body to react differently. And that prepares a better defense response," justifies the president of the immunologists.

In fact, on the occasion of the XXI Scientific Conference on Vaccines and Public Health, held earlier this month, José Antonio Navarro Alonso, honorary consultant to the Ministry of Health, explained in his presentation the virtues of hybrid immunity in those who had received the guideline heterologous: "At the time, many did not understand that mixing two vaccines is not detrimental to obtaining a better immune response".

He did it with examples of pneumococcal and polio vaccines.

"The rationale is clear, the RNA vaccine eminently triggers humoral responses and the viral vector vaccine, what it does are better cellular responses. If we mix the two, we have the best of both," said Navarro, also a member of the Group of ECDC Vaccines.

In addition, in the presentation he also mentioned that over time "we have observed and learned that, the longer the interval between doses, at least in primary vaccination, the greater the generation of antibodies."

While the moment for the debate of this document in the Public Health Commission arrives, already in the first week of May, the position of Health, through the Conference on Vaccines, is not to recommend the inclusion of an additional booster dose , "but continue to assess weekly the epidemiological situation of COVID in the most vulnerable groups (especially in nursing home inmates and adults aged 80 and over) and based on it, establish the appropriate recommendations to protect this vulnerable population from serious illness by SARS-CoV-2".

In these assessments, it must be taken into account that of the more than 280,000 in the last month, according to the Health reports of the Center for the Coordination of Health Alerts and Emergencies (CCAES), 44% correspond to people over 60 years of age.

In addition, according to the recent report of the Respiratory Infection Surveillance System, a hospitalization rate for Covid-19 is estimated at 3.9 cases per 100,000 inhabitants compared to 2.9 cases in the previous week.

And, it underlines that the highest rates are observed in people aged 80 or over: 28.9 cases compared to 24.7 in the previous seven days.

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