The Design of Covid-19 Recovery Contributions: Taxes or Social Security Contributions?

To cover the large financial spending caused by the Covid-19 pandemic, countries worldwide are forced to take substantial fiscal actions. This contribution takes a closer look at the extent to which EU law has an influence (restrictive or otherwise) on the freedom of Member States to opt for (additional) taxes and/or social contributions as a means to finance the (additional) deficits in their social security system. First, a brief numerical overview will be given of the various sources of financing and expenditures of social security in the European Union (II). Subsequently, the question will be addressed to which extent the concept of social security contributions under European Union law interferes with the national definition of taxes (III). The most relevant rulings of the European Court of Justice (CJEU) in this respect will be discussed (IV) followed by a number of final considerations (V). © 2021 Kluwer Law International BV, The Netherlands

Systematic screening of kidney transplant patients points towards deficits in neutralizing antibody capacity against sars-cov-2

Purpose: The majority of kidney transplant recipients (KTR) is able to develop SARS-CoV-2 antibodies (Abs). Little is known about the virus neutralizing capacity of these Abs. Methods: KTR were systematically screened for SARS-CoV-2 at the Antwerp University Hospital by nasopharyngeal swab and serum sampling for the detection of respectively SARS-CoV-2 RNA and SARS-CoV-2 IgG Abs using an in-house Luminex assay. Results of Abs against the nucleocapsid protein (NP) and Receptor- Binding Domain (RBD) of the spike protein were expressed as Median Fluorescence Intensities (MFI). Virus neutralisation assays were performed on serum samples of patients with SARS-CoV-2 Abs or a positive RT-PCR test and on samples of an age and sex matched control group of 23 COVID-19 positive immunocompetent patients. Results: 135 KTR were included;13 were known to be RT-PCR positive. Of these 13, 10 (77%) tested positive for SARS-CoV-2 Abs. Antibody screening revealed two (2%) additional KTR with detectable Abs. Virus neutralizing capacity was observed in 11/12 (92%) antibody positive KTR vs. 22/23 (96%) immunocompetent antibody positive controls (p = 0.63). In patients who showed virus neutralizing capacity (expressed as sample dilution reducing the number of infected wells by 50% (NT50)), significantly higher neutralizing antibody capacity was observed in immunocompetent controls vs. KTR (median NT50 1027 (IQR 395-1601) vs. 217 (IQR 108-534);p=0.01). There was no difference in IgG-NP MFI and IgG-RBD MFI values between both groups (median IgG NP MFI 24554 (IQR 11218-27017) vs. 11387 (IQR 3062-24825);p = 0.13);median IgG RBD MFI 20302 (IQR 13464- 24251) vs. 21736 (6288-24993);p = 0.85). Conclusions: Our results suggest that KTR have lower neutralizing antibody capacity compared to immunocompetent subjects. The latter might be of high importance for future COVID-19 vaccine trials.

Reduced humoral immune response after BNT162b2 coronavirus disease 2019 messenger RNA vaccination in cancer patients under antineoplastic treatment.

BACKGROUND: Cancer patients are at a higher risk of developing severe coronavirus disease 2019 (COVID-19). However, the safety and efficacy of COVID-19 vaccination in cancer patients undergoing treatment remain unclear. PATIENTS AND METHODS: In this interventional prospective multicohort study, priming and booster doses of the BNT162b2 COVID-19 vaccine were administered 21 days apart to solid tumor patients receiving chemotherapy, immunotherapy, targeted or hormonal therapy, and patients with a hematologic malignancy receiving rituximab or after allogeneic hematopoietic stem cell transplantation. Vaccine safety and efficacy (until 3 months post-booster) were assessed. Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor-binding domain (RBD) antibody levels were followed over time (until 28 days after the booster) and in vitro SARS-CoV-2 50% neutralization titers (NT50) toward the wild-type Wuhan strain were analyzed 28 days after the booster. RESULTS: Local and systemic adverse events (AEs) were mostly mild to moderate (only 1%-3% of patients experienced severe AEs). Local, but not systemic, AEs occurred more frequently after the booster dose. Twenty-eight days after the booster vaccination of 197 cancer patients, RBD-binding antibody titers and NT50 were lower in the chemotherapy group {234.05 IU/ml [95% confidence interval (CI) 122.10-448.66] and 24.54 (95% CI 14.50-41.52), respectively} compared with healthy individuals [1844.93 IU/ml (95% CI 1383.57-2460.14) and 122.63 (95% CI 76.85-195.67), respectively], irrespective of timing of vaccination during chemotherapy cycles. Extremely low antibody responses were seen in hematology patients receiving rituximab; only two patients had RBD-binding antibody titers necessary for 50% protection against symptomatic SARS-CoV-2 infection (<200 IU/ml) and only one had NT50 above the limit of detection. During the study period, five cancer patients tested positive for SARS-CoV-2 infection, including a case of severe COVID-19 in a patient receiving rituximab, resulting in a 2-week hospital admission. CONCLUSION: The BNT162b2 vaccine is well-tolerated in cancer patients under active treatment. However, the antibody response of immunized cancer patients was delayed and diminished, mainly in patients receiving chemotherapy or rituximab, resulting in breakthrough infections.