COVID-19

Vaccines against Covid: can the imminent arrival of Novavax convince the anti-RNAs?

At the end of 2020, the world discovered messenger RNA (mRNA), used as part of a vaccine against Covid-19. This technique, which consists of injecting a genetic code (for SARS-CoV-2, of its Spike protein, in order to generate an immune response), had been studied for several decades, but had never been approved before. in such a framework. With a formidable efficacy of over 90% against severe cases, the assay has since been transformed, and messenger RNA should be used in the coming years to make new treatments and vaccines against influenza, tuberculosis, other rare diseases or even certain cancers

But mRNA vaccines (Pfizer-BioNTech, Moderna) are also the subject of much fake news or excessive fear. A few examples, all demystified: “we don’t have enough perspective on them”, “they modify our genome”, “they affect fertility”… When some, who do not necessarily declare themselves “anti-vaccines”, would simply prefer a more “classic”. Like Nathalie, a 59-year-old landscaper interviewed by Agence France-Presse (AFP). She admits to being scared for her “defenses,” and was looking forward to vaccines like Valneva, or even Novavax.

This is good, the last city is now authorized in France, the High Authority for Health (HAS) announced on Friday. This serum from the American laboratory Novavax, the fifth available in France, is a so-called “subunit” vaccine, based on proteins that trigger an immune response, without viruses. The first of its kind for the Covid. Still, the technology is similar to that used in the decades-old hepatitis B and whooping cough vaccines that are widely used around the world. Novavax will be used for primary injections, according to a schedule with two doses spaced three weeks apart. Due to insufficient data, withdrawals are not affected.

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At the same time, the Janssen (Johnson & Johnson) single-dose, but viral-vectored vaccine, like AstraZeneca, can now be used in two doses, as well as as a booster, in people over 55 years of age. The HAS itself recognizes in its opinion that both vaccines are “effective alternatives” for people who are resistant to mRNA vaccines, and those who cannot receive mRNA serum, for very rare cases of allergy or a history of myocarditis, pericarditis or severe hepatitis after a first injection.

“The fear of RNA is based on manipulation”

The objective: to search for the last refractories. Especially when it comes to Novavax. Like HAS before him, the infectologist Éric Caumes also considered it possible on Friday morning in Europe 1 that the arrival of the new vaccine raises the fears of some unvaccinated because “it uses a technique that we know much better”.

His first injections are scheduled for “early February.” Unlike Janssen’s, it is the only one that can be administered to people between the ages of 18 and 55, among whom there are still several million unvaccinated people. The 35-49 age group alone still represents 1.2 million people to convince. Some 3.2 million doses of Novavax are expected in the country in the first quarter.

According to L’Express, the head of the department of medical pharmacology at the Bordeaux University Hospital, Mathieu Molimard, is instead a little more pessimistic. “Being anti-vaccine is not a matter of technology, it stings. Very often, we find among this population people who do not believe that the epidemic exists, who completely deny the science.” RNA is, in that sense, based on manipulation. I always tell my patients, in the hospital: the virus itself injects RNA!”

The most zealous “antivax” will always find reasons to refuse the injection, he thinks. Even within Novavax itself, with the so-called “classic” technique. Simply because “the adjuvant used to enhance immunity in this vaccine, Matrix-M, is a new adjuvant,” he specifies. This is enough to recall the “novelty” and “lack of hindsight” arguments commonly used against mRNA vaccines.

The adjuvant question

This is also what Françoise Salvadori, professor of immunology at the University of Burgundy and co-author of the book Antivax, fears. Resistance to vaccines from the eighteenth century to the present day (ed. Vendémiaire). “I fear that we are going to go from ‘we are the guinea pigs of mRNA’ to ‘we are the guinea pigs of the new Matrix-M adjuvant,'” he says. What do we really know about him?

No serum has ever been marketed with this adjuvant, designed by Novavax itself. It consists of a unique blend of saponin (extracted from Panama wood), cholesterol and phospholipids. “Its first data seem to indicate that it could help limit the escape of vaccines due to variants… But will the general public be sensitive?” Françoise Salvadori confides. The HAS, for the moment, remains cautious about Novavax, explaining that “the long-term efficacy, the efficacy against the transmission of Sars-Cov-2 and the efficacy against the Delta and Omicron variants (which have emerged after the end of the follow-up).-up clinical trials) remain to be confirmed”.

But in general, the adjuvant is perceived as the “evil” by many pre-Covid anti-vaccines anyway, according to Françoise Salvadori. “Especially those based on aluminium”, following the publication of a study by the French researcher, Professor Romain Gherardi, on possible links between these adjuvants and a new disease, macrophage myofasciitis. A very controversial theory in the scientific and medical world.

Difficult to really identify the unvaccinated

Therefore, the mistake would be to oppose the “classical” aspect of the “subunit” technique to the “modern” technique of mRNA, emphasizes the doctor specialist in tropical diseases and philosopher Anne-Marie Moulin. This “would indirectly allow prior doubts to be approved or legitimated” about the latter, the most currently used (by far) in France. And that some say, finally: “It was enough to wait.”

“My idea is that the cohort of people who resist becomes very difficult to characterize. There are, for example, many people who have been vaccinated, but who still oppose it…” breathes Anne-Marie Moulin. For them, the technique or the specificities of the adjuvant are of little importance.

In an important interview granted to L’Express, Pr. Alain Fischer evokes the political reasons for “antivax”, over which science has little control. “Very often we find people who distrust all authorities, who refuse to speak officially, who are very hostile to the state and the current government. Politically, they are often classified as extreme left or extreme right. Half of the voters of the National Group are anti-vaccines, and that is reflected in the speech of the leaders of this party”, he formulates.

The express

A reason for satisfaction, Novavax will not be useless no matter what. Like the mRNA vaccines, this serum is effective against the symptomatic forms of Covid-19 (almost 90%), “and in particular against the severe forms with an efficiency of almost 100%”, presumes the HAS in your press release. “One of its strengths will also be its conservation mode, between 2° and 8°. This poses fewer problems for cold management. Therefore, it can be sent to more remote areas, far from urban centers”, says Mathieu Molimard. In short, Novavax will be less a tool of persuasion than a reference tool, essential to further improve vaccination coverage in France.

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