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Under-55s who had AstraZeneca jab should get different Covid vaccine for second dose, says French medical regulator

People in France aged under 55 who have already had one dose of AstraZeneca's Covid vaccine should have a different product for their second dose, the French medical regulator has recommended.

Under-55s who had AstraZeneca jab should get different Covid vaccine for second dose, says French medical regulator
Photo: Joel Saget/AFP

After a three-day suspension of the AstraZeneca vaccine over concerns about blood clots, France resumed using it on March 19th, but with the recommendation that it should not be used on people aged under 55.

However by that point around 500,000 under-55s had already received the AstraZeneca vaccine, mostly health workers including Health Minister Olivier Véran, 40, who had his injection live on TV in an attempt to boost confidence in the vaccine campaign.

The medical regulator Haute autorité de santé (HAS) has therefore conducted a review and on Friday is set to publish a recommendation that in those cases, the second dose should be administered with a different type of mRNA vaccine, such as the Pfizer and Moderna vaccines which are both already being used in France. 

The HAS is an advisory body so the final decision lies with the government, but the French government overwhelmingly follows its regulator’s advice.

Véran, speaking on radio station RTL on Friday morning, said: “It will be confirmed today, it is totally logical.

“It is consistent to say: we do not recommend the AstraZeneca vaccine for people under 55. If you have received a first injection and you are under 55, you will receive a second injection of an mRNA vaccine.”

Jean-Daniel Lelièvre, head of the department of infectious diseases at Henri Mondor Hospital in Créteil and expert adviser to the HAS, told France Info: “In the end the decision was relatively simple.

“We know that a single dose of vaccine is not enough to ensure long-term immunity against Covid-19. So a decision had to be made about the vaccine administered for the second dose. It was therefore decided to use an mRNA vaccine.”

READ ALSO When will I be eligible for a vaccine in France?

He added that the choice of the HAS comes after the opinion of the European Medicines Agency, “which considered that there was a very clear link” with the cases of thrombosis “and the AstraZeneca vaccine”.

He added that the use of two different vaccines against the same virus is not unprecedented, saying: “These techniques have been widely used with other vaccine strategies, notably against HIV or even Ebola. We know that it works very well. And it gives immune responses that are greater than when you use the same vaccine twice.”

People under 55 who have had one AstraZeneca dose and been given an appointment date for the second dose should attend as planned, unless contacted by their doctor or pharmacist to change the appointment. The second dose for people who have had AstraZeneca will continue to be given 12 weeks after the first dose.

People aged over 55 will continue to receive the AstraZeneca vaccine and those who have already had the first dose – including the 55-year-old Prime Minister Jean Castex – will get AstraZeneca for their second dose.

READ ALSO How to sign up for ‘spare’ vaccine doses in France 

France currently has four vaccines licenced for use; Pfizer BioNTech and Moderna which are both licenced for use on all age groups, AstraZeneca which is used on people aged between 55 and 74 and the single-dose Johnson & Johnson vaccine, deliveries of which are expected later this month and which is licenced for use on all age groups.

The European Medicines Agency on Wednesday said that there was a link between the AstraZeneca vaccine and rare blood clots, but concluded that the benefits still outweigh the risks.

The EMA continues to recommend the vaccine for all age groups, but several national medical regulators have limited its use on younger people, including the UK, where the medical regulator now says that under 30s should be offered a different vaccine. 

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HEALTH

Where in France are there concerns about pesticides in drinking water

An investigation has revealed that tap water supplied to some 12 million people in France was sometimes contaminated with high levels of pesticides last year.

Where in France are there concerns about pesticides in drinking water

Data from regional health agencies, and collated by Le Monde, found that supplies to about 20 percent of the population, up from 5.9 percent the year previously, failed to consistently meet regional quality standards. 

The study highlighted regional differences in tap water quality. Hauts-de-France water was the most likely to be affected, with 65 percent of the population there drinking water contaminated by unacceptable pesticide levels. In Brittany, that level fell to 43 percent; 25.5 percent in the Grand-Est, and 25 percent in the Pays de la Loire.

Occitanie, in southwest France, meanwhile, showed the lowest level of non-compliance with standards, with just 5.1 percent of the region’s population affected by high pesticide levels in their tap water. However, figures show that 71 percent of people in one département in the region, Gers, were supplied with water containing high levels of pesticides.

Regional discrepancies in testing, including what chemicals are tested for, mean that results and standards are not uniform across France. Tap water in Haute-Corse is tested for 24 pesticide molecules; in Hauts-de-Seine, that figure rises to 477. 

One reason for regional testing standards are differences in local agricultural requirements.

Part of the increase in the year-on-year number of households supplied with affected water may also be explained by the fact that tests in many regions now seek to trace more molecules, Le Monde noted.

Water quality standards in France are strict – with a limit for pesticide residues set at 0.1 microgramme per litre, so the “high” levels found in tap water supplies may not represent a danger to health.

The question of the level of health risk to humans, therefore, remains unclear. The Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (Anses) has not defined a maximum safety level for 23 pesticides or their metabolites. Le Monde cites two metabolites of chloridazone, a herbicide used until 2020 on beet fields, for which only provisional safety levels in tap water have been set. 

Many of these molecules and their long-term effects remain unknown – and “the long-term health effects of exposure to low doses of pesticides are difficult to assess,” admits the Ministry of Health.

Michel Laforcade, former director general of the ARS Nouvelle-Aquitaine told Le Monde that health authorities have “failed” on this subject. 

“One day, we will have to give an account,” he said. “It may not be on the same scale as the contaminated blood affair, but it could become the next public health scandal.”

In December 2020, the Direction générale de la santé (DGS) recommended “restricting uses of water” as soon as the 0.1 micrograms per litre quality threshold is exceeded, in cases of residues for which there is no formal maximum health value.

But this principle is not always applied, according to France 2’s Complètement d’enquête programme.

In December 2021, the DGS asked the Haut conseil de la santé publique (HCSP) “for support on the management of health risks associated with the presence of pesticides and pesticide metabolites in water intended for human consumption.”

The HCSP, in response, said that “an active and urgent policy must be implemented to reduce the contamination of resources by pesticides”.

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