3rd dose of Covid vaccine: vaccination in nursing homes, with Pfizer?

 THIRD COVID DOSE - The recall campaign begins this Monday, September 13. People over 65 and those at risk of severe forms of Covid-19 can make an appointment. For who? With which vaccine? Pfizer, Moderna, Janssen? What timeframe? Vaccination indications and schedule.

This booster dose is not mandatory. In addition, "the third dose of covid 19 will not have an impact on the health pass," said Olivier Véran, during his press conference on August 26. The health pass has been therefore always valid after the second dose, whether or not you make a third. Registrations for booster dose appointments are open on the Doctolib, KelDoc and Maiia platforms. For whom? How long after the second injection? With which vaccine? A messenger RNA vaccine? Pfizer or Moderna? When does the recall campaign start? What are the potential side effects?

Indications, eligibility of the 3rd dose: for whom, why?

With vaccination, "we are 8 times less likely to be contaminated, 11 times less likely to go to the hospital," said Prime Minister Jean Castex on RTL. However, recent studies suggest a reduction in the effectiveness of all vaccines, especially against the Delta variant. This decrease in protection mainly concerns infection and symptomatic forms of the disease. Health authorities and scientists are also observing a slight decrease in efficacy on severe forms that are still well covered by vaccines. This decrease in effectiveness not only affects the elderly and populations at risk of severe forms, but the latter remains the most affected. Hence the need for a booster dose of vaccine in these people (provided they have a complete vaccination pathway).

As a first step: 

On 12 August 2021, the Ministry of Health confirmed the implementation of a vaccination booster campaign from mid-September for certain categories of people:

• Residents of nursing homes and long-term care units (LTCU): the recall campaign begins on September 13.
• People over the age of 80 living at home
• Immunocompromised people. 
• People who have a very high risk of the severe form of Covid-19 including people with: moyamoya angiopathy, cyanogenic syndromic congenital heart disease with unstable heart failure, idiopathic pulmonary fibrosis, cystic fibrosis, amyotrophic lateral sclerosis (ALS), cerebral venous thrombosis, autoimmune pancreatitis...

See the complete list of rare diseases and at very high risk of hospitalization or death established by the HAS. 

In a second step:

• People 65 years of age and older
• People with comorbidities that increase the risk of severe forms of Covid-19. 

List of comorbidities: the High Authority of Health has retained the comorbidities identified in the scientific publications as having a proven risk of hospitalizations or death in case of infection of the Covid-19 virus: pathologies at very high risk of death including people with

• Trisomy 21
• transplanted solid organ or hematopoietic stem cells,
• renal insufficiency (dialysis)
• people with rare and severe pre-existing conditions or severe disabilities, 
• diabetes (type 1 and type 2), obesity (BMI 30 kg/m2),
• cancer,
• COPD or respiratory failure
• heart failure
• complicated high blood pressure
• chronic liver disease
• psychiatric disorders,
• dementia,
• A history of a stroke...

3rd dose after Janssen

For people first-vaccinated with the Janssen vaccine, the HAS recommends that they be offered a booster dose with an mRNA vaccine (Comirnaty® or Spikevax®) from 4 weeks after the first injection. The data show insufficient protection conferred by a single dose of vaccine (Comirnaty®, Spikevax® or Vaxzevria®) against symptomatic forms related to the Delta variant, and the available data do not confirm the long-term efficacy of the one-dose vaccination regimen of Janssen vaccine against the Delta variant.

3rd dose after Covid?

Currently, "patients who have contracted Covid-19 after their first vaccination regimen should not be offered a booster dose," says the Directorate General of Health.

Calendar: when does the recall campaign start in France?

► Since 1 September 2021: people over 80 living at home, those at very high risk of severe Covid-19 and immunocompromised people can receive their booster dose. 

