Fourth dose Covid vaccine for everyone or just frail? What Ricciardi, Galli and Andreoni say

The fourth dose of the anti Covid vaccine for the frail kicks off from March 1st. This was announced today by General Francesco Paolo Figliuolo. But is a fourth dose for everyone conceivable in the future? Here’s what the experts on the subject think. Read also “As regards the fourth dose of the anti Covid vaccine we are about to give the implementing provisions because with the Ministry of Health and the Regions we are well identifying the audiences. Obviously it will be quite extensive” for the most fragile categories of people “and my indication is that we will leave on March 1: therefore we will certainly continue to keep the organization that is now in place “said Figliuolo, today in Florence, at the end of the visit to the Meyer pediatric hospital.” autumn “the fourth dose of the anti Covid vaccine” will be useful to everyone “, is the picture outlined by Walter Ricciardi, consultant to the Minister of Health, Roberto Speranza. The fourth dose for the frail, he told La Stampa, “is a start in the light of the Israeli experience, but it is likely that in the autumn it will be useful to everyone. Antibody immunity drops, but cellular immunity could last longer. We will see “.” The fourth dose of anti Covid vaccine, if made with the available products, also given the epidemiological situation, with numerous vaccinated people and an important number of people cured by Omicron, would make no sense except in a medical key: in some categories particular of the population, that is in the immunosuppressed and in the elderly in which an insufficient response to previous doses may be suspected “, explains to Adnkronos Health Massimo Galli, former director of Infectious Diseases at the Sacco hospital in Milan. Galli also invites us to evaluate another alternative, “consisting of the administration of some monoclonal antibodies for preventive purposes in those people who are unable to respond to the vaccine. Some of these drugs have been tested in this direction. It is therefore a a discussion that could open up for patients who are completely unable to defend themselves and to whom transitory protection could be given for serious illness. It is a hypothesis that deserves consideration “. The fourth dose of anti Covid vaccine for the frail and immunosuppressed “is fine because it will allow these people to have a more effective response”, while extending it to the rest of the population, starting perhaps with the elderly “it seems premature to establish it today” he tells Adnkronos Health Massimo Andreoni, head of infectious disease at the Tor Vergata Polyclinic in Rome and scientific director of the Italian Society of Infectious and Tropical Diseases (Simit). “Autumn will be a period in which there may be a greater circulation of the virus – recalls Andreoni – but already planning a fourth dose is early. And then there is the need to have an updated vaccine, or compared to the variants in circulation today,” or a broad spectrum one. It is clear that we cannot exclude, however, that a booster dose will have to be taken. We should use these months that separate us from autumn to arrive at a new formulation of the current vaccines that may have a cross reactivity, that is to act against different but very similar viruses “. Claudio Mastroianni, president of the Italian Society of Infectious and Tropical Diseases (Simit) and full professor of Infectious Diseases at the Sapienza University of Rome, underlines to Adnkronos Salute that it is “good to start now with a fourth dose for the most fragile because it is the segment of the population more delicate and that must be protected, while I think it is too early to plan this recall for everyone. “Soon we will also have a new monoclonal to be used in the preventive phase, as a prophylaxis, precisely for the most fragile and for those who do not respond to the anti Covid vaccine”, adds Mastroianni. Whether it is with an updated Covid vaccine or with the same one we have already done, in any case a recall in the autumn will be made according to the target and the anti-flu strategy. The virologist Fabrizio Pregliasco, a professor at the University of Milan, is convinced of this. “The updated vaccine is already in place – says the expert at Adnkronos Health – some companies have said that it takes 100 days to have it available. The efficacy data – underlines Pregliasco – show not very big differences compared to the current one. So it will be necessary to see . I believe it is a question of product availability, production and validation because as for the flu vaccine – says the doctor – every year a simplified but still necessary procedure of reviewing and registering the efficacy is followed “. In short, we must understand “if and when there will be the availability of doses” of the new product “or if in any case – he says – in the autumn we will do what we have with the same strategy and target of the flu vaccination”. Then a fourth dose with the vaccine based on the Wuhan virus? “It is possible but I would not speak of a fourth dose – replies the doctor – but of a vaccine booster which, as for tetanus, always uses the same drug”. After all, the vaccine we have “has a cross-reactivity so the effectiveness is there: 63% of avoiding infection and 93% of avoiding severe forms. And as we have seen from experiences on other vaccines – concludes the doctor – the fact of making a less close administration could give a more than good immune response “. “Today we know that vaccination coverage on contagion declines rapidly. Against serious disease, the vaccine allows, after 3-4 months from the booster, 90% protection. The EMA asked European countries to consider a further dose for the immunosuppressed. To date, for the general population there is no scientific evidence that says that the fourth dose is needed “says Nino Cartabellotta, president of the Gimbe Foundation, speaking at ‘Italy has awakened’ on Radio Cusano Campus.