It is a matter of health emergency. In view of the progression of the Covid-19 epidemic on the national territory and the threat of the spread of new variants, the High Authority of Health (HAS) recommends postponing the second dose to forty-two days for the two vaccines messenger RNAs now available in France: Pfizer-BioNTech and Moderna, whose administration schedules provide for two doses spaced twenty-one and twenty-eight days apart respectively.
In a notice published on Saturday 23 January, the HAS, considering “The need to optimize the distribution of doses and ensure equity of access to very short-term vaccines for the elderly”, recommended “The postponement of the 2e dose at 6 weeks (…) in order to speed up the administration of the first dose to the most vulnerable people ”. And to specify that the available doses must be reserved “In priority” to people aged 75 and over, then to 65-74 years old, “Starting with those with co-morbidities”.
“700,000 additional people”
The objective is to carry out the first injection in more patients in the coming month, instead of completely vaccinating fewer people and this, in a context of tensions on the vaccine production chains.. According to models commissioned by HAS from the Institut Pasteur, extending the time between the two doses to 42 days would make it possible to vaccinate “At least 700,000 additional people in the first month depending on vaccine capacity”.
So far, for the Pfizer-BioNTech vaccine, the government relies on an opinion from the National Agency for the Safety of Medicines and Health Products (ANSM) published on January 7, which already implies using the second dose as an adjustment variable. A “Flexibility of administration of the second dose between 21 and 42 days can be considered, in view of the specific current circumstances, in order to broaden the vaccination coverage of priority people and to cope with supply fluctuations ”, estimated the ANSM, while recalling that the efficacy data for this vaccine come from the phase 2/3 study developed over a window “Ranging from 19 to 42 days”.
In the field, hesitations on this question of the recall punctuated the first weeks of vaccination and, for patients, it is sometimes difficult to navigate. At the Assistance publique-Hôpitaux de Paris (AP-HP), the first people vaccinated with the Pfizer-BioNTech vaccine were given an appointment for their second injection on D + 21. Carole, occupational health nurse, received the first dose at Hôtel-Dieu on January 13. But this 53-year-old caregiver was offered as a recall date on February 24, exactly forty-two days later. “I tried to ask if it was possible earlier but I was not given a choice. Apparently, there was a sudden change in gear … “
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