► September 13, 2021: start of the recall campaign for residents of nursing homes and long-term care units (LTCU) 

► From the end of October 2021, from the beginning of the flu vaccination campaign (for organizational reasons): people aged 65 and over and those at risk of severe forms of Covid-19 (comorbidities) will be able to receive their booster dose. They can make an appointment "from the beginning of September," said Jean Castex on August 26 on RTL. The HAS proposes, to avoid any delay in influenza vaccination and simplify the vaccination process, to carry out the concomitant administration of vaccines against Covid-19 and against seasonal influenza. And this, as soon as a person will be eligible for both vaccinations, the majority of the priority audience of influenza vaccination also presenting risks of severe forms of Covid-19.

Registration: how to make an appointment for the 3rd dose?

If you meet the criteria (be over 65 years of age, suffer from comorbidities or have a pathology at risk and have received your second dose more than six months ago, people immunocompromised or vaccinated with Janssen), you can make an appointment now for a booster dose on the Doctolib, Keldoc or Maiia platforms. Slots will be offered depending on the vaccination location. You will have to click on the button 'You want to book only a third injection or booster dose'. Then, you will have to choose your vaccine: Pfizer, Moderna or 'without preference'. It is also possible to make an appointment directly with your doctor or pharmacy. From 13 September, a recall campaign specifically targets nursing homes and USLDs. Residents do not need to make an appointment.

With which vaccine: Pfizer or Moderna?

After analyzing the available data, the HAS proposes a booster dose with a messenger RNA vaccine. In France, the two mRNA vaccines available are the Pfizer-BioNTech (Comirnaty®) and Moderna (Spikevax®) vaccines. Regardless of the vaccine used for primary vaccination with an mRNA vaccine, the HAS considers that there is not enough argument, to date, to preferentially recommend one vaccine over the other for the booster dose, as the two available mRNA vaccines (Comirnaty® and Spikevax®) are both very effective against severe forms of Covid-19,  including those related to the Delta' variant

The delay between the 2nd and 3rd dose?

► For people, The booster dose should be given after at least 6 months after primary complete vaccination.

► For people first vaccinated with the Janssen vaccine, the booster dose should be given from 4 weeks after the first injection.

Where to do the 3rd dose?

The booster dose should be given at least 6 months after the last vaccine injection. From now on, and if this 6-month period is respected, the people concerned can make the vaccination appointment:

to their attending physician (or doctor of their choice);

in a pharmacy;

with a nurse;

in a vaccination centre

► The Health Insurance launched a postal mailing campaign in September to all people aged 80 and over indicating the procedure to follow to benefit from a booster dose or a first injection. Also communicated in the mail is the skip-the-line number to easily get an appointment in a vaccination center. This message will then be declined for 65-79-year-olds and sent to their Ameli account.

What are the side effects of the 3rd dose?

An Israeli preliminary study published on Reuters on August 8, 2021, conducted on 4,500 people who received a booster dose from July 30 to August 1, states that:

• 88% of people who received a third dose of the Pfizer vaccine 'experienced similar or lesser side effects than after receiving the second injection. 
• 31% of them reported side effects, the most common being pain at the injection site.
• 0.4% reported breathing difficulties
• 1% said they sought medical treatment because of one or more side effects.

Towards a 3rd dose of vaccine for all?

Professor Jean-François Delfraissy, president of the Scientific Council of Covid-19, believes that the third dose of vaccine will soon be necessary "for a large part of the population", he said on France 2, Wednesday, August 25. This booster dose will serve, according to him, to "restimulate the immune response to the vaccine". The HAS considers that there are, to date, no data in favor of the systematic administration of a booster dose beyond the people targeted by government announcements and its opinion. The World Health Organization does not recommend a booster dose. "We clearly believe that the current data does not indicate that recalls are necessary," WHO Chief Scientist Soumya Swaminathan told a news conference. "We have to wait for science to tell us when boosters are needed, which groups of people and which vaccines need boosters." However, the administration of a booster dose will probably become necessary in the coming months, without it being possible at this stage to make a precise decision on either the target population or the timetable. The health authority will therefore have to review its recommendations as soon as new data justify it. "In this situation, the priority should now be to vaccinate all eligible people who have not yet completed their recommended vaccination program," the European Medicines Agency said in a statement on 2 September.