MONTREAL —
It’s been 42 days since residents of Maimonides Geriatric Centre in Montreal received their first doses of the Pfizer COVID-19 vaccine, and with no appointments scheduled to administer the second dose, Quebec is now heading into the “wilderness,” says a leading Montreal geriatrician.
Dr. Jose Morais, Chief of Geriatric Medicine at McGill University, emphasized that he thinks “these are difficult decisions,” and “from the public health standpoint, maximizing the distribution of the vaccine is the right thing to do,” to protect a larger number of vulnerable seniors and front-line health-care workers.
From what is known about vaccines and immunity, he also said it’s unlikely the protective effects of one dose will just abruptly disappear. They usually diminish more slowly, and it is possible the effects could last for three months.
But Quebec’s decision to delay the second dose up to 90 days so that double the number of vulnerable Quebecers can be immunized with a first vaccine is not risk-free, Morais said.
“We are in unknown territory. We may be taking undue risks for these particular people because the science supports giving it up to six weeks, 42 days, and the WHO (World Health Organization) has looked into this data and this is what they suggest,” the geriatric specialist said.
Benoit Masse, a public health researcher at Universite de Montreal agreed with the assessment made by Morais.
“Yes, there are potential risks with delaying the second dose beyond six weeks. Unknown risks,” he said.
Canada’s National Advisory Committee on Immunization (NACI) also recommended a six-week delay in a report issued on Jan. 12, because that specific waiting period between doses has been proven to work in clinical trials for Pfizer and Moderna vaccines.
It advised the strategy only be deployed in response to a perfect storm: a rising number of cases, strain on hospitals and a limited supply of vaccines.
In a Jan. 21 update on the province’s decision to delay second shots as long as 90 days, the Quebec Public Health Institute (INSPQ) noted in French, that “no maximum interval between doses is specified,” by the NACI and that “the proposal to not exceed 42 days is therefore not based on data of decreased efficacy after this time period.”
That means the decision to not exceed 42 days was also made by the NACI, because there is currently no data to back it up, as Morais and Masse explained.
Quebec’s immunization committee does conclude administering a second dose is necessary to assure long-term protection, and that the timing of the second dose could be advanced if studies eventually show efficacy wanes after the first dose.
FAMILIES IN LIMBO
As they mark day 42 on the calendar, family members of the long-term care residents at Maimonides remain in the dark about the timeline.
Joyce Shanks, whose father lives at the facility, said the families did not get a response “to the original legal action that we took.”
The Maimonides Family Advocacy Committee is accusing the government of breach of contract.
Lawyer Julius Grey sent an open letter to the premier and health minister more than two weeks ago.
Nor have they heard anything from the West-Central Montreal health authorities (CIUSSS) about the second dose, said Shanks.
“They are toeing the government line. We have nothing specific to go on about the vaccine,” she said, adding “we are exploring every legal opportunity.”
When CTV asked the West-Central Montreal CIUSSS if it has set a date for the second shot to be administered, a spokesperson directed us to Quebec’s health ministry. A Quebec health ministry spokesperson, in turn, invited us to “reach out to the West-Central Montreal CIUSSS with that question.”
But the government is likely recalculating its timeline for the umpteenth time now that most of the province’s doses have been administered – and because Pfizer has delayed shipments of its vaccines to Canada, it is putting public health officials in an even more precarious position.
That was confirmed Monday when the health ministry told CTV that because of the “important” reduction in the number of Pfizer doses they had expected to receive over the next two weeks, they “must review the vaccination calendar, notably for the RPAs,” which are private seniors’ residences.
Above all, the vaccine shortage and dosing strategy have now pushed Quebecers waiting for the booster shot well past the goal lines – three weeks past the vaccine manufacturer’s recommendations, and past the 42-day emergency interval laid out by the NACI.
CALCULATED RISKS
The decision to give the second dose any time past Pfizer’s 21-day schedule or Moderna’s 28-day recommendation has divided scientists and clinicians around the world, particularly in Canada and also in the U.K, where a 12-week dosing interval has also been approved.
“Even us, we are torn apart between these two scenarios,” revealed Morais, who works at two MUHC hospitals as well as the Jewish General Hospital.
“I have a colleague who decided to take no vaccination. He said if I didn’t receive the second dose within 42 days, why bother taking the first vaccination?” Morais said.
In an email exchange with CTV, public health expert Masse acknowledged that Quebec is walking a tightrope as he spelled out the province’s predicament.
“The benefit of delaying the second dose is (almost) immediate. We protect more people with a first dose, as we are in a large outbreak that we are barely able to control. We are talking about saving lives and hospitalizations in the short term,” he wrote.
Once immunity starts to kick in though and then builds – at 14 days after the first dose, according to a study in the New England Journal of Medicine – even some protection can mean the difference between a survivable illness and one that’s fatal.
However, if the risk turns out to be real – that the vaccine’s protective effects decline quickly or the effectiveness of the first dose turns out to be considerably weaker than expected – then Masse said we could “end up with no net gain overall or worse, an overall increase in death and hospitalizations.”
Masse argued, though, that it’s likely the intensity of the second wave will ease in the coming months and only if there is a rapid decline in the efficacy would we “undo all the benefits we can get right now by vaccinating the maximum number of people.”
Also, getting one dose of the vaccine, even two doses doesn’t mean anyone should stop following all recommended hygiene and distancing measures in the short-term. No one knows yet if the vaccines approved in Canada, will prevent transmission of the virus.
Finally, Masse offered the following assignment, suggesting people ask themselves what they’d do if they have two parents who are both 80 years old (as he does).
“If you give me two doses of a vaccine right now, what do I do? Vaccinate only my mother and keep the one dose in the freezer – or, vaccinate both my mother and father right now?”
In the current climate, when case numbers and community transmission are still high, “I choose the latter without hesitation. In the context of a huge outbreak, I want to protect both of them,” the public health researcher said.
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.
