Covid-19, do we need a third dose of vaccine for everyone?



“It would not be efficient”

Yves coppieters

Director of the epidemiology and biostatistics research center of the School of Public Health of the ULB (Free University of Brussels)

From a scientific point of view, the interest of a third dose remains to be proven. We now know that the general population is protected for ten to twelve months after the second injection, perhaps longer – time will tell. As for the delta variant, it does not call into question the effectiveness of the vaccines. If, however, new mutants appeared, a new messenger RNA vaccine would have to be developed, adapted to their characteristics. It would then not be a third dose but a first dose of another vaccine. Considering now a recall for the entire population is therefore very premature and, in my opinion, is a communication error, because it gives the impression that we have entered a continuous process of vaccination. It’s discouraging.

Such a “boost” can however be justified for the elderly, on the one hand because they lose their antibodies more quickly, and on the other hand because, in certain cases, their immune reaction is not optimal. However, offering a third dose to all nursing home residents without distinction, as France intends to do from September, does not appear to be relevant. Many elderly people have already received two doses at the beginning of the year, when they had contracted the Covid and could have been satisfied with one dose. Stimulating their immune system even more would be pointless. There is also an ethical aspect: why use doses of vaccine for people who do not need them? Making this distinction seems necessary to me, even if it would involve all the logistics, in particular serological tests.

I fully agree with the Director-General of WHO when he says that rich countries are showing selfishness by already considering third doses, when other less well-off countries still have insufficient access to vaccines. Governments have yet to realize that this pandemic must be managed globally, not just out of altruism but out of common sense. Because letting the virus circulate elsewhere, even far away, is to risk seeing it return to us like a boomerang.

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To return to the national level, a good public health policy must distinguish the question of effectiveness from that of efficiency. Initially, the rich countries vaccinated massively, we set up large vaccination centers and, in the case of France, made this act free without worrying about the costs. In a context of acute crisis, this logic of efficiency was fully justified. But now that we know this lasting crisis, we must seek efficiency. Investments cannot be made indefinitely, they must be part of a sustainable strategy and be proportional to results. The administration of a third dose, in addition to not having proved its effectiveness, does not meet this criterion of efficiency.

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