Science

Pr Alain Fischer: “As of March, a period of calm should open before us”

Little by little, the public powers are increasing the pressure on the unvaccinated and on all those who have not yet taken the third dose. As of this Saturday, January 15, all people without a reminder seven months after being double vaccinated must have their health pass deactivated. A pass that will soon no longer be “sanitary” but “vaccinal”: it will be necessary to have benefited from injections, or to have been infected for less than six months to validate it, a test will no longer suffice.

In an interview with L’Express, Professor Alain Fischer, who advises the Government on the vaccine strategy, insists on his “obsession of the moment”: the urgency of this reminder for the elderly, to protect them and limit the uptick in hospitalizations scheduled for the coming weeks. He also explains how, according to him, we could reach the unvaccinated, and calls on Marine Le Pen, Jean-Luc Mélenchon and Didier Raoult to stop “instrumentalising vaccination”.

L’Express: Olivier Véran has announced that the health pass of several hundred thousand French people could be deactivated this Saturday, January 15 for lack of a reminder. Is this really the best way to encourage them to get vaccinated?

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Alain Fischer: These are definitely people who do things a bit at the last moment, as we all do. The pressure that will be exerted on them -and that will increase with the arrival of the vaccination pass- should push them to regularize their situation, since a priori they are not opposed to vaccination.

This reminder is very important. Especially for those over 65, 24% of whom have not yet received it. Protecting them is really a priority. The curves produced by Guillaume Rozier on his Covid Tracker site based on data from the statistics service of the Ministry of Health are eloquent: people aged 60 to 79 years vaccinated with two doses are five times more likely to be hospitalized after becoming infected than those who they received three doses. It is the best pedagogy that exists!

After six months, does the vaccine no longer protect against Omicron?

Antibody levels decline over time: available data shows zero protection against infection. Without recall, people who have received only two doses are in an identical situation to unvaccinated people.

Cellular immunity remains, however, which protects against severe forms. It is also undoubtedly declining, although today it is difficult to say by what proportion. Instead, it is sure to be much better with a third dose.

“This reminder is key to avoiding the saturation of hospitals”

How long does it take for the reminder to take effect?

Just seven days. Therefore, we can act immediately to reduce the expected spike in hospitalizations in the coming weeks. I’m almost obsessed with it. This reminder is the key factor to avoid hospital saturation, in addition to primary vaccination. All studies show that the unvaccinated are the ones with the most severe forms. But we know the difficulties to achieve them.

Precisely how did you react when you heard Emmanuel Macron say that he wanted to “piss them off”?

I prefer not to answer this question. I can only tell you how I see the situation. Among these 500,000 unvaccinated elderly, we count 10% of patients with chronic diseases, 13% of people in a situation of obesity and 30% of subjects dependent on opiates. Therefore, a large number of people at risk are not protected at all.

In addition, vaccination rates are lower in municipalities where the standard of living is lower. Here there are already three important factors that come into play – age, illness, precariousness – in the face of ideological or cultural opposition.

Under these conditions, will the past, be it health or vaccination, change the situation? Will he be able to convince the hesitant, especially the most precarious?

The incentive effect probably plays less than for the richest, because they certainly go to restaurants less, travel less, etc. Sure, there are real anti-vaccines among them, but most of them are outside the system. So you have to go to them, even if it is very difficult.

“The instrumentalization of the vaccine for political purposes is totally reprehensible”

Have we done enough?

We can always do better. If we had ten times as many actors on the ground, we would reach more people. But the mobilization is already strong, through health services, municipalities, associations. These efforts, combined with the incentive effects of the past, are paying off: we are currently registering between 50,000 and 60,000 primary vaccinations per day. I don’t know how far we can go, because the real opponents of the vaccine represent a small fraction of the population.

Who are they ?

Very often people are found in defiance of all authorities, in a rejection of the official word, very hostile to the State and the current government. Politically, they are often categorized as either the extreme left or the extreme right. Half of the voters of the National Group are anti-vaccines, and this is reflected in the speech of the leaders of this party.

Should Marine Le Pen or Jean-Luc Mélenchon call for vaccination?

Absolutely. The instrumentalization of the vaccine for political purposes is nothing new. But whether it is the work of politicians or a few doctors like Didier Raoult, this deviation from health issues is totally reprehensible. It does not serve the general interest.

What do you think of the idea put forward by the Quebec authorities to tax the recalcitrant?

This may affect a fraction of the rich antivax, but the most precarious would not be solvent anyway: you can’t accept money from someone who is in RSA. Here we return to the question of obligation. I’m not sure it’s effective. For the chronically ill, the very old, everyone I mentioned before, I wouldn’t change a thing.

“At this time, we do not have data to justify a fourth dose”

Some are tempted to get infected to avoid being bitten. What do you think ?

Without vaccination or reminder, given the current circulation of the virus, they have a high chance of being contaminated. It’s risk taking, even for the youngest. Also, being vaccinated slows down transmission a bit, which helps protect the most vulnerable, particularly immunocompromised people, for whom the vaccine doesn’t work well.

The older ones, among the first to be vaccinated, are worried about not having the fourth dose yet. What can you tell them?

So far, we’re not seeing an increase in hospitalizations among fully vaccinated people. The Israelis, the only ones who have started, have not yet communicated data that goes in that direction. In contrast, the British results show that three months after the booster, protection against severe forms remains at 90%. We will have to make sure of it after four months, five months, etc. The health authorities of all states are constantly vigilant on this issue.

The idea that herd immunity might be possible has recently resurfaced, thanks to the Omicron wave. What do you think ?

During the current wave, probably six weeks from now, the general level of protection for the population will be quite high. Around 30 million French people are currently fully vaccinated. It will probably be 45 million by then, not counting the protection induced by the infection. This will control the circulation of the virus.

“There will be new variants, but we can expect them to be less aggressive”

But at the end of last year, the British population was already very protected by the different waves, and yet Omicron was able to circulate in the United Kingdom…

They are two different situations. Omicron exhibits partial resistance to the immune response, as well as being inherently more transmissible. In March we should get a very good control of the current wave. Then a period of calm should open up before us. Of course, there can always be new variants, but we can expect them to be less aggressive.

For what reasons?

Omicron is very different from its predecessors. It was probably selected in an immunocompromised individual, in which it accumulated favorable mutations to resist the immune response, however, without killing the patient. This implies that, indirectly, this evolution made him lose virulence. Now we will develop immunity against Omicron. For a next variant to be selected, it will itself have to be very different. And for it to have a lot of mutations, which, again, will take time. Again, you won’t have to kill the patient it spawned on, which means less aggressiveness. Of course, this is not a certainty, but plausible reasoning.

The express

Some countries, such as Spain, are already considering abandoning the monitoring of all Covid cases, but also lifting most of the barrier measures. Are they going too fast?

Along with Portugal, Spain is one of the most vaccinated countries in the world. We are not in the same situation yet. Beyond that, I think we will never be able to vaccinate 100% of the population. This means that, at least in the short term, it will be necessary to maintain the braking measures. In the medium term, a different monitoring of the epidemic may be proposed, with fewer tests and a “sentinel” surveillance system similar to that of the flu. But as far as we’re concerned, it’s probably still too soon.

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