When could someone not make the fifth

When are we finally going to get rid of Corona? : "We will not completely eradicate the virus despite vaccinations"

Vaccinate, vaccinate, vaccinate - the hopes for an early end to the corona pandemic rest primarily on immunizing as many people as possible in the shortest possible time. But the lack of vaccines and organizational problems in Germany are still slowing the progress of the vaccination campaign.

We spoke with vaccine researcher Leif Erik Sander about how vaccinations can be accelerated, whether people can still be contagious after the injection, when the longed for herd immunity will finally be achieved in Germany and how safe the Russian vaccine Sputnik V is. Sander heads the research group for infection immunology and vaccine research at the Medical Clinic for Infectious Diseases and Pneumology at Charité Berlin.

Mr Sander, three of the four vaccines against corona approved in the EU require two syringes for full vaccination protection, which must be administered a few weeks apart. In view of the current shortage of vaccines, more and more experts and politicians are calling for the second vaccination to be postponed. You too were one of the first to advocate concentrating on the first vaccinations while the vaccine is scarce.How long can the date for the second vaccination be postponed?
For reasons of liability law, the second vaccination should only be postponed as long as it is at most possible according to the approval. At Biontech / Pfizer, for example, this means that the second dose should not be given after exactly 21 days, as before, but only after 42 days. And the Astra Zeneca vaccine can be administered a second time after three months instead of two. The British have already done this and have had good experience with it.

Studies indicate that there is already a high level of vaccination protection after the first vaccination. Wouldn't it be possible to forego the second vaccination altogether until the vaccine deficiency phase is over?
In theory, this is a conceivable scenario, as shown by some interesting model calculations. However, as already mentioned, it is problematic in terms of liability law. In addition, such a discussion would soon become obsolete. Because if 70 to 80 million vaccine doses are delivered in the second quarter as planned, Germany will be faced with the challenge of inoculating the available vaccines quickly enough.

That is why it is a good plan to focus on the first vaccinations now and thus build up initial protection for as many people as possible without forgetting the second vaccinations, which further improve protection.

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What do we now know about whether the virus can still be transmitted after vaccination?
More than at the end of last year. According to current preliminary publications of study data, the viral load in the nose or throat of those who become infected with the coronavirus despite being vaccinated is so marked that it is probably no longer enough for the majority of those vaccinated to infect others. However, one can also see from these studies that individual immunized people, especially if they still contract Covid-19 with mild symptoms, are at risk of infection due to a higher viral load.

That sounds like "both, and" ...
In other words: At the population level, vaccination will lead to a significant decrease in the number of infections. But at the level of the individual there is a residual risk of being infected with someone who has been vaccinated. We therefore recommend that you keep the precautionary measures against infection, i.e. hygiene, distance and masks, for the time being, even with vaccinated people. At least as long as large parts of the population are still unvaccinated.

A somewhat sobering finding.
No, I see it very differently. In general, there are only very few vaccinations that achieve sterile immunity, after which there is no longer any risk of any person being infected with the pathogen. And that usually only applies to diseases in which the pathogens are distributed in the body, for example via the blood or the lymph. An example of this is vaccination against measles. But in diseases in which the pathogens multiply almost exclusively in the respiratory tract, such as the flu, and in which the pathogens are transmitted directly via droplets or secretions from the mucous membranes, there is often no sterile immunity through the vaccination.

Against this background, the vaccination against the coronavirus is a huge success. Otherwise there would not be this effect now observed with the vaccination world champion Israel, which with a high vaccination rate in a population group also reduces the number of infections so significantly. That is a lot more than one should have expected.

Again and again new numbers on herd immunity haunt the headlines. They range from 60 percent to more than 80 percent. At what level of vaccination can one say that the spread of the virus is interrupted because it can no longer build an infection chain?
The herd immunity threshold for many infectious diseases can be roughly calculated using the R-value - i.e. the statistical measure that describes how many other people a single infected person infects. This means that the more contagious the disease, the higher the threshold value for herd immunity.

