Friday, October 7

The fourth dose of covid-19 arrives: the keys to vaccination


A health worker administers the third dose to a resident in September of last year. / Eph

Three million residents in nursing homes and over 80 years of age will be able to receive the second reinforcement puncture from Monday

Alvaro Soto

The fourth dose of the vaccine against covid-19 will begin to be inoculated from Monday throughout Spain. The situation of the covid-19 pandemic has never been better than now, with the accumulated incidence and the occupation of ICUs at a minimum (although in September there are still 62 deaths on average per day), but on the horizon they may appear complications, such as a possible increase in cases in the fall or the appearance of new, more contagious variants; some risks that will be mitigated in part with this second reinforcement puncture, which comes with some novelties compared to the previous ones, and also with some fears.

Who will now receive the fourth dose?

At first, the vaccine will be administered to three million residents in nursing homes and those over 80 years of age, although the Public Health Commission has given its approval that all those over 60 years of age can progressively receive the injection, the rest of residents in centers for the elderly and other centers for the disabled, those under 60 with risk conditions and health personnel. Some communities anticipate that vaccination can be started in those under 80 years of age within two weeks. In addition, some 350,000 immunosuppressed people (people who have received transplants, are being treated for cancer or are over 40 years of age with Down syndrome) have already been inoculated with the fourth dose.

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What vaccines will be given?

Here are some of the most important changes. This time, the health authorities will administer vaccines adapted to the omicron variants, called bivalent. The Minister of Health, Carolina Darias, said that Spain already has 10 million doses and expects to receive up to 44 million before the end of the year. As detailed by the European Medicines Agency (EMA) when it approved the new compounds on September 1, “these vaccines are adapted versions of the original Comirnaty (Pfizer/BioNTech) and Spikevax (Moderna) vaccines intended for to attack the ómicron BA.1 subvariant, in addition to the original strain of SARS-CoV-2.

Vaccines are tailored (ie updated) to better match circulating variants.” The European agency reminds that these doses are highly effective if the full guideline has been received before. Regarding side effects, the trials suggest that they are similar to those of previous vaccines, “mild and short-lived.” “The new compounds offer spectacular results,” confirms Rafael Bengoa, former director of Health Systems of the World Health Organization (WHO), who anticipates that next year’s vaccines will already be intranasal.

Where will you get vaccinated?

Except for catastrophe, the images of the queues in the great ‘vaccination centers’ seem to have gone down in history. This time, the inoculations will be carried out in nursing homes or health centers, by appointment.

Will it coincide with the flu campaign?

According to the calendar of the Ministry of Health, the flu vaccination campaign will begin between September 26 and October 17, depending on the availability of vaccines. In this way, communities that already have doses of the flu will be able to administer both, one in one arm, and the other in the other. And even the covid and flu vaccines can also be administered together with others, such as the pneumococcal vaccine.

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Why will the fourth dose be given now?

“There was a moment, before the summer, with the incidence going up, that seemed propitious to administer the fourth dose. But paradoxically, we are going to inoculate it now, that we are in a good situation, ”says Fernando Moraga-Llop, vice president of the Spanish Association of Vaccinology. Months ago, Carolina Darias hoped that the fourth dose could be inoculated with the Spanish Hipra vaccine, “which, moreover, being from another pharmaceutical company, would have served to comply with the recommendation of the heterologous guideline,” Llop stresses. But this objective has not been met because the EMA has not yet given its approval to the Catalan pharmaceutical compound. In any case, here too the ‘better late than never’ applies and the fourth puncture is still necessary. “These vaccines will serve to prevent serious diseases,” highlights the vaccinologist.

Vaccine fatigue, the great fear

Spain has been an exemplary country in vaccination against covid, with a rate of 92.8% of vaccinated with the first two doses. But in the third puncture what experts call ‘vaccine fatigue’ has begun to be noticed and the rate of those who have this first booster dose has fallen, although not among those over 70 years of age, where it is at 92.6%, that is, almost everyone who has the second has also received the third. “But there is a risk that fewer people will wear it now,” says Llop.

“The good evolution of the pandemic and debates such as the end of the mask in public transport can mean that certain people do not see it as necessary,” says this specialist. “We are going into a winter in which covid-19, influenza and syncytial viruses are going to coexist, and some people are very vulnerable because these viruses have not passed through protection measures in recent years. All this can stress the health system », indicates, for her part, Bengoa, who calls for an « aggressive campaign » to encourage vaccination.

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