Health opens the debate on the fourth dose for the entire population, although experts believe that it is not justified

Neither will there be a fourth general dose of the COVID vaccine – for the moment, at least – nor has the vaccine report recommended it, nor is there evidence that it is necessary. "There is no scientific evidence [que justifique esta medida] nor therefore can it be recommended", sums up Amós García Rojas, president of the Spanish Association of Vaccinology and head of Epidemiology of the Canary Health Service.

The second reinforcement puncture will remain as it was for the moment: for people over 80, for immunosuppressed people and for users of residences, as approved last weekas confirmed by the Ministry of Health.

Experts say that at the moment the second booster dose (fourth in total) is not necessary for the entire population. "I see it as necessary for vulnerable groups that will need to be more protected against possible variants," says Inmaculada Cuesta, a retired nurse and member of the technical working group for vaccination against COVID-19 of the Ministry of Health, "but as soon as to the general population at the moment we are fine as we are", he adds.

Sonia Zúñiga, a virologist at the National Center for Biotechnology, explained to the Science Media Center Spain that "we will have to see if it represents an advantage in the rest of the population. At this time it does not seem that the usefulness of a fourth dose in the entire population will go to be very high, given that you are already protected from severe disease, as evidenced by the constant current numbers of hospitalizations and ICU admissions. In addition, the high circulation of the virus these weeks, generally with mild symptoms, is reinforcing general immunization, "so it would not make much sense to give them a fourth dose in the fall-winter," he explains, alluding to the fact that it is recommended that six months between infection and a booster stick.

This Thursday has been a confusing day. Minister Darias generated a little chaos when announcing in the morning on La Sexta that there would be a fourth dose for the entire population. The phrase of the person in charge of Health did not leave much room for interpretation: "There will be a fourth dose for the entire population, this is how the Public Health Commission has decided; what remains is to decide when. Probably, a date that can be considered as possible around the fall, and also because we are waiting for the arrival of new vaccines adapted to variants by that time, as is stated in the contracts that the Government of Spain has signed through the European Union with pharmaceutical companies," he explained. .

The news jumped to the covers of the media because it was a novelty: the only thing approved at this time is a booster dose for people who are immunosuppressed and for people over 80 years of age. It was also incorrect, although it would take the Ministry four hours to clarify it.

Voices had already come out denying the minister. Sources from both the vaccine presentation and the Public Health Commission explained that what was approved was not the fourth universal dose, but rather the acquisition of vaccines to cover the entire population in case at some point it is decided that a new vaccine is needed. prick for everyone.

Health slipped in the afternoon, however, that the entire population will receive a fourth dose, although the technical groups (and politicians) that must propose and approve this decision have not even discussed it.

Members of the vaccine conference argued that this group of experts had not made any proposal to modify the strategy, a step prior to the Public Health Commission modifying it. Neither had it been proposed to change it nor, in fact, had there been any talk of expanding the fourth dose to the general population.

"The European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) issued a joint report on April 6 in which the scientific evidence on the need and potential benefits of administering this second booster dose (or fourth dose) is reviewed. Based on the available evidence from Israel, both agencies agreed that a fourth dose (or a second booster) can be administered to adults aged 80 and over, although there is no evidence that this vaccination is necessary below this age" argued the last document prepared by the paper, from last week. "There is no clear evidence to support the immediate use of a fourth dose," the European agencies maintain.

In addition to the lack of evidence, the specific Spanish situation is not worrying, the document continues: "A high incidence rate with low impact on hospitalization is observed in the population aged 60 and over and in nursing homes." According to that report, all these age groups have lower hospital and ICU admission rates today than in the first weeks of the year.

All the evidence points in the same direction. Reports on vaccine effectiveness (EV) support the reasonable overall performance of vaccines, which lose some efficacy with time and age. "EV against severe disease remains high, with a slight decrease in EV against hospitalization observed over time, especially in people aged 80 and over," explains the report approved by the Public Health Commission, which clarifies that the omicron variant had a certain impact on this factor, but at the same time recalls that a booster dose managed to raise the antibody levels "to levels similar to those observed at the beginning of the vaccination program".

Similar messages arrive from Europe, although the authorities are asking the corresponding agencies to review their indications in this regard. The European Commissioner for Health, Stella Kyriakides, explained this Tuesday before the EU Health Ministers the position of the Community Executive on booster doses: "We have asked the ECDC and the European Medicines Agency (EMA) to update the recommendation on additional booster doses before the winter period," said the Cypriot: "We expect that the booster dose will be necessary in groups at higher risk of severe disease, such as those over 60 years of age or medically vulnerable populations.

"In the meantime," Kyriakides said, "we continue to urge ministers to continue vaccinating those who have not yet completed the full course and first booster dose before the fall and winter season." Without going specifically to Spain, this last comment appeals to our country: there is talk of the fourth dose when almost half of the country has not taken the third (there is 47% without the booster).

The Commissioner for Health also referred to the evolution of vaccines and the possibility that the next ones to arrive are adapted to the different variants of SARS-CoV-2: "We are working intensively with manufacturers to adapt the supply of vaccines and ensure an optimization of supply and demand conditions for vaccines. This means postponing dose deliveries to after the summer, when Member States will likely need them, and hopefully in the form of tailored vaccines if they are authorised."

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