However, we know that the R-value for the coronavirus is a dynamic value that is primarily influenced by the various containment measures and contact restrictions. For that reason alone there is no fixed number for herd immunity, according to the Moto we have to vaccinate up to this quota, then everything will be fine.

In the case of Corona, this will be a smooth transition, in which we will only know in retrospect that herd immunity has been achieved because the spread of the virus has suddenly been curbed. The value will be a rule of thumb, but will already be in the range of 60 to 80 percent mentioned.

Will we finally get rid of the virus?
We will no longer completely eradicate the coronavirus, even with very high vaccination rates. The virus will repeatedly report back to unvaccinated population groups and perhaps also circulate at a low level among the vaccinated. It will become an endemic virus, which means that it will break out again and again in limited areas or groups and will probably also cause sporadic severe disease processes again and again.

In the long run, it will simply circulate as a cold virus. But with the vaccinations, the virus will no longer be able to lead to the threat of widespread overloading of the health system.

The Russian vaccine Sputnik V is now also being tested by the European Medicines Agency (EMA). Hungary has given the vaccine special approval and wants to buy Sputnik V. Before that, however, there were always doubts. What has changed?
We know more now. The data on the phase 3 study for the vaccine, which have now been published in the journal Lancet, are overall convincing. The procedure works anyway. Like the products from AstraZeneca or Johnson & Johnson, Sputnik V is a vector vaccine.

Part of the genetic information of the coronavirus ‘is used for a harmless adenovirus. At the same time, the virus can no longer multiply. Our immune system can memorize the characteristic features of the coronavirus in order to be able to fight it quickly if it comes into contact with the real coronavirus. In Sputnik V, two different adenoviruses are used in combination, thus strengthening vaccination protection. This is also an established procedure.

But the Russian developer - the state-run Gamaleja Institute of Epidemiology and Microbiology -, unlike the big pharmaceutical companies, is not very well known.
The institute has a solid international reputation and is scientifically sound. The researchers there have also developed other vector vaccines. They can do it.

So Sputnik V is effective. But what about its security?
We know a little less about this than we do about its effectiveness. From the information that has been publicly available to date, it is not possible to draw complete conclusions as to whether and how often, for example, undesirable side effects occurred. It is unclear whether the subjects were asked about the side effects of the vaccine in the studies. Because if study participants are not actively asked again and again whether side effects have occurred, these are underestimated. Hopefully such information is now available to the EMA for review.

Are you advocating approval of Sputnik V in the EU?
I see Sputnik V as a good vaccine and the EMA should look very carefully at approval. But I also think that Sputnik V cannot fix the current vaccine shortage in the EU. On the one hand, the vaccination rate in Russia is still low. On the other hand, the Russian manufacturer obviously cannot deliver any number of cans either, because production is difficult. In addition, because of the combination of two viruses, the regime of first and second vaccination must be followed with Sputnik V even more precisely than with the vaccines previously approved in Europe.

If you believe the announcements by the EU Commission and the federal government, enough vaccine should be on the market by the summer even without Sputnik V.
Hopefully we will actually see the vaccine shortage end in Q2. Then there will probably be around 80 million doses available. But then we are faced with a different challenge: The current vaccination infrastructure will not be able to cope with the inoculation of such large amounts of vaccine in the foreseeable future. We are already in a race against time, in which every day counts and should be vaccinated as much as possible.

Therefore, in my opinion, it is immensely important to use long-established logistics for vaccinations. Above all, the involvement of resident doctors, ambulances and company medical services.

How so?
All forecast models predict that we could slide into a third wave of pandemics in May and June - including overloading the intensive care units. That is why it is absolutely right to now involve the general practitioners in the vaccination.

And at the same time I advocate liberalizing the application of vaccination prioritization. If we always have to carry out a lengthy attestation and classification into priority levels, we lose too much time.

The task now is to vaccinate as many people as possible as soon as possible to stop the virus. If we manage to provide around 50 to 60 million people with a primary vaccination of the doses announced for the second quarter, then we will no longer have a problem in the summer, then we will have herd immunity.

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