Canada has delayed second doses of COVID-19 vaccines by up to four months — the longest interval recommended by a country so far — but has yet to provide any new guidance to Canadians on what they can or can’t do while waiting for the second shot.
NACI said it based its revised guidelines on emerging real world evidence and the reality of Canada’s limited supply of COVID-19 vaccines, although there is no research yet on the long-term effect the delay could have on immunity to the coronavirus disease.
The decision was also informed by findings from the British Columbia Centre for Disease Control that determined that one dose of the vaccine was actually more effective than clinical trials had initially shown.
NACI said if second doses were stretched to four months across the country, close to 80 per cent of Canadians over 16 could get at least one shot by the end of June.
But Canada’s chief science adviser, Mona Nemer, has said the decision to delay second doses amounted to a “population level experiment.”
The United Kingdom has delayed second doses by up to three months, but no other country is known to have delayed them by up to four months. Spokespeople from Pfizer and Moderna said they recommend sticking with intervals of three and four weeks for their respective vaccines as studied during clinical trials.
What can Canadians do after being vaccinated?
Many Canadians are wondering what they can do after getting vaccinated and if they can safely see their families, other vaccinated people or generally feel less at risk from COVID-19 after a year under strict public health measures.
But the recommendations still haven’t been updated weeks after the change was made — meaning Canadians could be tempted to make up their own rules in the interim.
The U.S. Centers for Disease Control and Prevention released guidelines on March 8 for fully vaccinated individuals, saying they can safely meet indoors without masks or physically distancing with others who had received both shots.
The CDC also said those who have had both shots can visit with unvaccinated people from a single other household who are at “low risk for severe COVID-19,” as well as skipping quarantine and testing if exposed to COVID-19 without showing symptoms.
But unlike Canada, the U.S. hasn’t delayed second doses by up to four months and answers to those questions have been harder to come by for Canadians weeks after guidelines changed and close to 5 million doses administered.
Canada’s Chief Public Health Officer Dr. Theresa Tam said during a news conference Tuesday that the issue is being actively discussed with the provinces and territories and that while new guidance is coming, the country is in the “early days” of its vaccine coverage.
“For now, the key message is that everyone needs to keep up with their personal protective measures which are wearing a mask, handwashing, watching your distance and avoiding closed, crowded conditions,” she said.
“I think as more and more people get vaccinated I would expect the advice to evolve as we go along, but it’s a little bit too early.”
WATCH | ‘Too early’ to update guidelines for vaccinated Canadians: Tam
Canada’s Chief Public Health Officer Dr. Theresa Tam says guidance for Canadians who have been vaccinated will likely evolve as more people get vaccinated, but it’s too early in our roll out to update recommendations yet. 1:35
Tam said the spread of coronavirus variants across Canada amid already high levels of community transmission should factor into “local decisions” on what public health measures need to be put in place or lifted for vaccinated individuals.
She provided no timeframe for when Canadians can expect to see new guidance from the Public Health Agency of Canada on what they can and can’t do after being vaccinated.
Guidelines for Canadians with only one dose even less clear
And what about guidelines for Canadians who have only had one dose?
“It’s maybe not clear to the general public, but it should be clear that you’re only fully vaccinated after two doses,” said Prof. Alyson Kelvin, an assistant professor at Dalhousie University and virologist at the Canadian Center for Vaccinology.
“I can completely sympathize that it’s been a long haul for everybody, but it’s really important that we continue with those public health measures until we have a low level of virus transmission within the community.”
She says until Canada’s hardest-hit regions have significantly lowered their rates of community transmission, Canadians will have to continue practicing physical distancing, proper hand hygiene, avoiding crowds and wearing masks in public.
“You’re still at risk even though you’re fully vaccinated,” says Kelvin, who is also evaluating Canadian vaccines with the VIDO-InterVac lab in Saskatoon.
“Even with two doses, you can still be infected and transmit the virus — you just might not be as ill as somebody who wasn’t vaccinated.”
A team from Humber River Hospital administer first doses of the Pfizer-BioNTech COVID-19 vaccine to parishioners of St. Fidelis Parish church on March 17, 2021. (Evan Mitsui/CBC)
Until Canada has a large proportion of vaccinated people across the country who can help decrease overall COVID-19 levels, Kelvin says it makes sense for hard-hit regions to hold off on relaxing public health measures.
Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, says communication from public health officials on what people can do after getting a COVID-19 vaccine has been lacking — especially for older Canadians.
“I’ve had patients who have showed up at the vaccination clinic expecting to get their second shot and have been turned away, so they are devastated emotionally, I’ve had people who have found out immediately beforehand,” he said.
“I think their questions are very reasonable, which [are]: ‘Do we have evidence to support this? Am I going to be at higher risk? How does this impact my behavior during the third wave now?'”
WATCH | The science behind delaying the 2nd dose of COVID-19 vaccines
Federal government scientists have put their support behind delayed second doses of COVID-19 vaccines — which several provinces were already doing — and ongoing research shows some of the benefits of the adapted strategy. 2:04
Stall, who is a member of NACI but does not speak on behalf of the committee, said it’s important for public health officials to be transparent about the emerging data on delaying second doses and that the guidelines will likely change.
“I think we need to do a much better job of messaging,” he said. “Because this population [of older seniors] has been living in terrible isolation for a year.”
Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta, says updated guidelines will likely come in the near future as new data emerges.
She said it was important to note that the recommendations allowed for a maximum interval of up to four months, though the actual interval between doses could be shorter and the guidelines revised if new data showed certain groups were at higher risk.
“So the main thing is to kind of stay light on your feet and make changes that make sense to try to protect everyone the best we can,” she said.
Saxinger said the second dose delay made sense given Canada’s limited vaccine supply, because it allowed for an expanded vaccination rollout and offered protection to a greater number of vulnerable Canadians.
“It really will actually save a great many lives,” she said.
“But if there’s populations where deferring the second dose will actually make them less likely to be immune in the longer term, then obviously that’s a place that has to be readdressed.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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