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The big challenge now is to accelerate. You need to make sure that as many people as possible, especially those at greatest risk of developing severe forms of Covid-19, are at least partially protected against Sars-CoV-2 virus infection. To clarify the scientific methods to achieve this goal is a document developed by the experts of the SItI (Italian Society of Hygiene, Preventive Medicine and Public Health) containing some precise recommendations to aim towards this goal.
Pay attention to the 65-79 year old range
While the vaccination campaigns for the over-80s are proceeding, the scholars of the scientific society propose to preserve as much as possible, based on age, those who are in the previous age bracket. The objective must be to arrive as soon as possible to protect at least in part, therefore without closing immediately the vaccination cycle, as many subjects as possible.
In this sense, it is proposed to offer a first dose of Pfizer / BioNtech or Moderna vaccine with the consequent postponing the second dose to two months laterwhile maintaining the two doses for the over 80 cohorts and the two doses for the “super-frail” categories (as a response to vaccination, immunosuppressed subjects), who would be invited to vaccinate at the same time as the 65-79 year-old cohorts.
How did this indication come about? According to scholars there are clear sources that show the existence of an effective level of protection after the first dose exists for the aforementioned mRNA vaccines, although it is not clear what the duration of the response and protection is. Although the level of vaccination protection beyond the terms set by the current vaccination schedule is not certain, this choice would lead to the possibility of vaccination coverage of the 65-79 population by May-June 2021, it would increase the doses in favor of the population at risk (over 80 and immunosuppressed) with a reduction in hospitalizations and also a (minor) reduction in mortality. It would also reduce the time to complete the vaccination campaign.
What to do with those who have had the infection
For those who have developed the infection for less than four months, the scientific panel that examined the problem recommends carrying out a single dose of vaccine, as a kind of “recall” after natural infection. This population includes both subjects with a previous diagnosis of Covid (within four months) and people who have shown recent serum-positivity.
It is believed, in fact, that the presence of circulating antibodies in such subjects it is sufficient to postpone vaccination. With this strategy it would be possible to avoid the administration of the second dose on subjects on whom the effects of the same are not clear; at the same time, a saving of at least two million doses of vaccine would be ensured, which can be immediately used in the vaccination of subjects who do not have pre-existing immunity and who could benefit more from vaccination doses.
Finally, a “practical” advice should not be underestimated: thanks to precision syringes and adequately trained personnel, one should aim to try to recover the seventh dose from the Pfizer vaccine vial and the eleventh dose from the Moderna vaccine and the AstraZeneca vaccine.
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