South African option: should AstraZeneca vaccination be suspended in Ile-de-France?

The share of the South African variant in the Ile-de-France increased from 6% to 10% of targeted tests. This raises questions about the future of the AstraZeneca vaccine, which is less effective against this variant.

For a new blow to the AstraZeneca vaccine? The future of the British-Swedish vaccine, which is already ill-treated in public opinion, may be called into question in Ile-de-France, where the share of the South African variant is growing.

The government “has watched for a long week an increase in the proportion of the South African variant, especially in the inner suburbs, which accounted for 6% of diagnoses and now accounts for 10%,” Olivier Veran said on Tuesday, April 27. So far, published data have not been able to distinguish the South African variant from the Brazilian variant, which share the common mutation E484K.

Reduced effectiveness against mild forms

South Africa, where this option is the majority, has abandoned the Astra Zeneca vaccine due to its very low efficacy, opting for Moderna and Pfizer vaccines. According to several studies, the effectiveness of the Astra Zeneca vaccine against mild forms can drop by up to 30% against the South African variant. On the other hand, no data was provided on efficacy against severe forms due to the South African variant, the Scientific Council noted in its opinion on 12 February.

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In France, the Supreme Health Authority has banned the Astra Zeneca vaccine in regions where the South African variant is in the majority, such as Mayotte and Reunion, indicating that the vaccine has not yet been used there due to logistical constraints.

HAS does not recommend AstraZeneca in the Moselle

In the Moselle, where the South African variant accounted for 40% of new infections in early February, HAS recommended against the Astra Zeneca vaccine. Confirming concerns about the vaccine’s effectiveness for the South African variant is that Olivier Veran gave Mosel 30,000 additional doses of Pfizer in February to combat the spread of the variant.

“The ideal would be to swap doses of Astra Zeneca from Ile-de-France for doses of RNA vaccine from a region where this variant circulates less. But it’s hard to imagine, ”says epidemiological researcher Michael Rochau.

Percentage of suspicion of a South African or Brazilian variant among tests tested.

If the proportion of the South African variant increases in the Ile-de-France, the British variant remains largely dominant, from 65% to 85% of cases, depending on the departments.

“Better to get vaccinated with AstraZeneca than waiting for another vaccine”

“Should we abandon the Astra Zeneca vaccine, which is effective against the British variant, which is dominant in the Ile-de-France and which is partially effective against the South African variant, or risk being infected with any variant? Waiting for RNA Vaccine? In the current situation, it seems preferable to get vaccinated with AstraZeneca, ”summarizes epidemiological researcher Michael Rochey. The incidence of Ile-de-France is about 460 cases per 100,000 inhabitants, well above the national average.

Suspension of the AstraZeneca vaccine, which Axel Kahn does not currently support. “There is no point in suspending Astra Zeneca in Ile-de-France, because the problem will become national in the coming months. As vaccination progresses, the proportion of the British variant will decrease, and the proportion of the South African and Brazilian variants, against which vaccines are less effective due to the E484K mutation , will increase mechanically, ”said the geneticist.

In his opinion, “we should continue to introduce the AstraZeneca vaccine, which will save lives and limit infection with the UK variant, but we should not order new doses and prioritize RNA vaccines in the future,” continues Axel Kahn.

Alert threshold 20%?

The General Administration of Health appears to have set a threshold of 20%, from which the proportion of the South African variant requires an adjustment in the vaccination strategy. HAS wrote on April 15 that “the so-called ‘South African’ option is spreading at a much lower level, currently estimated at less than 20% in all other departments, which does not justify a differentiated strategy for the use of vaccines in other territories at this stage.” With 9 to 10% of the South African option in the Ile-de-France, HAS therefore should not recommend an adaptation of the strategy at this time.

In the Moselle, HAS recommendations were not followed by the Regional Health Agency and the Moselle Prefecture, which indicated that they would continue the “vaccination campaign started in February”, prioritizing messenger RNA vaccines, of course, but continuing to use Astra Zeneca.

However, the situation in the Ile-de-France remains under scrutiny as the share of Brazilian or South African variants in the region has doubled in two weeks. If the momentum persists, it could shuffle the vaccine recommendation cards in the Ile-de-France region, where 559,000 people have received at least one dose of the Astra Zeneca vaccine, according to official figures.

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