Ministry of Health will release 4th dose of Covid vaccine for people over 40

The Ministry of Health will announce next week the expansion of the fourth dose of the Covid vaccine (or the second booster dose) to people over 40 years of age.

The measure was discussed this Thursday (16) at a meeting of the PNI (National Immunization Program), and a technical note on the expansion should be published from next Monday (20).

The second booster dose had been released for the population over 50 years of age since the last day 4. As with the other age groups, the fourth dose can only be administered at least four months after the third.

Some places, such as the Federal District, Teresina and Belém, have already started applying the fourth dose even before the ministry’s recommendation. States and municipalities are not obliged to follow the recommendations of the federal government and can draw up their own rules to combat the pandemic, as the STF (Supreme Federal Court) reinforced in a 2020 decision.

In the opinion of Renato Kfouri, director of SBIn (Brazilian Society of Immunizations) and who makes up the technical chamber that advises the PNI, the expansion to the 40s is a trend.

“There are more comorbidities in this age group. It’s better than releasing it for diabetics, for those with heart disease. It’s a time when there’s a vaccine. [A imunização a partir dos 40] it will be with [a vacina da] Astrazeneca in particular, but it still has Janssen and a little Pfizer. Let’s see if we speed up vaccination coverage.”

For him, although the benefits of the fourth dose to young adults are not so clear, there are data showing that current vaccine protection is sustained for a short time. “As the country faces a new wave of cases, it’s worth it. [uma medida] not wrong.”

Infectologist Julio Croda, a researcher at Fiocruz, sees the expansion with reservations. According to him, after the third dose, the data show that there is evidence of an important immune response gain compared to the second dose. But the same is not true for the fourth dose.

“This population of young adults, up to 50 years old, has a lower risk of hospitalization and death. With three doses of vaccine, they already have excellent protection.”

Although there is an important discussion about the decline in vaccine protection over time, especially among the elderly, there is still no definitive answer as to what would be the best time to vaccinate this population of young adults.

“There are doubts from a scientific point of view whether it is important to reduce the age group to 40 years because the gain may be very small in relation to hospitalization and death.”

At the same time, Croda recalls that third-dose vaccine coverage is extremely low among young adults, around 50%. “We need to improve this coverage of the third dose. This is what will generate protection for hospitalization and death. Every population over 12 years old has to take three doses of the vaccine”, she says.

He states that the fourth dose is extremely relevant for the elderly over 60 years, however, the coverage is also not adequate.

“We cannot divert the focus. The United States has done this. They have started to recommend several booster doses and have a public with low coverage of the third dose. This is very complicated. We cannot send the message of ‘whoever wants to vaccinate, as many doses as you want’. To avoid collapse, it’s important to have high coverage.”

According to Croda, the health system knows who has and who has not had two or, possibly, three doses of the vaccine and should create strategies to go after those who are not yet immunized. “It has an address, it has a telephone. It is the function of the municipalities to work on this active search. And of the federal and state governments to carry out campaigns.”