Saturday , January 23 2021

Vaccination of the Elderly in the Past, Is It Really Clear?

Haute Autorité de Santé wants to vaccinate residents of nursing homes first – GILE Michel / SIPA

  • A dose of the coronavirus vaccine is expected to trickle down to France, forcing authorities to think about the best vaccination campaign.
  • The High Health Authority delivered its ruling on Monday, and wants to vaccinate the population in nursing homes as priority, then other most vulnerable people.
  • Is this strategy the most optimal for fighting disease?

This Monday, the High Authority for Health decided: residents of nursing homes will be the first to be vaccinated in France by a future vaccine against the coronavirus. Several doses will be available in advance, implying priority for vaccination. Campaigns should start in late 2020-early 2021 for priority audiences, before becoming more massive in phase two.

In fact, the Haute Autorité de santé has set a clear strategy: “Protecting the most vulnerable and those who care for them is a priority”, as explained by its president Dominique Le Guludec. But is this decision really the best? 20 minutes make the point.

Why vaccinate the nursing home first?

Because they represent a significant proportion of deaths related to the coronavirus. Of the 52,731 deaths in France, more than 16,000 occurred in nursing homes (the rest in hospitals), representing a population category particularly at risk because of their age. Matthieu Mulot, scientific collaborator and lecturer at the Institute of Biology at Neuchâtel University, reminds us: the older a person is, the greater the risk of coronavirus developing into a serious form.

As of November 17, according to data from Public Health France, 79% of people hospitalized for Covid-19 and 66% of people in intensive care were over 65 years of age in France. The median age of death from the coronavirus is 84 in the country. Matthieu Mulot adds that nursing homes are more contaminated than the average space. Roughly speaking, this means that once someone is infected, the virus is more likely to spread to other individuals in nursing homes than elsewhere, which would explain why targeting as a priority is advised. seniors in nursing homes than all seniors.

Another thing that the researcher put forward, adhesion. Vaccines are not mandatory, as Emmanuel Macron announced, “as much to target the categories of the population that support them”, he added. All studies on anti-vaccines show that vaccination acceptance increases with age. Vaccinating seniors first is to ensure an effective vaccination campaign.

Why not vaccinate the “super spreader” first?

This process, vaccination with the aim of reducing serious forms, is called tertiary prevention: we don’t stop the disease but only the most dangerous consequences, explains Mounia N. Hocine, a biostatistician and vaccine specialist. “Basically the purpose of vaccination is to stop a disease, not its severe form. This is the main prevention, “he recalled. So the question arises: instead of targeting the most vulnerable people, why not target the most contaminated, to reduce the spread of the virus?

If the idea is tempting, it arises from two problems. First, the High Health Authority explained this Monday in its report, for now there is no certainty about the fact that vaccination prevents transmission of the virus. A person can be protected but continues to spread the virus, which would undo the purpose of targeting infected people.

Second, even if the vaccine stops transmission, there will still be a big difficulty: who should be vaccinated? If the phenomenon of “super spreaders” (super propagators, namely the minority of people responsible for the majority of pollution) is almost a consensus in the spread of the corona virus, they are still very difficult to determine and locate. “We are increasingly leaning toward social practices – lots of sightseeing, contact – more than physiological explanations – age, gender … -, which makes the task of finding locations practically impossible”, estimates Matthieu Mulot. However, given that the vaccine dose will arrive in the first place in the dropper, “it is difficult to randomly aim and hope to find it. supers spreader. The elderly are much easier to identify and we are sure of the interest in vaccination for them. Therefore, it is a security option. “

Are Nursing Home Vaccinations Effective?

With this choice of nursing homes, the virus will continue to circulate, because the “super spreaders” will remain infectious, as will a large part of the population. It is not without consequences: prolonged infectious disease, severe forms in some young people and people with comorbidities, etc. However, “one of the biggest concerns with this virus was hospital burnout,” recalls Matthieu Mulot. Saturation is bad not only in Covid-19 patients, but also in other patients, due to the cancellation or delay of surgery. The fact is: “If we prevent severe forms, we can hope to avoid further saturation, even though the virus is already circulating.” For example, if all people over 65 are vaccinated and “only” 34% of patients are currently in intensive care, the epidemic will still have less impact on society. “Mainly because of lower age, the consequences of resuscitation are less serious”, supports Mounia N. Hocine.

Nevertheless, he recalls, “this was definitely not the most effective strategy for stopping the epidemic. This is just the one we have set up by default, because we believe it will have an impact first ”. Therefore, the first tertiary preventive vaccination, but which can also provide information about many things: the vaccine is effective or not, side effects, and especially the cut of the vaccine? Essentially, preparing the groundwork to enable, later on, to maximize vaccination campaigns among other population categories, when the dose arrives. Matthieu Mulot cautioned: “We should see vaccinating nursing homes, and people in general, fragile, as a first step, and not as a goal.”

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