Mix of vaccines, Prof Giacometti: “Less risk and more coverage If I could I would be a heterologous”

INTERVIEW director of the infectious disease clinic of the Hospitals gathered in Ancona after the chaos over the heterologous Covid-19 vaccination, the administration of the second Pfizer and Moderna dose to the under 60s who received AstraZeneca at the first: “The news we have acquired so far they say the procedure works the same, maybe even more. However, the studies are still incomplete, not planned “at the table” but carried out as needed ”

June 22, 2021 – 8:12 pm


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Andrea Giacometti

of Francesca Marsili

The Marche Region has also chosen to observe the indications of the Ministry of Health regarding heterologous vaccination: the administration of mRna, Pfizer and Moderna vaccines to be clear, to those under 60 who had received the AstraZeneca vaccine at the first injection. A government decision announced last week and which has caused much discussion because if on the one hand it derives from the choice to proceed with a “principle of maximum caution” after the rare adverse events recorded, on the other it implies implementing an “off label ”that is, outside the conditions authorized by the established bodies, which is still based on few scientific studies but considered effective. To try to understand this methodology better, we interviewed Andrea Giacometti, director of the Clinic of Infectious Diseases of the Ospedali Riuniti of Ancona.

Professor, is immunization induced with the vaccine mix just as effective?

«The news we have acquired so far tells us that the procedure works the same, perhaps even more. In fact, it is possible that the immune stimulus generated with two different vaccines is even higher. We are gathering information that tells us that it is valid, perhaps even to a greater extent. However, the studies are still incomplete, not planned “at the table” but carried out as needed. What has happened in several States, now also happens in Italy: vaccination with two different vaccines must be used ”.

An Astrazeneca vaccine

Some studies have found more recurrent undesirable effects in the case of heterologous vaccination, however, attributable to those commonly reported for both vaccines. Is this an effect that can bode well?

«Yes, it is an expected effect that gives us hope. Pain at the injection site, fatigue, muscle aches, fever and headache are side effects that do not cause concern. The stronger the immune stimulus, the more likely it is that the body will feel it by reacting with various types of ailments, such as General ailments. These ailments with a more potent vaccine may be more noticeable. There are people who claim that with the first dose of AstraZeneca vaccine they felt almost nothing but that at the second dose with Pfizer they did, and this is good. When the organism reacts suffering it means that it has heard the vaccine, it has established a state of inflammation that stimulates the immune response, after all the disturbances pass in a few hours or days “.

It might be said if heterologous vaccination is so effective why was it not done from the beginning?

“Because every big pharma has created protocols where everyone studied his vaccine and checked only that. Mixing their own vaccine with that of other drug companies was not their intention. From the scientific point of view this information has not been collected, now it is the necessity that pushes us to collect it ».

FermoVacciniDonDinoMancini48-scaled-325x217Premier Draghi last week to reassure the skeptics about the vaccine cocktail said: “The heterologous vaccination works and I am booked to do it too” and added, despite not falling into the under 60 category, because 75 years old: “The first dose of Astrazeneca she gave a low antibody response and I am advised to be heterologous ». So everyone who has had a low antibody response with the first dose, especially the elderly, who are more at risk, should be able to request heterologous?

«First of all, by low antibody dose we mean from ten units downwards. If the law is the same for everyone, what applies to Draghi must apply to everyone, if I had an elderly person with two response units I would say to him: “You are not covered at all, get another vaccine”. The serological test is not mandatory and unfortunately it is at the expense of the citizen but if you want to do it and a response below the threshold should be highlighted in my opinion at the time of the second dose you should expect the heterologous, if they do it for Draghi because for the others not? ».

Professor Giacometti, the clarification of Minister Speranza regarding the possibility for subjects aged between 18 and 59 who refuse the heterologous, after signing the informed consent, to be able to proceed with the double dose, to confuse the citizen even more. of AstraZeneca vaccine. Although the goal is to safeguard autonomy in health-related choices, isn’t there a risk of putting the person who has to vaccinate with responsibility?

“Here two problems contrast: one is that the citizen should not decide which type of vaccination is most suitable for him but on the other hand he cannot be forced to a heterologous vaccination which – although it seems effective – is not yet supported by scientific data. Of course, medically it’s a bit strange. As long as we do not have certain data, it is as if a doctor advises a medicine on data that are not yet certain, they will certainly arrive, but to force now is not possible. The suggestion is to always involve your GP and get advice on the choice, you cannot leave everything to the great experts. If I were to decide at this moment on the basis of risks and benefits, I would be heterologous, less risks and greater immunity coverage should the Delta variant arrive ».

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