Covid-19: green light for Novavax in France, a second alternative to messenger RNA vaccines

Will it convince the most refractory? The American Novavax Covid-19 vaccine, based on classic technology, will become the fifth to be made available in France after the green light from the High Authority for Health (HAS) on Friday. This vaccine and that of Janssen (already available for people over 55 years of age) may in some cases be “a useful alternative” for people who are reluctant to inject themselves with messenger RNA vaccines from Pfizer and Moderna, the HAS judges in its opinion. In fact, Novavax’s product is a protein-adjuvanted vaccine: a technology that “has proven its efficacy and safety in the production of other vaccines used for a long time.” Janssen’s vaccine uses a viral vector, an equally classic method.

The advantage of the last and fifth vaccine authorized in France and the European Union (EU) is that it can be administered to people over 18 years of age. As a reminder, after the thrombosis cases, Janssen’s vaccine was restricted, like its counterpart developed by AstraZeneca, to people over 55 years of age. Data that allow, according to the High Authority, to modify the vaccination strategy, in order to protect those who are reluctant to messenger RNA vaccines.

Thus, in the primary vaccination, people not yet vaccinated against Covid-19 and over 55 years of age can be vaccinated either with the Janssen vaccine according to a primary vaccination schedule with two doses spaced two months apart, or with the Janssen Novavax vaccine according to a primary vaccination schedule with two doses spaced three weeks apart. Unvaccinated persons under 55 years of age can be vaccinated with the Novavax vaccine using a two-dose schedule three weeks apart. “Exceptionally, and within the framework of a shared medical decision that allows people to be informed about the risks posed by this vaccine, the use of the Janssen vaccine may be considered in the event that the Novavax vaccine is not available”, specifies the High Authority Health in a press release.

As for people who have received a single dose of Janssen vaccine and are over 55 years of age, they can complete their primary vaccination with a second dose of Janssen vaccine 2 months after the first injection. Persons over 18 years of age who have received a single dose of any vaccine, and who refuse or are unable to receive a second dose of the same vaccine, may complete their primary vaccination with the Novavax vaccine.

No Novavax as a booster dose, for the moment

But what about the booster injection? Some people who initially had a bad experience with RNA vaccines from Pfizer or Moderna may prefer to get a booster dose based on more conventional technology. Thus, the High Health Authority considers that “when the mRNA vaccine cannot be used, the Janssen vaccine can be offered to people over 55 years of age”.

However, if you are younger, this vaccine can only be used as a booster shot “only exceptionally, as part of a shared medical decision that provides clear information about the risks associated with this vaccine,” specifies the HAS. Furthermore, if you are under 55 years of age and refuse a messenger RNA boost, it will not be possible, for the time being, to trust the vaccine developed by Novavax. Firstly, because the latter has not obtained marketing authorization (AMM) from the European Medicines Agency as part of the withdrawal of the vaccine. But also because the HAS considers “that it does not have real data to justify its management”. But it is probable that this opinion will evolve later, “according to the evolution of knowledge”.

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