Booster dose in the elderly will be done exclusively with Pfizer’s vaccine in the city of SP from this Wednesday | São Paulo

The city of São Paulo will apply from this Wednesday (15th) exclusively the Pfizer vaccine as a booster dose to seniors who have already taken two doses of the vaccine against Covid-19, according to information from the municipal Health Department of the capital.

Pfizer’s vaccine is recommended by the Ministry of Health for a booster dose, but until then, it was not prioritized by the city, which will change from this Wednesday.

This week, the state of São Paulo began to apply the booster dose to elderly people aged 85 to 89 who have already taken the second dose or the single dose for at least six months. The application of the reinforcement began to be made on September 6 in the population aged 90 and over, according to the state calendar.

During this Tuesday, the vaccination posts in the city of São Paulo registered a shortage of doses of the Pfizer vaccine against Covid-19, since the vaccine is also applied as an alternative second dose to those who took the first dose of AstraZeneca, which is missing in the state’s health units.

The city had pledged to prioritize the use of Pfizer in booster doses after it received new shipments of the immunizing agent by the Ministry of Health, which was already scheduled to take place on Wednesday.

“From the moment we receive Pfizer, we will prioritize Pfizer,” said the secretary in an interview with GloboNews this Friday morning (3), when the booster dose began to be applied to people over 90 years of age.

At first, the doses of vaccine that were available were used.

“Then, from September 15th, when the Ministry must send the larger batches of Pfizer and AstraZeneca, then we will prioritize the application of the booster dose with these immunizers that we will receive. But we will start the application anyway. of the third dose on Monday,” completed the secretary.

The measure partially follows the direction of the management of João Doria (PSDB), who has been supporting the decision to not prioritize Pfizer’s immunizing agent for vaccination with a booster dose against Covid-19 in the state, in disagreement with the guidance of the Ministry of Health and with the opinion of scientists.

“The technicians here provide us with exactly this security (using CoronaVac) and also the technicians from the state. Now, obviously, we will start in a very restricted age group and when we effectively receive large-scale doses from Pfizer, we will apply “, said Aparecido.

In a press conference this Wednesday (1st), the state administration criticized the ministry’s technical note and stated that the federal government’s decision not to consider CoronaVac in the application of the booster dose was political (read more below).

The São Paulo state government’s vaccination plan differs from that drawn up by the federal government. The Ministry of Health recommended the booster dose for people over 70 years of age and immunosuppressed, and determined that immunization should preferably be done with a dose of Pfizer.

The government of São Paulo did not stipulate the manufacturer of the dose to be used in the booster. Thus, the vaccine must be “whatever is available at the health center at the time”, according to the state plan.

However, studies have not yet evaluated all possible combinations between different brands of immunizers. Scientists studying the pandemic criticized the state government’s option and highlighted studies showing greater protection for the elderly with a booster dose of Pfizer, as stipulated by the federal government.

They claim that the CoronaVac has good results to prevent the severe form of the disease, What a should not be the first option for a booster dose..

Immune Response for the Elderly

Elderly over 85 years old receives vaccine against Covid-19 in Recife (PE) — Photo: GENIVAL PAPARAZZI/PHOTOPRESS/ESTADÃO CONTEÚDO

Fiocruz researcher Júlio Croda considers that the decision of the state government not to use Pfizer as a first option for the elderly is wrong.

“I agree with the Ministry of Health regarding the use of Pfizer in the elderly and immunosuppressed. This population has a lower response in terms of neutralizing antibodies and we need a vaccine that can induce a greater response”, he said.

Croda was once a member of the group of scientists that advised the Doria administration on decisions about the pandemic. The Contingency Center was dissolved on the 16th, on the eve of the end of measures to restrict time and public in the state – a decision that was also criticized by experts.

The researcher highlighted the study published in The Lancet that showed a 10-fold higher response in neutralizing antibody production with a boost from the manufacturer Pfizer, in comparison with a reinforcement made with CoronaVac. The research, linked to the University of Hong Kong, was carried out with 93 health professionals who had previously received two doses of the CoronaVac vaccine.

Although CoronaVac has already proven effective in reducing hospitalizations and deaths by Covid, the comparative study with Pfizer’s vaccine shows a better result precisely in the elderly population, where it is more difficult to achieve a greater immune response.

During a press conference on Wednesday (1), the director of the Butantan Institute, Dimas Covas, said that the technical note from the Ministry of Health that defined Pfizer as a priority in the booster dose did not follow technical parameters.

“We are here dealing with technical and scientific issues, and these point out that the third dose with CoronaVac enormously increases the immune response. But, on the other hand, we have a position that is even more political by the Ministry of Health when it discredits this vaccine as a third dose,” he said.

Specialists summoned by the Doria administration stressed that the protection from all vaccines is reduced for people over 80 years of age.

“What was observed is that, over 80 years of age, you have a reduction in the immunoprotective factor regardless of which vaccine is used, that is, any immunizing agent, both inactivated immunizers, viral vector, messenger RNA vaccine. All vaccines have this profile,” said Sérgio Cimerman, an infectious disease specialist at the Emílio Ribas hospital.

Members of the state government of São Paulo, alongside Governor João Doria (PSDB), at a press conference at Palácio dos Bandeirantes this Wednesday (1) — Photo: Marina Pinhoni/G1 SP

However, doctors did not address the different studies on possible combinations for the booster dose. Asked about the subject by journalists, the coordinator of the Committee against Covid-19 of SP, physician João Gabbardo, claimed that there are advantages in applying reinforcement with any manufacturer.

“There are works, and the Ministry of Health’s own technical note also points to the positive aspect of people who were vaccinated with two doses of receiving the third dose of CoronaVac,” said Gabbardo.

Booster dose manufacturer

Last Wednesday (25), oo G1 asked the São Paulo Department of Health about the adoption of vaccine combinations that have not yet been studied. The folder replied that all government clarifications “were made at a press conference this Wednesday (25)” and said that the vaccines are safe to use as a booster dose.

“All vaccines against Covid-19 available in Brazil are safe, effective and have the same purpose: to protect against the disease and reduce chances of serious infections by the coronavirus. All available immunizing agents can be used in the application of a third dose in the state” , said the state government, in a note.

Vials of CoronaVac vaccine against Covid-19. — Photo: WILLIAN MOREIRA/ESTADÃO CONTENT

In Brazil, there are at least four ongoing studies that assess the possibility of a booster dose for Covid-19 vaccines used in Brazil. These studies assess the following possibilities:

  • Two doses of Pfizer, followed by another dose of Pfizer;
  • Two doses of AstraZeneca (AZD1222), followed by another dose of a new version of AstraZeneca (AZD2816);
  • Two doses of AstraZeneca (AZD1222), followed by another dose of the same version of AstraZeneca (AZD1222);
  • Two doses of CoronaVac, followed by one of the following four immunizers: Pfizer, AstraZeneca, Janssen and CoronaVac.

However, there are no studies evaluating the application of a booster with CoronaVac in people immunized with Pfizer and AstraZeneca, for example, which could be the case of several elderly people who should receive the additional dose in September in the state of São Paulo.

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