Should the 4th dose of the COVID vaccine be taken for people 60 and over?

More than 76,000 appointments were made for a fourth dose of the COVID-19 vaccine on Wednesday, the first day that those 70 and over had access to it. Those 60 and over will be able to get it on Monday. Should they try to receive this second booster dose as soon as possible? Or should they wait? The opinions of the four experts consulted by The duty diverge.

The acting National Director of Public Health of Quebec, Dr.^r Luc Boileau, announced Tuesday that people aged 60 and over could have access to the fourth dose if they wish. However, he did not make a recommendation. “We don’t tell people [de 60 ans et plus] that it is absolutely necessary to get vaccinated right away, he said. You normally have to wait a good 5 months, at least 4 or 5 months [entre les doses]. »

However, Public Health allows Quebecers aged 60 and over to receive a fourth injection three months after the third. What to do in this case?

Nathalie Grandvaux, director of the CHUM’s Laboratory for Research on the Host Response to Viral Infections, does not believe that people in good health should rush to receive this fourth dose.

“We are in the middle of the sixth wave, if the appointments are spread out, it will take a few weeks before people are vaccinated and we will have passed this wave, she explains. For someone who doesn’t have a comorbidity or immunosuppression, I would wait at least the [délai de] 4 or 5 months [depuis la troisième dose] to get the fourth. This would lead to the end of April or the end of May, considering that those 60 and over could receive their third dose from the end of December.

However, Nathalie Grandvaux recommends that those who suffer from comorbidities (eg diabetes, cardiovascular problems, etc.) take advantage of the fourth dose now. She cites a recent Israeli study that looked at its effectiveness in people aged 60 and over, compared with that of the third dose.

“What they observed is that there is still an advantage to having the fourth dose for protection against severe symptoms of COVID, indicates Nathalie Grandvaux. This protection held for at least six weeks — the longest period for which they have data. On the other hand, we see that the improvement in protection against infection is really very temporary. »

Virologist Benoit Barbeau, for his part, believes that all Quebecers aged 60 and over have an interest in receiving the fourth dose as quickly as possible, even if the sixth wave has already begun. “We don’t know how long it will last,” he said. When people receive their booster dose, they will be protected ten days later. We might as well put the odds on our side. »

A personal choice

Maryse Guay, professor at the Faculty of Medicine and Health Sciences at the University of Sherbrooke, points out that people aged 60 and over who have received three doses have “fairly good protection” against COVID-19.

In people aged 80 and over, the effectiveness against hospitalizations is 71% 20 to 23 weeks after the third dose, indicates a recent opinion from the Committee on Immunization of Quebec, of which she is a member. “If it’s effective in older people, it’s all the more effective in younger people,” says Dr.^D Guy.

According to her, the decision to take the fourth dose is personal. Several factors must be taken into account, such as our state of health, our “level of concern” about COVID-19, our reaction to other doses and whether or not we have had an infection.

“If someone feels safe enough, feels able to take all other measures [de protection] and says to himself, “Well, I’m ready to wait until the fall”, maybe that would be a good solution, says the D^D Guy. It’s not the same situation for a 73-year-old who has several chronic illnesses and who says to himself, “Well, if I have a BA.2, that wouldn’t be funny”. »

The D^r Gaston De Serres, physician-epidemiologist at the National Institute of Public Health of Quebec, believes that “the benefit of an additional dose” for 60 to 79 year olds “is not clear”. “We are in a wave,” he said. In May, we will start or we will already be in the descent of the wave. At that point, the benefit of vaccination during a period of low incidence becomes much less attractive in the short term. He recalls that the virus circulates less during the summer.

The Comité sur l’immunisation du Québec, of which he is also a member, recommends planning a recall campaign against COVID-19 either at the beginning of September or around mid-October 2022.

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