UPDATED: Which parts of Austria are already administering second boosters?

The fourth dose of the Covid-19 vaccination is already available in some countries but what is Austria’s approach to the fourth shot, or second booster? Here’s what you need to know.

UPDATED: Which parts of Austria are already administering second boosters?
Austria has started rolling out a fourth dose of the Covid-19 vaccine for older people and those at high risk of serious illness. (Photo by ALEX HALADA / AFP)

The debate surrounding the fourth dose of the Covid-19 vaccine – or “fourth stitch”, as it is known in Austria – has been picking up pace in recent weeks.

Some medical experts around the world are advocating for a fourth dose, especially before the next autumn and winter season, and a handful of countries have already started administering the jabs. 

Meanwhile, others are taking a more cautious approach and waiting for further data about the effectiveness of the second booster before making a decision.

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Until Wednesday April 13th, Austria had been sitting somewhere in the middle with a tentative roll out of the fourth dose for older people in Vienna, while acknowledging data about the second booster is still sparse.

Now though, Austria’s National Vaccination Committee (NIG) has officially recommended the fourth dose for people over the age of 80 and those deemed at risk between the ages of 65 and 79.

Confused? Here’s an explainer on the current situation.

Which countries are already administering the fourth dose?

As with earlier stages of the pandemic, some countries around the world have been pushing ahead with their vaccination programs and are already administering the fourth dose to older generations and at-risk groups.

In Sweden, a fourth vaccination is currently available to people over the age of 80, but the country now wants to open up eligibility to those aged 65 and over. According to Sweden’s health authority, it has now been four months since people over 65 received the third dose and immunity could be waning.

In Israel, a second booster campaign was launched at the start of 2022 for medical staff, those who are immunocompromised and people over the age of 60. The eligibility group was then expanded further at the end of January to include anyone aged 18 and above who is in a risk group or cares for someone at risk. 

READ MORE: New Austrian Covid-19 vaccine could protect against Omicron

In the USA, the US Food and Drug Administration (FDA) recently issued emergency approval for a fourth dose of the Pfizer/BioNTech and Moderna mRNA vaccines. The fourth dose is for people aged 50 and over, those with weakened immune systems or for those who received the third dose more than four months ago.

A fourth dose of an mRNA Covid-19 vaccine has also been available in Germany since February for people over the age of 70 and those at risk of serious illness.

And in the UK, a second booster is already available to people aged 75 and over, care home residents and children over the age of 12 with weakened immune systems. It is expected that a wider group of people will be eligible for the fourth dose later this year.

What is Austria’s approach?

The NIG currently recommends the fourth dose of the Covid-19 vaccine only for high-risk people and those over the age of 65. The dose should be administered between four and six months from the first booster shot (third dose).

This is the approach that was already being taken in Vienna, where the Pfizer/BioNTech and Moderna vaccinations will be offered to eligible residents.

However, the NIG also recommends that if people outside of the risk groups request a fourth dose of the vaccine they should not be denied. This is known as “off-label” and should follow a benefit-risk assessment by a doctor.

For those wishing to get a second booster, they are requested to contact their GP and discuss the matter. 

Additionally, a report by the NIG states a fourth dose is not yet generally recommended for “immunocompetent individuals” (people with a normally-functioning immune system) due to limited data.

What is the official recommendation in the EU?

Currently, there is not an official EU-wide recommendation regarding a fourth dose of the Covid-19 vaccine.

But at a meeting in Brussels on March 29th, several European health ministers urged the European Commission to establish an EU protocol regarding the second booster.

READ ALSO: How Austria’s attempt to make vaccines mandatory changed the country

According to Reuters, ministers are particularly concerned about those over the age of 60. Concerns were also raised that a vaccine adapted to new variants of the virus will probably not be available until later this year.

The meeting in Brussels followed a statement by the European Medicines Agency (EMA) on March 17th which said there was not enough data to support a recommendation for a fourth dose of the vaccine for the general population. The EMA added that this will be reviewed when more data is available.

Do we really need a fourth dose of the Covid-19 vaccine?

Data coming out of Israel – which has been a pioneer in authorising the use of Covid-19 vaccines – shows that there is a reduction in hospitalisation and deaths in older people (aged over 60) who have received the second booster four months after the first.

Despite the figures though, there is still a lot of discussion within Austria, and around the world, as to whether a fourth dose is really needed. 

The general consensus of health experts seems to be that a second booster can be beneficial for older people or those with existing health conditions, but the jury is still out when it comes to the general population.

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EXPLAINED: How Austria’s compulsory vaccine mandate could be back in June

The much-debated policy sparked controversy since before it was approved in February, meaning that May could be a definitive month in the country.

EXPLAINED: How Austria's compulsory vaccine mandate could be back in June

Austria’s Federal Government has a ticking time bomb on its hands: an ordinance that suspended its vaccine mandate law is set to expire by the end of May, which means that the controversial mandatory vaccination would be again in place as early as June 1st.

In order to keep that from happening, Austria’s Health Ministry needs to extend the current regulation or create a new one.

If it doesn’t, the Covid-19 mandatory vaccination law would automatically be back in June.

READ ALSO: EXPLAINED: What are Austria’s plans to bring back the vaccine mandate?

Since, by June, the vaccine mandate stated that non-vaccinated would start getting fines, the resumption of the law would mean that, from next month, those who are not vaccinated could be fined in routine checks, such as traffic checks.

The ins and outs of the vaccine mandate

The law was first introduced in February, even though the technical requirements for it to be enacted were not in place. The first stage of it was purely “informational”, and Austrian residents received letters explaining about vaccines and about the regulation.

A second stage, when people could have been fined if they were not vaccinated, was set to start in mid-March. Before a single person was fined, though, Health Minister Johannes Rauch (Greens) suspended the law with an ordinance.

The law was suspended for a variety of reasons, primarily due to the relatively high vaccination coverage the country had already received, along with the lower virulence of the Omicron variant. 

READ ALSO: Austria to scrap mandatory Covid vaccinations

To create a new regulation or extend the existing one stopping people from being fined, Rauch must await the report of the vaccination commission, which should be ready in May, according to the Ministry.

The coronavirus commission will assess whether the Vaccination Act is suitable and useful from a medical and legal point of view. A previous report said there were arguments for and against mandatory vaccination for those who were completely unvaccinated.

READ ALSO: How Austria’s attempt to make vaccines mandatory changed the country

Der Standard reports there is little political support for compulsory vaccination and says there are still technical problems regarding automated fines. However, according to the Ministry of Health, the infrastructure should be completed in June.