While it’s tempting to compare various aspects of AstraZeneca-Oxford’s newly approved COVID-19 vaccine to others, several experts cautioned against focusing on data that is not comparable and the danger of underrating the product’s ability to curb hospitalizations and deaths.
Health Canada’s long-awaited announcement Friday that a third vaccine would soon be deployed came just as the provinces faced heightened scrutiny over regional immunization plans that vary by timeline, age eligibility and priority groups.
Prime Minister Justin Trudeau promised the boost to Canada’s pandemic arsenal would mean “more people vaccinated, and sooner,” and would be key to helping contain spread.
Nevertheless, Health Canada chief medical advisor Dr. Supriya Sharma acknowledged questions over how the public should evaluate trial results that show AstraZeneca has an efficacy of 62 per cent in preventing symptomatic cases. That’s compared to the 95 per cent efficacy of the country’s two other approved vaccines, from Pfizer-BioNTech and Moderna.
But Sharma stressed that all three have been shown to prevent 100 per cent of hospitalizations and deaths due to COVID-19.
“Each vaccine has unique characteristics and Health Canada’s review has confirmed that the benefits of the viral vector-based vaccine, as with the other authorized vaccines, outweigh their potential risks,” Sharma said.
Several medical experts including Dr. Stephen Hwang say Canadians do not have the luxury to pick-and-choose as long as COVID-19 cases continue to rage in several hot spots and strain health-care systems.
With multiple COVID-19 projections warning of a variant-fuelled third wave without tighter suppression measures, any tool that can slow the pandemic should be embraced, he argued.
“It would be important for people to be vaccinated with whichever vaccine is first available in their community to them, rather than trying to hold out for a specific vaccine,” advised Hwang, who treats COVID-19 patients at St. Michael’s Hospital in Toronto.
Still, Toronto resident Maria Brum couldn’t help but question whether AstraZeneca was safe for her 79-year-old mother.
The vaccine was not tested on people over the age of 65. Health Canada, however, says real-world data from countries already using the product suggest it is safe and effective among older age groups, promising an update on efficacy in the age group as more data comes in.
“I personally would take that one out as an option for my mom,” said Brum, who is her mother’s main caregiver.
“Maybe I am wrong but, I don’t know, I don’t see that it’s more useful. I’d like to see one that has a higher percentage of (efficacy).”
As for herself, Brum said she has allergies that she believes may put her at greater risk of adverse reactions and so she is unsure whether she can take any vaccine.
But she’d like the option of choosing, if possible, even while acknowledging that limited supply could make that unlikely.
“As a Canadian, I would like to see us all have choices, regardless of age, gender, or ability,” says Brum.
“I’m going to wait where I can have more choices.”
Such hesitancy could pose public health challenges to Canada reaching the vaccination coverage needed to build protective immunity against COVID-19, said Hwang.
He noted that Germany has seen a reported preference among some for the vaccine made by Germany’s BioNTech with Pfizer, as well as a misconception that the AstraZeneca vaccine is inferior because of a lower efficacy rate.
Hwang says efficacy between vaccines cannot be compared because each involved completely different trials at different time periods, in different countries, with different volunteers of different age groups and varying trial designs.
“Until we have direct comparison studies where we give people one vaccine versus another and directly compare, it’s very difficult to know for sure how it’s going to pan out,” he says.
Then there’s the fact Canada’s initial AstraZeneca doses will be made at the Serum Institute of India, which dubs its version CoviShield, while later packages will be produced at the drug giant’s own manufacturing facilities.
Hwang acknowledges that could invite further scrutiny but says the Pune, India-based biotech firm has a “strong track record of producing vaccines.”
Sharma also stressed the similarities between the two shots Friday.
“For all intents and purposes they’re the same vaccine,” said Sharma.
“There are some slight differences in terms of manufacturing and the places that they are manufactured are different. The analogy is a bit like the recipe – so the recipe for the vaccine is the same, but they’re manufactured in different kitchens.”
Ontario hospitals may have to withhold care as COVID-19 fills ICUs
By Allison Martell and Anna Mehler Paperny
TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.
Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.
The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.
Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.
Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.
The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.
“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.
“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”
In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.
Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.
“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”
In COVID-19 vaccination pivot, Canada targets frontline workers
By Anna Mehler Paperny
TORONTO (Reuters) – Canada is shifting its vaccination campaign to target frontline workers, moving away from a largely age-based rollout as the country tries to get a handle on the raging third wave of the pandemic.
