Fourth dose also for young people? “I wouldn’t just look at the recommendations of the EMA”

According to the words of the Minister of Health, Adam Niedzielski, we are approaching the climax of the sixth wave in Poland. Meanwhile, huge numbers of citizens are not adequately protected against COVID-19 – a long time has passed since they took the third dose of the vaccine. Is it worth waiting for autumn with the release of the fourth? Dr. Michał Posobkiewicz, former Chief Sanitary Inspector, comments on the topic in an interview with PAP.

1. The effectiveness of COVID-19 vaccines declines over time
2. It is now possible to take the fourth dose (second booster)
3. In Poland, it is available only to people aged 60+ and with reduced immunity
4. More current information can be found on the Onet homepage.

From July 22, it is possible to sign up for a vaccination with a second booster dose for people over 60 years of age. It’s a good idea? Maybe it would be better to wait for the vaccine to be updated with the new variants?

Dr. Marek Posobkiewicz, former Chief Sanitary Inspector: Today we know that neither disease nor vaccination gives full immunity forever. Our body “remembers” the existence of the virus when it comes into contact with it, but we never know what the reaction will be if it becomes infected. We can also “remind” him of this virus by vaccination. As shown not only by the history of vaccination, but also by our pandemic, which has been going on for over two years, it is much better to get vaccinated, because the mortality rate has decreased significantly since the emergence of vaccines. Before the vaccination era, every 50th person exposed to the virus died, i.e. the mortality rate was around 2%. This, in the case of several hundred million people infected, resulted in several million deaths worldwide. Today, in the vaccine age, the mortality rate is a fraction of a percent – somewhere between one-hundredth and one-tenth. This shows that it is better to protect yourself and get vaccinated.

So it is better to take the second booster now, even if it does not offer such resistance to the new variants?

We must remember that there is such a thing as cross resistance. On this principle, a very simple vaccine against smallpox was produced years ago. In the case of smallpox, the death rate was around 30%, and in some communities it was over 90%, which resulted in the extinction of entire towns. However, it was noticed that the women who milked the cows suffered from smallpox infection with little or no disease. Someone then noticed that the cows also had smallpox, i.e. the so-called krowianka. It is not terribly virulent for humans – it causes mild symptoms. However, contracting a cowpox infection resulted in a person having cross-resistance to a similar virus, which was the smallpox virus.

Is this also happening in the case of COVID-19 and its mutations?

If we are dealing with different variants, there is always some resistance. While waiting for a vaccine to appear targeting the new variant in a few months’ time, this variant may be replaced by another one circulating in the environment. It is much more logical to vaccinate with the next booster dose if many months have passed since the previous vaccination – in order to have this immunity refreshed. Our body will cope with exposure to the virus worse if many months have passed since the last vaccination. It seems to me that what people often perceive as being infected with the new variant, caused by the immunity being missed from the previous vaccine, is in fact because too many months have passed since the previous vaccination and the body did not inhibit the virus at the outset.

In that case, what to do with the group of people under 60? Also introduce the possibility of accepting a second booster now, or can it wait for the next recommendations of the European Medicines Agency?

I wouldn’t just look at the recommendations of the EMA or the WHO. It is clear to me that in the coming weeks, further booster doses for younger people should also be released so that they can get vaccinated before the fall season. There are already a lot of infections in the world. There are also a lot of these infections in Poland, more than the official statistics provide. If we wanted to release these booster doses in the fall, when there is another, very high wave of infections, then it will be too late because all of them will not get vaccinated at the same time. It would be much better if booster doses were made available for the next age groups in the coming weeks.

You said that there are more infections than the official statistics. Should the same return to population testing?

We must be aware that we are in a completely new reality. Then, especially in the first year, we were in the pre-vaccination era, when the only possibility of protecting ourselves was distancing ourselves, thorough disinfection, and face protection. It was important to limit the spread of the virus and limit its importation into our body. The virus showed for the first few months, for the first year, that these barriers were not able to stop it completely, but managed to effectively slow down its spread. Currently, vaccination is far more important in terms of safety than mass testing. Mass testing will not prevent anyone from becoming infected, and if we have a fresh vaccination status, the likelihood of infection will be minimal.

In this new reality, when the peak of infection is approaching, countermeasures will be useful – such as wearing masks in public places, limiting the number of people allowed to stay indoors or lockdown?

If there are a large number of infections, some restrictions will be helpful. It doesn’t matter if it’s going to be a lot of COVID-19 infections, or the flu or any other virus that may emerge. We should counteract such free spread. There is absolutely no point in introducing a lockdown at this stage. On the other hand, introducing such restrictions, which have been in many Western European countries – entry to cultural, sports and gastronomic facilities for vaccinated people, when everyone has already had the opportunity to receive the vaccine – would be perfectly justified. But definitely not lockdown.

Let’s go back to the new variants. Now there is a lot of talk about BA.4 and BA.5, but is it possible to predict what awaits us in the fall? Will there be an even more infectious mutation?

It is normal for viruses to mutate. This is a known phenomenon in nature. As a rule, if a virus is more contagious, then its virulence is less. Viruses with less virulence displace more malignant variants from the environment. I would see more of the possibility of milder versions of the coronavirus emerging. Of course, nothing precludes the emergence of a more virulent version of COVID-19 or other viruses. Influenza viruses mutate every so many years and there are slightly more virulent ones, causing more severe pneumonia and more deaths than in previous seasons (PAP).

Author: Aleksandra Kiełczykowska

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