Who should take booster of the covid vaccine? Understand the WHO recommendation – 03/30/2023

Cordless phone is a dangerous joke when it comes to health. And, in this case, at the end of the day, almost no one understood the SAGE conclusions about the near future of covid-19 vaccination. There are people who still don’t know if, according to what was disclosed, they will have to take a booster this year or not.

Translated, SAGE is the Strategic Advisory Group of Experts on Immunization, created to help the WHO (World Health Organization) to establish its recommendations.

There were four days of intense discussion that ended exactly a week ago, on the 23rd. And the day before yesterday, when the highlights the meeting, the news that not everyone would need more doses of the vaccine against the coronavirus jumped out at the eyes. For what! Confusion ensued.

On the one hand, the group eaten up with ignorance or evil that, while science points ahead, prefers to engage reverse gear, uttering pearls such as “they finally recognized that the vaccine is no use”. And it’s nothing like that.

I say more: there wouldn’t even be the current recommendation, releasing some people from taking the booster, if the vaccine hadn’t got us out of a predicament that, in our country alone, buried more than 700 thousand people.

On the other hand, people who, faced with the prospect of not receiving a new dose of immunization, are afraid of ending up unprotected, putting their lives at risk. And it’s none of that either.

In fact, there were even those who fantasized that something very different was happening for the group of experts meet at the request of the WHO. This has no foot, no head: vaccination is such a serious and important thing that this group historically meets at least twice a year. A new disease appears there, the cases of an infection there decrease, a vaccine is launched against a certain infection and everything is reviewed by this counseling group. Since always.

And, no, SAGE didn’t just discuss the Covid-19 situation, as if there was something unsettling about it being veiled. The agenda included measles, tuberculosis, polio and malaria vaccination. And, to boot, the specialists reflected on what would be the disease-causing agents that would deserve new immunizers.

So less. Breathe. It’s much simpler — and, between us, that’s what we always want to hear. “Apparently, from the picture we have today, the pandemic is ending and the disease is taking on an endemic character”, says infectologist Renato Kfouri, vice president of SBIM (Brazilian Society of Immunizations), who was at that meeting representing Brazil.

The transition happens because a large part of the world’s population already has antibodies at that time of the championship. Many gained immunity because they received the vaccine. Others, unfortunately, got sick. Others took the vaccine and caught the virus — because, as you already know, immunization does not prevent infection, but it does prevent the disease from getting worse.

“This scenario justifies migrating to a vaccination model similar to the flu, which implies understanding who is part of the most vulnerable groups”, explains Kfouri. “There is currently no scientific evidence that it is necessary to boost the vaccine in the entire population.”

Therefore, in principle, the WHO is dividing people into three groups – the high, medium and low risk of having complications from covid-19 and even dying from it. It is necessary to understand who is who and a few more details.

If you are over 60 years old

So you fall into the high risk group for covid-19 to have complications. By the way, as with the flu. Therefore, the recommendation is to take the vaccine booster at most every 12 months from now on.

Regardless of age, if you are an immunosuppressed person

“There, there is nothing to discuss: the reinforcement should also be applied, bursting, every 12 months”, explains Kfouri. The defense response cannot be relied upon to last longer than this in these patients. Hence the need to stimulate it again from time to time.

If you have a comorbidity that could greatly increase the risk of Covid becoming severe

Children, adolescents or adults under 60 years of age in this condition take an annual booster. But the point here is to refine the concept of which comorbidities would really increase the probability of Sars-CoV-2 doing great damage. It is worth noting that the final SAGE document will only be released in the first week of June. Patience.

If you are a healthcare professional

So you are part of another group whose recommendation is to reinforce every 12 months. In the first place because, taking care of sick people, there is a greater risk of becoming infected. Second, so as not to lack professionals on the front lines if there is an outbreak of covid-19 in a given location — which, mind you, can always happen from now on. She’s here to stay.

if you are pregnant

You should take a booster dose if the last time you were vaccinated against covid-19 was six months old. In addition to pregnant women being a risk group, a good reason is that the vaccine antibodies will pass from the mother to the newborn, protecting him by default.

If you are healthy and under 60

You are in the moderate risk group. According to the recommendation, once you have completed the initial scheme and a booster – that is, you have already taken the vaccine at least three times -, you are exempt from additional doses.

What’s the astonishment? “With the flu it’s like this: we don’t campaign to vaccinate young and healthy adults”, compares, once again, Renato Kfouri. “Of course, no one wants to get the flu and it would be good if everyone had the chance to be immunized against influenza. But we prioritize those who are hospitalized and die more because of it, which are about 80 million Brazilians. And, with Sars- CoV-2, it will be the same idea”, he predicts.

Nobody told you not to get vaccinated!

This is a point that needs to be very clear: what was debated regarding the vaccination of adults was the need for a booster or additional dose, according to the risk of each one.

No one cast a shred of doubt on the need — I repeat — for the first three doses for those who do not belong to any priority group, nor questioned the effectiveness and safety of approved immunizers.

And how are children and adolescents between 6 months and 17 years old?

Depending on each country, this age group may even be exempt from vaccination. It forms, according to SAGE, the low-risk group, but with the WHO’s own caveat that this is relative. We will therefore have to wait to see what Brazil’s position will be after a careful assessment of our situation.

“It is not easy to establish a single recommendation for the most diverse countries that, after all, have very different realities”, comments Renato Kfouri. “The risk of a child or teenager dying from covid-19 in Brazil is between 10 and 15 times higher than in the United States or the United Kingdom.”

Several factors are capable of increasing this danger according to the region of the globe — from access to treatment and hospitals to the nutritional status of young people, to name just a few examples.

The decision on what will be done in one country or another will consider them, as well as analyzing the availability of vaccines and the burden of disease in each locality. Therefore, where there are few cases of covid-19, it will be easier to dispense with the injection of children.

Will I have a problem if I get the vaccine because I’m not in a priority group?

From a medical point of view, nothing against it. Recommendations such as SAGE’s are made with public health in mind — for example, the risk of infection spreading and cost-effectiveness — rather than individual health,

“Compared with the flu immunization one last time, in the future those who are not part of priority groups will always be able to go to the private network to get vaccinated”, explains Renato Kfouri. It will, at the very least, prevent the discomfort of the infection.

Will the new WHO recommendation be valid forever?

not all experts of SAGE gathered have a crystal ball to know if it will be like this forever. The virus will not disappear from the map and it, as the WHO states, “is constantly evolving”.

It is quite plausible that, from time to time, an outbreak of covid-19 explodes in a certain region of the globe. So, at that moment, health authorities could see the need for additional doses of immunizer for those outside the priority groups, why not?

Understand that the recommendations are based on a frozen moment in time — in this case, a picture of a world with a lot of people carrying antibodies and a variant that seems to take it a little lighter. If the virus changes, everything changes.

In order not to be soft, you have to do the minimum. WHO recommendations are exactly that: the “basic 1” to protect humanity from covid-19.

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