Canada‘s approach thus far has left unvaccinated many so-called “essential workers,” like daycare providers, bus drivers and meatpackers, all of whom are among those at higher risk of COVID-19 transmission. Provinces are now trying to adjust their strategy to tackle the surge driven by new variants.
Targeting frontline workers and addressing occupation risk is vital if Canada wants to get its third wave under control, says Simon Fraser University mathematician and epidemiologist Caroline Colijn, who has modelled Canadian immunization strategies and found “the sooner you put essential workers [in the vaccine rollout plan], the better.”
Initially, Canada prioritized long-term care residents and staff for the vaccines, as well as the very elderly, health workers, residents of remote communities and Indigenous people.
Targeting vaccinations by age made sense early on in a pandemic that ravaged Canada‘s long-term care homes, Colijn said. But now, immunizing those at highest risk of transmission brings the greatest benefit.
“If you protect these individuals you also protect someone in their 60s whose only risk is when they go to the store. … The variants are here now. So if we pivot now, but it takes us two months to do it, then we will lose that race.”
Data released on Tuesday from the Institute of Clinical and Evaluative Sciences showed that Toronto’s neighbourhoods with the highest rates of COVID-19 infections had the lowest vaccination rates, underscoring the disparities in vaccination.
‘IT’S A JUGGERNAUT’
On Wednesday, Ontario Premier Doug Ford announced a plan to have mobile vaccine clinics target COVID-19 “hotspots” and high-risk worksites, although he stopped short of giving people paid time off to get the shot.
Karim Kurji, medical officer of health in York Region north of Toronto, characterizes the shift in vaccination priority from age to transmission risk as moving from defence to offence.
“It’s a juggernaut in terms of the immunization machinery, and turning it around takes a lot of effort,” Kurji said.
Meanwhile, officials in the western province of Alberta say they are offering vaccines to more than 2,000 workers at Cargill’s meatpacking plant in High River, site of one of Canada‘s largest workplace COVID-19 outbreaks. Provincial officials said in a statement they are looking to expand the pilot to other plants.
Quebec will start vaccinating essential workers such as those in education, childcare and public safety in Montreal, where neighbourhoods with the highest vaccination rates have been among those with the lowest recorded infection rates.
The people doing the highest-risk jobs, from an infectious disease perspective, are more likely to be poor, non-white and new Canadians, health experts say. They are less likely to have paid leave to get tested or vaccinated or stay home when sick and are more likely to live in crowded or multi-unit housing. They need to be prioritized for vaccination and their vaccination barriers addressed, experts say.
Naheed Dosani, a Toronto palliative care physician and health justice activist, said making vaccines available to high-risk communities is not enough without addressing barriers to access.
“The face of COVID-19 and who was being impacted changed dramatically. The variants seemed to take hold in communities where essential workers live. … This [pivot] is a step in the right direction and will hopefully save lives.”
(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Aurora Ellis)
Canada finance minister: Pandemic an opportunity to bring in national childcare
OTTAWA (Reuters) – The COVID-19 pandemic and its damaging impact on women has underlined the need for a national childcare plan, which would also help the economic recovery, Finance Minister Chrystia Freeland said on Thursday.
Since taking up her job in August, Freeland has repeatedly spoken about a “feminist agenda,” and has said childcare will be part of a stimulus package worth up to C$100 billion ($79.6 billion) over three years. She will unveil details in her April 19 budget.
“I really believe COVID-19 has created a window of political opportunity and maybe an epiphany … on the importance of early learning and childcare,” Freeland told a online convention of Canada‘s ruling Liberal Party.
The budget is set to be a springboard for an election that Liberal insiders say is likely in the second half of the year.
Canadian governments of various stripes have mused about a national childcare program for decades but never acted, thanks in part to the cost and also the need to negotiate with the 10 provinces, which deliver many social programs.
Freeland said a childcare program would help counter “an incredibly dangerous drop” in female employment since the start of the pandemic.
“It is a surefire way to drive jobs and economic growth … you have higher participation of women in the labor force,” Freeland said. “My hope … is that being able to make that economic argument as well is going be to one of the ways that we get this done.”
Freeland, who is taking part this week in meetings of the Group of Seven leading industrialized nations and the International Monetary Fund, said U.S. Vice President Kamala Harris and Treasury Secretary Janet Yellen had told her they saw early learning and child care as a driver for economic recovery.
($1=1.2560 Canadian dollars)
(Reporting by David Ljunggren; Editing by Leslie Adler)