Immunity debt and vaccine shortages: more and more epidemics break out in Hungary

According to Oroszi, the Hungarian epidemiological system has worked well for a long time, but the situation has changed dynamically in recent years due to pandemics. Among the problems, she said, new infectious diseases have emerged and old ones have started to spread again.

Although the development and introduction of vaccines against Covid-19 has made significant progress, there are still shortcomings in vaccine availability and public attitudes in Hungary.

"Unfortunately, Hungary does not have vaccines against Covid-19 at the moment, even though there is an epidemic, while in Western European countries there is already a new vaccine," said Beatrix Oroszi.

She added that vaccination would be highly recommended for people over 60 years of age, chronic patients and health workers.

Are there (enough) vaccines?

On 30 April, the Emergency Task Force (ETF) of the European Medicines Agency (EMA) recommended updating COVID-19 vaccines to target the new SARS-CoV-2 variant JN.1 for the 2024/2025 vaccination campaign. JN.1 differs from the XBB family targeted by previous updated vaccines and has now surpassed the XBB variants to become the most widely circulating variant worldwide. In making its recommendation, the ETF consulted the World Health Organization (WHO), international partners and marketing authorisation holdersfor COVID-19 vaccines.

In early August, the Epidemiology and Surveillance Centre of Semmelweis University recommended immunisation with the new COVID-19 vaccine once it becomes available for the following groups:

• people aged 65 or over who have not been diagnosed with an underlying disease;
• people 6 months and older with a chronic underlying medical condition (cardiovascular, respiratory, liver, kidney or diabetes, obesity, chronic neurological disease, or immune deficiency);
• pregnant women repeatedly, once for each pregnancy;
• carers and staff of residential institutions providing long-term care;
• for social care workers;
• health workers in direct contact with patients,

if they have not received the COVID-19 vaccine for more than 6 months or never.

As reported earlier, Hungary's National Centre for Public Health and Pharmacy (NNGYK) keep stressing the importance of vaccinating against influenza, but act as if COVID-19 no longer existed. However, it not at all the same if you get infected with SARS-CoV-2 (more severe symptoms) or influenza (less severe symptoms).

On the 42nd week of this year, 92 or almost 47% of the 196 people hospitalised with severe acute respiratory infection were diagnosed with coronavirus infection. While this is a lower ratio than a year ago (65.3%), it clearly shows the the period generally referred to as the 'influenza season' is practically coronavirus season and based on the pattern of the previous years it will remain so for several weeks, if not all the way.

In the previous 'flu season', the share of influenza virus in the weekly samples tested started to be higher than the share of COVID-19 only on the 2nd week of this year, and the turnaround took place on the 1st week of 2023 one season earlier. Unlike in 2022/23, the percentage of influenza virus detected in all samples tested never exceeded the percentage of coronavirus in all samples tested in the 2023/24 season of respiratory illnesses.

The NNGYK has recently announced that as in last season, 949,000 doses of the 3Fluart flu vaccine would be available for the high-risk group of people aged 3 years and over, to be used free of charge this season. At the same time, they provide no data on Covid vaccination availability or coverage. Our request for a longer-term data series for flu shot coverage was left without a response. (We asked for data for the past 14 years, a number they quoted in one of their recent press releases.)

The 949,000 3Fluart vaccines compare with a public procurement tender called for only 100,000 COVID-19 vaccines, while the target groups are practically the same. And while the actual 'flu season' will kick in only next year, the number of coronavirus infections is already high.

All of Hungary's Covid vaccines expired at the end of August,

and when news portal Telex contacted the NNGYK about this, they replied that they were working on obtaining new doses, but did not say when or how many vaccines would arrive.

The vaccine procurement process has not always been transparent in the past. For example, details of last year's procurement were only revealed by anaccidental statement and procurement documents revealed that far less vaccine than planned was purchased. The procurement irregularities led the Public Procurement Arbitration Committee to fine the NNGYK HUF 14 million.

In the interview, Oroszi stressed that the prevention of epidemics and the control of communicable diseases is not limited to vaccination. The use of masks, keeping a safe distance and observing hygiene rules are also essential.

The epidemiologist stressed the importance of using a mask in crowded, confined spaces and on public transport.

It's a very simple and very effective thing to do for very little money, at almost no cost,

she said.

New variants of COVID-19 continue to emerge and spread rapidly, with greater infectivity and bypassing of the immune response, which reduces the effectiveness of earlier vaccines.

This makes regular booster shots a priority.

A week ago, the Centers for Disease Control and Prevention (CDC) recommended for people 65 years and older and those who are moderately or severely immunocompromised to receive a second dose of 2024-2025 COVID-19 vaccine six months after their first dose. 

Pertussis spreads also due to immunity debt

Oroszi also mentioned whooping cough, which is a bacterial infection. In Hungary, the number of cases has increased significantly in recent years, partly due to the relaxation and subsequent scrapping of the Covid-related lockdown measures, as "immunity debt" has developed due to reduced population-level immunity during the lockdown. And part of the reason why the disease has started to spread again is that the effectiveness of previous vaccines has also declined.

The term “immunity debt” has emerged, and basically proposes that children's immune systems are now weaker because they have not been exposed to as many pathogens as they would have been in the absence of the public health response to the pandemic. You can read more extensively about immunity debt and whether it really exists here, and here, here, and here.

So far this year, more than 1,000 cases have been reported, compared to 8-10 cases in recent years, the expert said. Oroszi noted that booster vaccinations against pertussis are needed, especially for pregnant women and people living around babies.

Finally, she stressed that preventing and controlling communicable diseases is not only an individual responsibility, but also a social and governmental task. It is important that the population is properly informed about communicable diseases and their prevention, and that vaccines are available to all.

Cover photo (for illustration purposes only): Portfolio