EU agencies recommend second COVID boosters for elderly, medically at risk

An elderly person who came to be vaccinated against the COVID-19 virus at Sõle Sports Center in Tallinn. April 3, 2021.
An elderly person who came to be vaccinated against the COVID-19 virus at Sõle Sports Center in Tallinn. April 3, 2021. Source: Priit Mürk/ERR

As the number of cases and hospitalizations in Europe begin to rise again, EU agencies published updated guidance on Monday recommending second booster doses of mRNA COVID-19 vaccines for the elderly and those with medical conditions putting them at high risk of severe disease. University of Tartu (TÜ) virology professor Irja Lutsar agrees.

The European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) and the European Medicines Agency (EMA) are recommending second boosters for people aged 60-79 and those with medical conditions putting them at high risk of severe disease, according to an ECDC news release.

"We are currently seeing increasing COVID-19 case notification rates and an increasing trend in hospital and ICU admissions and occupancy in several countries mainly driven by the BA.5 sublineage of Omicron," said Andrea Ammon, director of the ECDC. "This signals the start of a new, widespread COVID-19 wave across the EU."

This April, the two agencies initially recommended those over 80 years old be administered a second booster. They did note at the time, however, that it may be necessary to expand that recommendation to the 60-79 age group and at-risk persons of any age should a resurgence of infections occur.

Work is underway to adapt vaccines for Omicron variants considered to be of concern, and according to EMA Executive Director Emer Cooke, the European agency is working toward possible approvals of adapted vaccines in September.

"Our human medicines committee is currently reviewing data for two adapted vaccines," Cooke said. "In the meantime, it is important to consider using currently authorized vaccines as second boosters in people who are most vulnerable. Authorized vaccines in the EU continue to be effective at preventing hospitalizations, severe disease and deaths from COVID-19, even as new variants and subvariants continue to emerge."

"Yes, we have an expert immunoprophylaxis committee in Estonia that makes corresponding decisions and shapes corresponding positions, and some time ago already — a few weeks ago — we decided that starting at the end of August or beginning of September, we would start administering second booster doses to people over 60 and those in risk groups," said Hanna Sepp, director of the Health Board's Department of Infectious Diseases.

Estonia's State Agency of Medicines (Ravimiamet) follows ECDC recommendations.

Lutsar: We should primarily be vaccinating the elderly

Irja Lutsar, a professor of virology at TÜ, agrees that Estonia needs to focus primarily on vaccinating the elderly and risk groups. Nonetheless, she considers it unlikely that herd immunity can be achieved against COVID, a reality that was apparent a year ago already, as that would have required a sustained vaccine efficacy of 90 percent. The same goes for influenza.

"These are rapidly mutating viruses, and the reason they continue to make the rounds among us is that they manage to escape prior immunity — both that achieved by vaccines as well as that achieved naturally," Lutsar said on Vikerraadio's "Uudis+" on Monday. "I'm sure all of us know people who have been vaccinated three times and gotten [COVID] twice — that isn't very unusual with this illness."

According to the virologist, COVID patients currently being hospitalized in serious condition are unvaccinated elderly people, or elderly people whose most recent dose of a COVID vaccine was a long time ago already.

She said that vaccination efforts need to focus on those who are at higher risk of severe disease.

"Those are the elderly, and those are people with certain comorbid diseases," she explained. "From week to week, the majority of those hospitalized are elderly, and a vast majority of them — surprising even me — haven't received even a single vaccine dose, let alone a third or fourth."

The professor noted that the vaccine's efficacy in preventing severe illness dwindles around the six-month mark, due to which those at higher risk, i.e. those over 60, should receive a booster dose.

Lutsar nonetheless doesn't consider it sensible to provide a fourth dose to everyone.

"Vaccine side effects are very rare, but they exist — no one's even attempting to claim that [the vaccines] have no side effects whatsoever," she said. "Thus when vaccinating, one should always take the risk-benefit ratio weighing toward benefit into consideration."

Another essential aspect to consider regarding boosters in younger people is how short-lived the protection it offers is.

"How realistic is it to vaccinate the entire population three times a year?" Lutsar asked. "I seriously doubt that, and I think that it isn't necessary."

Nonetheless, she noted that if someone wants to get vaccinated, they should do so as soon as possible.

"Serious fear can be an indication as well — if a young person feels that if they get a fourth shot and their fear goes away, then in my opinion that is an indication [for vaccination] as well," Lutsar said. "In my opinion, they should also be able to get one right away as well."

'New restrictions may not have impact'

Lutsar believes previously employed restrictions aimed at limiting the spread of COVID in Estonia aren't reasonable anymore, as the need for restrictions has changed over the course of the pandemic.

"In March and April of 2020, restrictions were very necessary as we didn't know anything about the [COVID] virus and a vaccine wasn't even on the horizon," she explained. "At that point, restrictions were certainly indicated. Now, when we're dealing with a relatively milder illness, vaccines are available and vaccines are free for everyone, the impact of restrictions may be significantly smaller, if there even is any at all."

Older people should nonetheless still get vaccinated. Lutsar noted that if anyone has had side effects with a specific vaccine, they can now choose between several different ones.

Regardless, there are a lot of older people living in Estonia who for one reason or another remain unvaccinated, and according to the professor, it's difficult to justify why others' lives should be restricted as a result.

"I am very much in agreement with the chancellor of justice that fairness is also not being allowed to restrict some people's lives because others don't want to do something," Lutsar said. "We have vaccines, and older people can protect themselves well."

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Editor: Aili Vahtla

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