Health and communities propose injecting the third dose to people with cancer and elderly people in nursing homes

The third dose of the covid vaccine targets new groups. The Ministry of Health and the communities will propose this Thursday in the Public Health Commission to inject an additional dose of the drug against the coronavirus to people on hemodialysis, patients undergoing cancer treatment, individuals over 40 with Down syndrome and the elderly in residences. All of them join the first group to which an additional puncture was indicated, which are severely immunosuppressed people, a group that the health authorities consider is not sufficiently protected with the traditional vaccination regimen and requires one more injection to complete their cycle . In the absence of approval in the commission that brings together Health with all the autonomous general directors of public health, the communities have given this Wednesday in the Interterritorial Council the endorsement to extend the third dose to these groups.

The Minister of Health, Carolina Darias, explained this Wednesday after the Interterritorial Council that the Vaccine Conference has made a proposal that includes administering the additional dose to group 7 of the Vaccination Strategy and, as of October 4, to the elderly living in residences. The Commission will have to approve it, in any case, on Thursday, but Darias has indicated that, a priori, there has been no opposition from any autonomy: “Today the presentation has made another proposal and it has to be valued and agreed upon or not, but it is true that I have not seen any intervention against it. On the contrary, all the communities have participated in the proposal for the presentation ”, said the minister.

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Darias has confirmed that the communities and Health will also study, in the case of the elderly who live in residences, the possibility of administering the additional dose now or accompanying it with the injection of the flu vaccine, which is usually inoculated during the fall.

For now, the additional injection against covid is already reaching the group of immunosuppressed people – in total, there are about 100,000, including transplants, patients with lymphoma, lupus and multiple sclerosis, among other diseases. Catalonia, for example, announced this Wednesday that it has already administered 2,829 punctures between September 9 and 14. In this group of people, their immune system is weakened and the response of their body’s defensive army is insufficient, which is considered a complete pattern for the rest of the population. The new injection is not, therefore, a booster dose because there has been a loss of the immune response, but an additional prick to complete a vaccination cycle that, with the normal indication, does not achieve the adequate immune response. According to the Federation of Medical Scientific Associations of Spain (Facme), immunosuppressed patients have a risk between two and five times greater than the general population of being hospitalized, needing care in critical units and dying in the event of suffering from covid.

Les Fonts de Terrassa geriatric center, this Tuesday.CRISTÓBAL CASTRO

With the inclusion of the new groups envisaged, the communities try to protect the most vulnerable population and those most at risk of becoming seriously ill or dying from COVID. In fact, although Facme is cautious when it comes to indicating the groups susceptible to a third dose, already in a document dated August 30, it admitted that people on hemodialysis – around 28,000 patients in Spain, according to its calculations – had an immune response higher than that of transplanted patients, but lower than that of the general population and, although he assumed that the evidence was limited, he suggested that a third dose could be recommended for this group. With people being treated for cancer with chemotherapy, the paper was more cautious and, while admitting that there was evidence of a decreased response to the vaccine, it added that there is “currently no evidence of the benefit of an additional dose in these patients.”

Controversial dosage

Among experts, however, there is much debate about the appropriateness of administering a third dose. For starters, the European Medicines Agency (EMA) and the European Center for Disease Control (ECDC) last week presented a technical report that concluded that “there is no urgent need to administer doses of booster vaccines to fully vaccinated individuals in the general population ”. The priority, they pointed out, was to complete the vaccination regimen for people who have not yet been fully immunized.

The EMA and ECDC, of ​​course, admitted that, although the booster dose for people with a normal immune system was not very urgent, the possibility of administering additional doses to immunosuppressed people could already be considered and also, “as a precautionary measure , to the elderly and frail, in particular to those who live in closed environments, such as residents of long-term care centers ”. Precisely, the endorsement of the EMA and the ECDC is one of the arguments that Darias has used to justify the decision of the Vaccine Report, although he has called the meeting on Thursday to know all the arguments that support the new indication proposed by the advisory body of the Government.

Alberto Infante, emeritus professor of International Health at the National School of Health of the Carlos III Health Institute, warns that it is not yet known how long cellular immunity lasts and is committed to giving doses to third world countries with low vaccination rates before administering a third injection in rich countries: “We are not sure what effect the third dose has on people with these characteristics,” he adds. Precisely, the World Health Organization (WHO) has also argued in its positions that the administration of additional doses “must be firmly based on evidence and be aimed at the population groups most in need” and has warned that the administration of doses Reinforcement in the current context of supply shortages in the world encourages inequalities in access to drugs between countries.

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