“the third dose, it should not necessarily be done as an RNA vaccine”, according to Professor Jacque Cohen

Jacques Cohen, professor emeritus at URCA in Reims and immunologist, answers three questions on the value of a vaccination booster. Especially since a fifth wave threatens the country.

Doctor, scientist, researcher in the nanosciences research laboratory, professor emeritus at the University of Reims Champagne-Ardenne, immunologist, Jacques Cohen has spent several decades studying immune responses against viruses such as EBV, HIV or hepatitis B. It has also contributed to the fight against AIDS and is one of the inventors of the patent for one of its variants. Maintenance.

The President of the Republic, Emmanuel Macron, spoke last week. He advised the French, even almost forced some French, to take a third booster dose. Is it useful to give a 3rd injection of Jacques Cohen vaccine?

There are more or less lasting immunities depending on the infectious agents and the vaccines. The current covid, with its variants, presents infectious agents that require boosters of vaccines, but not in all populations. It is observed that vaccine immunity decreases, including for the vaccines which were presumed to have the longest duration of action, namely messenger RNAs and, consequently, boosters are required. The question is, which population should be vaccinated with this booster? Certainly, as has been said, subjects over 65 years of age. We could qualify by starting by looking at whether people still have a lot, not a lot or no antibody at all.

But we work, you have seen it these days, a bit like in the old days in the army “the same for everyone at the entrance!” We could have tested people to find out if they had enough antibodies before vaccinating them a third time. But we preferred to vaccinate everyone, namely those over 65 and people with co-morbidities because they are more at risk of developing a severe form of covid. The concern is that in France, we do not have than RNA vaccines which have risky effects. It would have been better to vaccinate with classic killed whole virus vaccines, such as the 1954 polio vaccine. This was done by the Chinese who injected at a young age since children are vaccinated from two years old. They have so few children that they wouldn’t risk losing them if this vaccine were dangerous.

Is it therefore reasonable in France to think of vaccinating 5-11 year olds or to give a 3rd dose booster for those under 65?

For the 50-65 year olds, it is preferable to make a booster since it is a population which risks to make a serious form. Probably the recall will then be offered to 30-50 year olds. But this slice, like that of those under 30, should be vaccinated with a killed whole virus vaccine. Especially those under 30 who have suffered too many side effects from the first two doses when they were doing well before these successive vaccinations. It is not known why, but it was mostly the boys who experienced side effects. Complications are myocarditis, pericarditis or heart rhythm disturbances.

We vaccinated with a number of incidents. But if we put a third dose, there is a bit of a temptation, that is to say, to increase the rate of side effects.

Jacques Cohen, professor emeritus at URCA in Reims and immunologist

Then, the question that will arise a little more widely is that we will have to revaccinate all the people we have vaccinated, otherwise, it is not very logical to have done so. And there, we fall on a bone. As you know, I had said that vaccinating under 30s, especially boys with RNA vaccines, was bad value for money and that it was not justified, that it was necessary to focus on subjects at risk in this age phase and on everyone over 30 years old. Also take up the problem of the very old, a good part of which is not vaccinated, and there we have a serious hole. But what is done is done.

Now we have vaccinated with a number of incidents. But if we put a third dose, there is a bit of a temptation, that is to say, to increase the rate of side effects. So what you have to look at is that we should actually vaccinate widely, but we should not necessarily do it with an RNA vaccine. Inert vaccines, i.e. whole virus or Spike polypeptide, exist elsewhere. There is even one in the United States which has not been authorized locally, but which is exported. And above all, you have to look at what is happening elsewhere.

There is a discussion with us about whether to vaccinate children from 5 years old, etc. In China, the question does not arise. Everyone is vaccinated from the age of 2 with a killed whole virus, an extremely classic vaccine that has far fewer incidents and side effects than the others. They have nevertheless already exceeded the billion people vaccinated as well. You will probably need a third dose. The question arises as to whether to do it with the same thing or with an RNA boost, which is what they are looking at with this 3rd dose.

The Indians also made over a billion doses of whole killed virus, and I believe they vaccinated roughly 500 million people. In the western zone, the whole virus killed is only the vaccine developed by Valneva. For a very long time, we totally snubbed them, it’s a Franco-Austrian company, I remind you. The British had taken it and finally said that they had enough other things, that it was no longer worth it. And finally, the European Union has just made a pre-order agreement after a negotiation that lasted, excuse a little, from January to November for, I believe, 27 million doses in 2022 and as many later. It’s just a start, I think, because it’s going to come off like hot cakes.

Because it is the solution to be able to vaccinate young people, and that we should move to make a new factory or ask classic manufacturers who have large production capacities, like Sanofi, to mass produce this vaccine. So there, I hope that we will take the second step after the first and that we will commit to having a killed vaccine that will allow vulnerable subjects to be revaccinated, and young people to be vaccinated and revaccinated. 2 years. For the moment, we are not there yet in terms of doses. The only solution is the RNA vaccine since it is the only thing we have, regrettably, but it is so. People need to have a booster, so a 3rd dose in order to maintain good immunity.

What is emerging is that we are not going to defeat this virus right away, unlike what might have been thought at the start of the pandemic. It will take two more years. Or a year if the new treatments work.

Will these new treatments be more effective than vaccination?
Three of them have been shown to be effective, preventive in two cases, and curative oxygen forms for the third pill. Which does not mean that we could give it to everyone tomorrow. We do not yet have enough perspective on the benefit / risk of these new treatments and their side effects. But their demonstrated efficacy encourages them to be administered as soon as possible on subjects at risk of severe forms.

There is Molnupiravir Lagevrio (Merck), a ribonucleoside inhibitor therefore interfering in the synthesis of the viral genome and as such interfering with its replication and ritonavir Paxlovid (Pfizer) It is a viral protease inhibitor which cleaves a polypeptide precursor into an active protein . It is associated with a product known to be active against the HIV virus, ritonavir, which is also a protease inhibitor but which here appears to be used to lengthen the life of the specific antivirus for Sars-Cov2. Ritonavir itself is not without side effects.

In both cases, they are simple tablets to be taken twice a day. The claimed efficacy of the Pfizer product (89% avoidance of severe forms) is slightly higher than that of the Merck product, but this is a sham because the Merck product has been given up to five days after the onset of infection in its clinical trial, while Pfizer’s product did so within the first three days only. The truly preventive use is not tested and cannot be before having enough perspective on their side effects.

A third drug which is a somewhat unexpected curative product: Festumatinib Tavalisse (Rigel Pharmaceuticals). This is a product developed to block the destruction of blood platelets in the spleen by targeting an enzyme (SYK) in specialized spleen cells, as a treatment for chronic autoimmune purpura by limiting thrombocytopenia. The surprise is that this enzyme appears to be used by immune cells contributing to the severity of covid19. Its inhibition in patients requiring oxygen would avoid mechanical ventilation and accelerate their recovery. The producer laboratory asked the US FDA for authorization for ATU distribution at the end of a phase 2 of a small number of patients, which the agency refused. But if the spectacular initial results are confirmed on a thousand patients in phase 3, the product will very quickly be widely used.

Other products from other firms will follow. And we can hope for a situation of drug control of the epidemic in the course of 2022. In the Covid 19 epidemic, vaccines have made significant initial progress. And the drugs that will arrive have a good chance of controlling Covid 19.