While the progress of variant BA.5 causes an increase in the number of contaminations and hospital admissions in Belgium, Professor Michel Goldman (ULB) alerts the government, which according to him is showing a harmful inertia for the protection of the immunocompromised, who do not respond sufficiently vaccines, even after a second booster, as well as seniors. As a reminder, this youngest of the line of Omicron, now the majority in Belgium has the ability to partially bypass the immune defenses caused by previous infections or vaccination.
Faced with its progression, the professor of immunology believes that there is urgency. “The responses I receive from the Task Force show a harmful inaction to these patients who are not so rare,” he regrets. To illustrate his point, he cites the figures published by Sciensano for the period from June 6 to 19, 2022, which “demonstrate that current vaccination schedules are no longer sufficient to protect the most vulnerable from serious forms leading to hospitalization. This applies not only to severely immunocompromised patients but also to seniors over the age of 65. Clearly, vaccination with a single booster is no longer enough to protect them”.
“The second recall is currently authorized, so I say that in particular for seniors and even more so if they suffer from an illness which exposes them, they must speak to their doctor quickly, especially with the virus which is circulating more. We see that the people there contribute to hospitalizations (at this stage, 80% of hospitalized patients have received the 3 doses, so for some, the oldest and most vulnerable, this clearly shows that the three doses are not enough). The example of France is striking, a campaign is being conducted for that and therefore the idea of telling ourselves that we have to wait until autumn is not relevant, we are putting these very vulnerable people at risk, nothing prevents us from having another vaccine in October. The government does not care enough about the most vulnerable, they must be encouraged to take this fourth dose now. For the others, in good health, we can wait until autumn”.
Seniors less well protected
Over this same period, 288 of the 362 people aged 65 to 84 who had to be hospitalized because of Covid had been fully vaccinated plus a booster dose, i.e. nearly 80%. ; the proportion is the same for admissions to intensive care: 35 of the 44 people in this age group admitted to intensive care had received a complete vaccination plus a booster dose. “While current vaccines continue to protect very well the youngest from serious forms, they protect much less well seniors whose immune system is less efficient. for two reasons: they are less effective against variants that become dominant (BA.5), and the duration of the protection erodes over time. In addition to the recommendations of the health authorities, it is useful to remember the weapons we have to protect the most vulnerable. “, he explains.
To further improve the protection of people aged 65 and over, the professor recommends considering with their doctor a second booster vaccine now, in particular if there are comorbidities predisposing to serious forms. “This second booster will protect until the fall and will not prevent re-vaccination during the planned vaccination campaign”. And if the person has had a Covid infection in the last few months, the immunologist believes that it may be useful to perform an anti-Covid antibody assay to establish the need for this second booster.
Underused monoclonal antibodies
For the severely immunocompromised, Michel Goldman suggests measuring their level of anti-SARS-CoV-2 antibodies in the blood as soon as possible.
“And if the level is below 260 BAU/ml, the patient is eligible for Evusheld, a combination of monoclonal antibodies that will protect the currently dominant variant (BA5) until the fall,” he continues. recent study by the reputable team of Prof. Ho at Columbia University in New York indeed demonstrates that Evusheld remains active against BA5.This opportunity is insufficiently used in our country although the drug is available because the recommended dose of Evusheld not our authorities is insufficient to ensure optimal protection.The Food and Drug Administration (FDA) in the USA also clearly explains why the dose must be doubled in the face of new variants and French patients also benefit from this double dose (600mg). also insufficiently used because of the imposed constraint of prior serology (assay of antibodies against the virus). This constraint has been lifted for patients treated with rituximab but this information was not known to most prescribers until today. In fact, this constraint should be lifted for all severely immunocompromised, as is the case in France”.
By refusing to market its monoclonal antibody, bebtelovimab, outside the United States, the Lilly laboratory is also depriving severely immunocompromised patients in the rest of the world of the only “fully effective drug against new variants of Covid19 and puts their lives in danger”, judges the professor. The laboratory prefers at this stage to focus on the American market. In France, epidemiologist Antoine Flahault speaks of a “scandal” as a seventh wave hits the country, “which also applies for Belgium”, concludes Goldman.