Vaccination against COVVI-19: priority to the most vulnerable

Number of doses available, methodology of clinical trials, efficiency according to the populations targeted ... The unknowns surrounding the vaccines against the COVID-19 remain numerous, but that does not prevent the authorities from engaging in the preparation of the upcoming campaign,even before placing permits (AMM) are issued.

The High Authority for Health (HAS) has itself deviated from its habits to start developing recommendations long before having all the cards in hand.Because these vaccines, which were just a "hypothesis", now represent "a real glow at the end of the tunnel", launched the Professor Dominique Le Guludec, president of the HAS college on Monday, by presenting the'Opinion on populations who will have to access vaccination as a priority.The health authorities must be ready "as soon as" the vaccines arrive ", therefore make decisions" before having all the data "of the problem.

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The "red thread" chosen by the members of the Technical Vaccinations Commission (CTV), responsible for developing the recommendations, has the merit of simplicity: "Protect the most vulnerable and those who deal with it, summed up," summed upDominique Le Guludec.Those whose experience has taught us that they paid the heaviest tribute "to the epidemic.Because if the preliminary data disseminated by the manufacturers indicate excellent protection against the serious forms of the disease, we do not know everything about their ability to prevent the infection by the SARS-COV-2, so contagiosity.

Reducing the number of hospitalizations and deaths seems to be within reach of vaccines, but putting an end to the epidemic thanks to them remains significantly more uncertain.Another unknown, the effectiveness in older people, whose immune system is less effective.Will also be taken into account the results of the "public consultation on the implementation of the vaccination which ends today, said Professor Elisabeth Bouvet, president of the CTV.All this is very evolving, and little by little we will see the rest of the vaccination strategy ".Decisions will ultimately return to government anyway.To make compulsory vaccination is to date not a privileged option, the HAS preferring to prevail "adhesion" of the population thanks to the virtues of transparency on the efficiency and potential risks of vaccines.

"A third of deaths took place in nursing homes"

Two types of priority audiences were defined after analysis of the scientific literature and the data collected by Public Health France.On the one hand, those who are at risk of serious form due to their age and/or their state of health.Regarding age "it is difficult to set a" cut-off ", noted Professor Daniel Floret, vice-president of the CTV, but we know that the risk increases in a linear way from the age of 50".As for the comorbidities, "a certain number are consensus *.Others less, but they can be integrated as you go "from the arrival of new scientific data.Second priority audience, the people most exposed to the virus, starting with "medical, paramedical, medical, medical and personal workers, social and personal services of personal services", Listed Daniel Floret.

Three first vaccination phases will target these two types of audiences.Without real surprise, residents of nursing homes and elderly patients of long stays and the staff of these establishments themselves presenting an increased risk of serious form of the disease (over 65 years and/or presence of comorbidity) will be theVery first guests to be vaccinated."For this phase, we will probably have a very limited number of doses of vaccine and we will not be able to vaccinate many people," justified Elisabeth Bouvet.

The older accommodation places have therefore been deemed priority, because their residents have two types of risks: a much greater fragility against the virus, and a significant risk of being infected because they live in places where they circulate."We know that in these establishments there have been many cases, clusters and a considerable number of deaths: it is estimated that a third of deaths in France took place in nursing homes," argued Elisabeth Bouvet.The fragility of their residents in addition obliged them to transform themselves into strong places to which neither families, nor certain caregivers such as physiotherapists.Obviously obeying the chances of very fragile people.

Once the vaccination has been proposed to the most at risk and the staff who take care of it, workers not necessarily at risk but deemed essential to the activity of the country can be integrated in phase 3, but "it does not return to the HASTo define the essential sectors, slipped Daniel Floret.It is a political, non -scientific data, which will be defined by the government.These first three phases will concern 840 respectively.000, then 14.9 million and finally 17 million people, and they should follow each other fairly quickly, said Daniel Floret.But all of this is "conditioned by the vaccine supply".

The 4 and 5 phases, however, will be "probably later".They will make it possible to expand access to vaccination, starting with those working under conditions increasing the risk (contact with the public, closed environment, difficulties in applying barriers ...) or who live in conditions making them particularlyvulnerable (residents of psychiatric hospitals, prisons, homes, precarious audiences, etc.) and those who take care of them.

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Gradually, the rest of the population can then be vaccinated.Pregnant women are not at the moment concerned, because in addition to an unaware of unaware at least at the beginning of pregnancy, "we always hesitate to vaccinate them with vaccines that we do not know very well," notes Daniel Floret.Another audience not targeted by these recommendations, those under 18, for a legal reason: clinical trials have not yet included them, upcoming AMMs will therefore be issued for adults alone.If the youngest are deemed little at risk and not contagious, "this is a problem for adolescents carrying comorbidity", agrees Daniel Floret to Figaro.But the laboratories will eventually conduct testing on the pediatric population: regulations require them.

* Comorbidities justifying priority in access to vaccination as listed by HAS are: obesity from a body mass index greater than 30, chronic respiratory diseases in particular BPCO and respiratory failure, theHypertension, heart failure, diabetes, chronic kidney failure, cancers treated recently, having had a transplant of organs or cell cells and trisomy 21.