THL recommendation: municipalities may extend fourth coronavirus vaccinations to certain population groups already in July
THL has issued a new recommendation on extending fourth vaccinations against coronavirus that differs from previous advance information. THL recommends that municipalities should start offering fourth vaccine doses to certain population groups already in July, and no later than 1 August.
Initially THL recommended that fourth vaccinations should be expanded so that from 15 August, they would be available to all those aged 65 and above, and to make them available to those over 60 and to those in risk groups aged 12–59 as of 1 September.
The new recommendation is, that municipalities may offer fourth vaccine doses in stages, as required by the epidemic situation, starting with those with the greatest medical risk of getting a severe case of coronavirus disease in the following order:
- those aged 70–79 who are not part of a medical risk group
- those aged 18–69 who are part of a medical risk group
- those aged 60–69 who are not part of a medical risk group
The optimum health benefit can be attained in proportion to the resources used in the vaccination effort when the vaccinations target those who are at the highest risk of a case of severe coronavirus disease. More detailed information on the sizes of the groups, the numbers of doses in proportion to the achieved health benefits, and different epidemiological scenarios is available in a recent THL working paper.
For now, the recommendation does not apply to members of risk groups aged 12–17. The children's sub-group of the National vaccination expert group KRAR will discuss the children's coronavirus vaccine programme in early August and will make its own proposal on the matter.
The recommendation also does not apply to social and health care professionals, who continue to have good protection against severe coronavirus disease. The protection offered by the present coronavirus vaccines against infections and mild cases of the Omicron BA.4 and BA.5 variants is weak and of short duration. Social and health care professionals should wait for vaccines tailored against the virus variants, which is also the recommendation of the European Centre for Disease Prevention and Control (ECDC).
New guideline based on ECDC and EMA recommendation
The new THL guideline is based on a recommendation issued on 11 July by the ECDC and the European Medicines Agency (EMA) urging countries to start offering fourth vaccine doses immediately to all those aged 60–79 and to those in risk groups for severe coronavirus disease.
In Finland municipalities are responsible for organising vaccinations for coronavirus.
“After the recommendation given by the EDCD and EMA, we have held discussions with the regions on the possibility of bringing the vaccinations forward. Our new recommendation authorises municipalities to start offering fourth vaccine doses already in July”, says THL Director Mika Salminen.
“It is worth noting that booster doses have already been available since March and May to all those 80 years of age and over and to those in younger age groups who are at risk of a severe disease and death.”
Omicron subvariants can accelerate the epidemic
The timetable in the advance recommendation issued by THL on 6 July was based on an estimate of seasonal variation and development of the numbers of cases and the presumed health benefits for different age and risk groups.
In Finland, the number of coronavirus cases had been declining until late June and early July. Since the beginning of July, hospitalisations have increased slightly, although a significant proportion of the patients are being treated for something other than a coronavirus infection.
In some European countries and in parts of Finland, BA.4 and BA.5 have been the dominant variants of the coronavirus since mid-June. They are known to be good at dodging the protection afforded both by vaccines and having undergone a case of coronavirus disease.
“BA.4 and BA.5 could cause a surge in the coronavirus epidemic in Finland already in the late summer. A fourth vaccination taken in early August at the latest offers the elderly and those in risk groups additional protection against a severe form of the disease slightly ahead of the original schedule”, says THL Chief Physician Hanna Nohynek.
Although existing vaccines do not give very good, or sustained protection against infection with the BA.4 and BA.5 variants, or against mild cases of the disease, preliminary information shows that vaccinations, either taken on their own, or in addition to having recovered from an infection of the disease offer good protection against severe forms caused by these variants.
Vaccines developed against variants expected in the autumn
Most of the elderly Finns and those in at risk groups were given their third coronavirus vaccinations more than six months ago. The fourth dose may be administered when a minimum of three months has elapsed from the third.
“According to current information, having recovered from a case of coronavirus disease offers protection corresponding to a single vaccine dose. Those who have had three vaccine doses and have recovered from one or more cases of coronavirus disease do not need to take a booster now”, Nohynek says.
At least in August, fourth coronavirus vaccine doses will still involve vaccines that are already in use in Finland. Vaccines tailored specifically for coronavirus variants are expected to become available later in the autumn.
“For the sake of effectiveness, there should be a gap of at least three months between booster doses. For those taking a fourth dose now, it is recommended that a possible new vaccine developed against a variant should not be taken until three months have passed, if additional boosters are recommended later”, Nohynek says.
“According to current information, the existing preparations also give good protection against severe forms of the disease caused by the variants.”
Recommendations will be changed as needed
THL is constantly monitoring the effectiveness of the coronavirus vaccination programme as well as international reports and recommendations, and will alter its own recommendations as needed. Gauges of effectiveness include the number of severe cases of the disease, as well as the frequency of deaths related to the coronavirus.
THL has previously recommended fourth doses for
- those aged 12 and above whose immune defences have been significantly weakened
- those aged 80 and above
- elderly residents in care homes
- seniors who receive organised home care or informal care, and other seniors whose health and ability to function have declined correspondingly and who cannot cope alone at home
- those aged 70-79 who are part of a risk group for severe coronavirus disease.
Check information provided by your municipality
Municipalities organise vaccinations and will announce where and when coronavirus vaccinations can be obtained. Therefore, you should follow your municipality's website and other communications.
In questions concerning your personal health, please be in touch with your own health centre or occupational health service.
Further information
Your own coronavirus vaccination: how, why, and when? (thl.fi)
Risk groups for severe coronavirus disease (thl.fi)
Are coronavirus vaccines suitable for everyone? (thl.fi)
Mika Salminen
Director
THL
tel. +358 29 524 8454
Hanna Nohynek
Chief Physician
THL
tel. +358 29 524 8246
[email protected]
