Starting Sunday, Hungary will become the first European country to make a third dose of coronavirus vaccines available for those who request it. In the government’s official guidelines, it will recommend the mixing of vaccine types, ultimately, however, leaving the decision up to doctors and general practitioners. Meanwhile, both issues have proven to be highly debated among Hungarian experts.
Starting on August 1st, a third dose of coronavirus vaccines will be available in Hungary four months after an individual’s second shot, Prime Minister Viktor Orbán announced recently.
With the decision, even though there is currently no consensus in the scientific community around the effectiveness of a third jab, Hungary became the first European country to allow the administering of a booster dose.
The government justified the decision by pointing out that the delta variant is spreading rapidly in Europe while the number of new coronavirus cases has also started growing significantly in Hungary in the past weeks, foreshadowing the beginning of a forth Covid wave in the country.
Shortly after Viktor Orbán’s announcement, Miklós Kásler, Minister of Human Resources (EMMI), also shared important details on booster shots revealing that the government’s official guidelines will recommend a mix-and-match vaccination regimen while leaving the final decision about the individual jabs to GPs and doctors. The question of the necessity of a third jab is also highly debated with no scientific consensus at hand.
As for who is advised to get a third shot, the chief medical officer gave information on Tuesday. Cecília Müller said at-risk groups such as elderly citizens and those battling a chronic illness, or who have a weakened immune system are especially encouraged to register for a booster jab.
The same day, the content of the official letter from the National Public Health Center (NNK) informing GPs and hospitals about the administering of the third vaccine was also revealed.
The letter, signed by Cecília Müller, summarizes the third vaccination recommended based on the different types of vaccines.
According to the letter:
- After the first dose of AstraZeneca: Pfizer, Moderna, or Sinopharm;
- After the single dose Janssen: Pfizer, Moderna, Sinopharm;
- After the first dose of Moderna: Sinopharm, Janssen, AstraZeneca;
- After the first dose of Pfizer: Sinopharm, Janssen, AstraZeneca;
- After the first dose of Sinopharm: Pfizer, Moderna, AstraZeneca, Janssen;
- After the first dose of Sputnik-V: Pfizer, Moderna, or Sinopharm is recommended.
Another important feature of the Hungarian strategy is that there are no priority groups- everyone will receive the booster shot according to their registration.
Virologist, Miklós Rusvai, told news site Telex that he believes the lack of prioritization is not a problem. “There is no need to put anyone first because there is no vaccine shortage. I wish we had the problem of people queuing up, like in April for the Pfizer vaccine,” he said, referring to Hungary’s sharp decrease in the willingness to vaccinate in the past months. Talking about the third vaccine dose, Rusvai added that a booster shot may not be necessary for people who already have high immunity, but it will not cause any harm so it is not a bad idea.
Some Hungarian experts, however, disagree, including immunologist, András Falus, who in a statement together with several epidemiologists claimed that administering a third dose to the general population is not a priority for the time being. Instead, it would be much more important to convince and vaccinate those who haven’t taken any vaccines, and then to solve the situation of the elderly with insufficient immune response to the Chinese Sinopharm vaccine with a third vaccination.
Falus drew attention to a long-running debate on whether the Sinopharm vaccine, which has been administered to nearly half a million people over the age of 60 in Hungary, can provide sufficient protection. In recent weeks, several studies have been published which suggest that the Chinese vaccine showed lower chances of providing adequate antibody levels than any other vaccine in elderly people.
Is vaccine mixing effective?
The other important question is whether mixing vaccines is effective. According to the government, scientific consensus seems to point towards this direction, which is why they are advising it.
However many scientists warn there is a lack of sufficient clinical data to determine whether the practice is effective.
The two largest studies available on mixed vaccines are Oxford University’s Com-CoV trial and the Spanish CombiVacS. Both of the trials were investigating the efficacy of the combination of an AstraZeneca shot with a Pfizer jab and both found that an AstraZeneca followed by Pfizer was more effective than two AstraZeneca doses.
While these findings could suggest that vaccine mixing is effective, it is important to note that the results only show that after being administered with one specific vector vaccine, Pfizer’s mRNA vaccine triggers a more powerful immune response.
Regarding the issue, renowned Hungarian biochemist Katalin Karikó, who is one of the pioneers of mRNA technology, told RTL News that people vaccinated with vector vaccines such as AstraZeneca and Sputnik-V should definitely receive a different type of vaccine as their third shot. At the same time, people who received mRNA-based vaccines like Pfizer and Moderna can safely get the same type as a booster dose.
Miklós Rusvai also talked about the issue, suggesting the same thing as Katalin Karikó. According to the virologist, people vaccinated with mRNA-based vaccines should receive the same type on their third visit to a vaccination clinic, since mRNA technology allows for multiple immunizations. Those vaccinated with vector vaccines or inactivated vaccines (Sinopharm) on the other hand, should receive a different type instead.
GPs left in the dark
The government was also criticized by many of the GPs for sending them the necessary information regarding the vaccination protocol extremely late, while simultaneously shifting the responsibility onto them. Although the booster shots will be available from Sunday, details about the third shot were only sent to healthcare providers on Monday, less than a week earlier.
Népszava reported on Tuesday that due to the late arrival of the official guidelines and the tight deadline, several GPs had to order vaccines even before receiving the necessary information to do so properly.
Practices can notify the authorities of their vaccine needs on a weekly basis, with the capital, for example, having until mid-week to submit the order needed. However, as no one has given their patients the details yet, they don’t know how much to order, a GP told the paper.
Featured photo illustration Tamás Vasvári/MTI