Reader question: Over 75% of the French population is fully vaccinated, so why are we seeing a fifth Covid wave?
France is now facing a fifth epidemic wave of Covid, Health Minister Olivier Véran said on Tuesday (November 23).
There has been an average of 18,520 new cases each day in the country over the past week, an increase of 81% from the week before. Yesterday, 32,591 new cases were reported.
The numbers of hospital and intensive care unit admissions, as well as of deaths related to Covid, are also increasing.
Jean-François Delfraissy, the president of the Conseil scientifique which advises the government on Covid matters, said this fifth wave will have an “important impact” between now and the end of the year.
This is despite the fact that in France, 90% of people aged 12 and over are fully vaccinated. Out of the entire population, 75.2% of people are fully vaccinated.
Why then is France facing a fifth wave of Covid, with such high vaccination rates?
More contagious strain of Covid
Professor Michel Cogné, immunologist at the University of Rennes and Rennes CHU (teaching hospital), said it is in part due to the fact that a more contagious variant of Covid is now dominant in France.
"You have to bear in mind that we were vaccinated against the original virus, whereas we are now faced with the Delta variant, which is much more contagious,” he told Le Figaro.
Dr Claude-Agnès Reynaud, immunologist and research director at the French National Institute for Health and Medical Research (Inserm), said the Delta variant can also affect vaccine efficacy rates.
“The messenger RNA vaccines (Pfizer and Moderna), which had efficacy rates of over 90% on the original virus, are most likely somewhat less effective on the Delta variant,” she said.
Vaccination protection subsides with time
In addition to this, it is now well known that in certain demographics, the efficacy of the vaccines subsides over time.
“From about six months after the first two doses, part of the population begins to be less well protected," said Dr Marie-Paule Kieny, virologist and president of France’s Covid-19 vaccine committee.
“However, protection against severe forms is still very good in people under 65 after six months.”
In France, almost 11 million people were fully vaccinated more than six months ago, mainly elderly and/or vulnerable people.
France has administered just over 5.5million booster shots.
There is also the fact that some people respond poorly to the vaccine from the outset, and there is great individual variability in terms of immune response, Dr Reynaud said.
"Added to this is the fact that some 10% of people in France have not been vaccinated at all. All of this means that the virus still has a large reservoir in which to circulate.”
Another element is the weather. With winter fast approaching, the temperatures are dropping around the country. This can create a better environment for the virus to circulate, with people staying indoors more and not aerating rooms as often.
There are also now far fewer Covid-related measures in place than there were at the same time last year, with venues such as restaurants and cinemas still open – albeit only for people who have a health pass.
How is this wave compared to last year?
On November 23, 2020, there were 31,500 people in hospital due to Covid, compared to around 8,500 today, Le Figaro reported.
There were also 4,400 in ICUs last year due to Covid, compared to 1,450 today.
The situation in other countries
“The severity of this wave depends strictly on the vaccination rate of countries," Dr Reynaud said.
“France is doing well, the UK a little less so because of two factors: They are a little less vaccinated (80.3% of the over 12s) and they have mostly used the AstraZeneca vaccine, which is a little less effective.
“As for Eastern Europe, it's quite dramatic,” she said.
In countries such as Bulgaria, Croatia, Romania and Serbia vaccination rates range from around 30 to 50% of the population.
The situation would be worse without the vaccines
Prof Cogné said that if it were not for vaccines, “we would be in the middle of a tsunami”.
“This country would be on the floor,” he said.
His colleague, Professor Jean-Marc Tadié, said the number of patients in ICUs is still manageable.
“It is true that our wards are filling up, but for the time being it remains contained. And the patients we are currently receiving are largely unvaccinated," he said.
Dr Kieny, president of France’s Covid-19 vaccine committee, said the number of hospitalisations and deaths is nothing like what it was last year.
“The primary objective of the vaccines, which is to protect against severe forms of the disease, remains fulfilled,” she said.
France is set to expand its booster dose campaign to include everyone aged 50 and over from the beginning of December. Health Minister Olivier Véran is also set to hold a press conference today in which he will address the Covid situation.
Dr Reynaud said that the necessity of booster shots was a scientific fact.
“It is normal for immunity to decline with a closely spaced two-dose vaccine schedule, as has been done with messenger RNA vaccines (Pfizer and Moderna).
“The more you space out the doses, the more effective the vaccination is. But the choice was made not to leave people unprotected for months and to give the doses only a few weeks apart.
“In reality, the first two injections we received were a primary vaccination. The third dose is ultimately a second dose,” she said.
Living with Covid
This raises the question of whether people will need to get a Covid vaccination every six months, something Dr Kieny hopes is not the case.
“The level of immunity achieved after a booster shot is higher than after primary immunisation. It is hoped that this immunity will last longer,” she said.
She said, though, that some people, such as the elderly and vulnerable, may have to be re-vaccinated regularly, like in the case of the flu jab.
“No one thinks it is possible to prevent this virus from circulating any more,” she said.
“On the other hand, we hope we can reach a situation where the harmfulness of this virus will be very minimal by protecting the most vulnerable through vaccination.”
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