Vaccination against Covid-19: how to speed up the campaign for the second booster dose? – franceinfo

“You have to get vaccinated when you’re fragile, and you have to do it now.” The new Minister of Health, François Braun, knows emergencies well. As soon as he entered the government, the emergency doctor had to look into a burning situation: the new wave of Covid-19 contaminations. It threatens to spoil the summer holidays, but above all to saturate the hospitals again, which are already suffering the consequences of an unprecedented lack of staff. Facing the deputies of the law commission, Tuesday July 5, François Braun did not announce new measures, but encouraged the French to put on the mask and to make a new injection of vaccine against Covid-19. >> Follow the evolution of the seventh wave with our infographics
More than 18 million French people are entitled to a second booster dose (which is generally their fourth, after two initial doses and a first booster). These are immunocompromised people, over 80s since March and over 60s since April. Sunday, July 10, however, only 3.7 million second booster injections had been performed, including 3.2 million by people aged 60 or over. A finding that is beginning to worry the government, at a time when nearly 129,526 positive cases on average have been detected daily for a week. “The dynamic must be further amplified”, hammered François Braun to the Assembly on Tuesday. On July 1, the directors of Ehpad received an alarming letter from the outgoing minister, Brigitte Bourguignon, about the “clearly insufficient” levels of vaccination of their residents. According to the ministry, only 51% of them had then received their second reminder. Pascal Meyvaert, president of a union of coordinating doctors and geriatricians, is “extremely surprised” by this figure. According to the feedback from its members in nursing homes, refusals are rare. Like others, he suspects the ministry of not counting residents recently tested positive for Covid-19, who must wait three or six months (for those under 80) before receiving a new dose of vaccine. At the beginning of July, more than 3 million people eligible for the second reminder were in this situation. Still, the majority of people affected by this vaccination campaign did not take the plunge. The specialists interviewed by franceinfo are however unanimous on the interest of a new injection in order to strengthen an immunity which decreases over time. A mechanism explained by Sandrine Sarrazin, immunologist at Inserm: “By soliciting the so-called ‘memory’ lymphocytes, which were activated during the first encounter with the virus via infection or vaccination, current vaccines continue to protect very well serious forms of the disease. Sandrine Sarrazin, immunologist at Inserm at franceinfo Nevertheless, vaccination alone will not stop the wave: current vaccines, designed to target the initial strain of Covid-19, are less effective in preventing infections linked to variants such as BA.5, more contagious and now the majority in France. But “the goal is no longer to prevent the circulation of this virus, which is often benign,” said epidemiologist Yves Buisson. It is “to do everything possible to prevent the hospital from being again saturated with serious cases that are difficult to take care of”, judges the president of the Covid-19 cell of the Academy of Medicine. The French eligible for this second booster, and who have therefore received the previous doses, know a priori the benefit of vaccination. But in the field, doctors face new resistance. “This morning, one of my patients refused the vaccine because she was afraid. However, she had no side effects after the previous injections”, says Agnès Giannotti, president of the MG France general practitioner union. According to the feedback from his colleagues, the candidates are “jostling at the gate” in certain rural regions. But in her office in a popular Parisian district, she fears having to throw away part of the bottle she opened, for lack of volunteers. “People are in denial,” agrees Pascal Meyvaert. “During the holidays, they want to think about something else. The speech is: ‘I will do it when it is mandatory’.” Pascal Meyvaert, coordinating doctor in Ehpad at franceinfo How to convince them not to wait? “Information and explanation remain the main solutions,” said Emmanuel Rusch, president of the French Society of Public Health. The epidemiologist is surprised at the “floating” in the speech of the authorities: “We can speak of weariness but, if we do not mobilize, we give the feeling that we can turn the page on the epidemic.” An observation shared by Yves Buisson: “Of course, the war in Ukraine and the elections mobilized the media and attention, but the essential messages should have been maintained”, as much on barrier measures as on vaccination. The idea of ​​offering this booster dose at all ages, to maximize vaccination coverage, is more debated. “Now that we have doses for everyone, I wonder why we respect the same order as at the start of the vaccination, wonders Sandrine Sarrazin. We should be able to offer it to everyone.” Especially since the risk is not limited to the elderly, recalls the immunologist: “We realized that some patients have a genetic predisposition to have severe forms or long Covids.” “It is not now that I will launch the campaign”, answers Michaël Schwarzinger, doctor at the Bordeaux University Hospital, author of several studies on behavior in the face of vaccination. He fears that in the middle of vacation, the calls will be ignored by the youngest. “For them, it’s not an emergency,” agrees Yves Buisson, who finds it more useful for healthy young adults to wait until fall and “second-generation” vaccines designed to fight newer variants. of the virus. “In the event of a recall, with the new vaccines, adapted to the BA.1 variant, the results show two to three times more antibodies for Pfizer, and five times more for Moderna”, notes Olivier Schwartz, director of the virus unit. and immunity from the Institut Pasteur. But these results have not yet been confirmed by independent analyses. And we must already “put them into perspective”, warns the researcher: since their conception, the BA.1 variant has been supplanted by BA.5, which is even more resistant to antibodies. The urgency is greater, on the other hand, for people under 60 with comorbidities. During previous vaccination campaigns, carriers of pulmonary or cardiac pathologies or who suffer from diabetes were given priority. Today, unless they are immunocompromised, they do not have the right to a second booster, contrary to what the High Authority for Health recommended in May. A serious error in the eyes of Yves Buisson. “People who have comorbidities should be eligible! We don’t talk about it and I can’t explain it. For me, it’s an unjustifiable fault.” Yves Buisson, epidemiologist at franceinfo Especially since the authorities’ discourse is ambiguous. On Tuesday, the Minister of Health also cited “people who have chronic pathologies” among those to whom vaccination is open, contradicting the information available on the site of his ministry (asked, his cabinet did not answer us). Alain Fischer, president of the orientation council for the vaccine strategy, even affirmed on June 30 on France Inter that “if someone wishes to receive their fourth dose and they are not 60 years old, they can do so”, without such eligibility having ever been announced. In practice, some doctors explain to franceinfo that they will give the injection to a young patient who needs it, but others recall the legal risk incurred in the event of a problem. Another strategic category is also left out of the vaccine campaign for now. “In my opinion, volunteer caregivers must be vaccinated with the second booster, especially in emergencies”, pleads Mathieu Molimard, head of the pharmacology department of the Bordeaux University Hospital. Not so much to avoid transmissions as to save themselves sick leave in establishments which, like his, are already sorely understaffed. “Right now, it’s dropping like flies,” he says. Paradoxically, the outbreak of contamination could be the best ally of vaccinators at the start of summer. “When the media have explained for a month that the intensive care units are full of elderly people, the patients will go for their fourth dose”, estimates Michaël Schwarzinger. “For the past fortnight, it’s true that I have had a few patients who, during consultations, have asked me for a booster dose”, rejoices Pascal Meyvaert. A quivering that begins to be seen on the curves of the number of injections. But which is still far from resembling a wave.