Health Canada’s chief medical adviser says variant-specific vaccines can be approved faster than the general ones first issued to combat COVID-19, but one targeting the Omicron strain still likely won’t be ready in time to help with the latest wave.
Dr. Supriya Sharma said what is really needed are vaccines that can possibly stop more than one variant at a time, including those yet to come.
Omicron became the dominant variant in Canada in just over two weeks, and the Public Health Agency of Canada said Friday it’s now believed to be responsible for more than 90 per cent of all COVID-19 cases.
Studies suggest two doses of the existing mRNA vaccines from Pfizer-BioNTech and Moderna are not good at preventing infection from Omicron.
Multiple studies, however, suggest the vaccines are excellent at keeping symptoms mild, preventing hospitalizations, and shortening the stay and lowering the level of care for those who do get admitted to hospital. Fewer vaccinated Omicron patients, for example, need mechanical ventilation.
Both Pfizer and Moderna are working on new versions of their vaccines that specifically target the Omicron variant.
Moderna is hoping to get its product into trials early this year. Pfizer said it could have 100 million doses of theirs ready as early as March, and Canada has contracts for boosters from both companies that would include vaccines for variants too.
But Sharma said even with the expedited review process for vaccine variants, that’s “probably not” fast enough.
“By that time, based on what we’ve known about the Omicron wave, it might well and truly be through,” she said. “And then the question is always, ‘is there another variant that’s coming up?”‘
The solution, she said, likely lies with vaccines that can target more than one variant at a time.
The COVID-19 vaccine technical committee of the World Health Organization said the same thing on Jan. 11, noting Omicron is the fifth variant of concern in two years and “is unlikely to be the last.”
Booster shots that heighten antibody development became the immediate response to Omicron for many governments, including Canada.
Dr. Srinivas Murthy, a British Columbia pediatrician and co-chair of the WHO’s clinical research committee on COVID-19, told The Canadian Press that boosters aren’t a long-term viable option.
“Boosting your way out of a pandemic is going to inevitably shoot you in the foot in the sense that you’re going to have a future variant that’s going to emerge that’s going to cause problems,” he said. “It’s going to evade your vaccines, and then you’re going to have to scramble.”
Omicron doesn’t evade the existing vaccines entirely but a future variant could, he said. The issue largely stems from the fact that the original vaccines train the body’s immune system to recognize what is called the spike protein found on the surface of a virus, and that spike protein is mutating significantly.
Think of the mutated spike protein as a bit of a disguise that makes it harder for the immune system to recognize the virus and mount a defence to kill it off.
Omicron has more than 50 mutations, and at least 36 are on the spike protein.
Multivalent vaccines that use the spike protein from more than one variant, or that target the genetic components of a virus rather than the spike protein, are possibly the ones that could offer protection for both this pandemic and the next novel coronavirus that emerges.
“It’s pan-coronavirus, where it’s looking at big broad neutralizing responses and you don’t have to update it every season and so on,” said Murthy. “That’s been the Holy Grail of flu vaccinology for the past number of decades. We haven’t achieved that yet, because flu is a bit tricky, but we think that it’s achievable for coronavirus, specifically.”
The United States Army has a version heading into Phase 2 trials that can attach multiple spike proteins. A vaccine with the specific spike proteins from all five COVID-19 variants of concern would likely be more successful, even against future variants, because they all share some of the same mutations and what one might miss another may catch.
Moderna is working on trials for multivalent vaccines using combinations of the spike proteins from the original virus and one of the variants, or two of the variants together. It’s not clear when they would be ready for use.
Sharma said even if the vaccines aren’t working as well against variants as they were against the original virus, to her “they’re still miraculous.”
“To have a vaccine that was developed that quickly, that still has, through multiple variants ΓÇª with boosters, up to 70, 80 per cent effectiveness against serious disease, ailments, hospitalization and death,” she said. “That is miraculous for a new vaccine for a new virus.”
This report by The Canadian Press was first published Jan. 16, 2022.
OTTAWA — While she has helped several migrant workers access abortion services in Canada, Evelyn Encalada Grez said one woman comes to mind.
“The migrant woman was so afraid of being found out that she needed to be taken by somebody else outside of the farm for a medical appointment,” said Encalada Grez, a transnational researcher and advocate for migrant workers who has been studying the subject for more than 20 years.
On the day she came to pick the woman up to bring her to Toronto to meet health-care workers who could perform the procedure, it was raining.
Because the woman was so worried about being seen, she met Encalada Grez far away from the farm in the Niagara region where she worked.
“When I met her in the designated place where we agreed to meet, she was soaking, soaking, soaking, and I’m like, ‘Why does it feel like I’m doing something wrong?’” Encalada Grez recalled.
“What if she didn’t have a friend or know anyone that does this type of grassroots work, what would have happened to her and her life?”
This experience is similar to many others Encalada Grez has had taking migrant workers to access an abortion. Moving in secrecy off farm property feels like organizing a heist.
Migrant women in Canada face profound barriers in accessing health care, especially when it comes to pregnancy. They often hide their pregnancies because if employers find out, they may send them home or refuse to hire them next season. Workers typically live on their employer’s property and lack the privacy to discreetly seek care. Many live in remote, rural areas where abortion access is already sparse and transportation is hard to come by. And they face the added challenge of being unable to receive health care in their first language.
Another major barrier is cost, said Elene Lam, executive director of Butterfly, an organization of sex workers, social, legal and health professionals that advocates for the rights of Asian and migrant sex workers.
The migrant workers Lam advocates for typically lack provincial health-care coverage, and are required to pay out of pocket, she said. Depending on the stage of pregnancy, that can cost anywhere between a few hundred dollars and up to $1,500.
While many migrant workers can access public health care, not all of them can, said Lindsay Larios, assistant professor at the University of Manitoba, who studies precarious migration and reproductive justice.
This can be a result of having to wait the three-month period after arrival, during which time they must rely on private insurance. To get it, their employers have to file paperwork that sometimes doesn’t get filed.
If they face issues with renewing work permits or visas, that can also mean a lapse in their immigration status.
When it comes to abortion, there is a lot of stigma around migrant workers having intimate or sexual relationships, said Larios.
She cited research that shows migrant workers are told by officials in their home countries or in Canada, or by their employers, that they should abstain from sexual relationships.
“Workers themselves feel that there’s a real risk to their job — for example, not being hired back the following year — if they are seen as problematic employees who are transgressing this accepted unofficial policy,” she said.
Despite the fact that the abortion pill, mifepristone, became available in Canada at the beginning of 2017, this has not necessarily translated into better access to abortion for migrant workers, said Larios and Lam.
The treatment, also known as medical abortion, can be done safely at home rather than requiring a trip to a clinic or hospital, but still requires a prescription from a doctor and costs hundreds of dollars if a patient has to pay out of pocket, Larios said.
Mohini Datta-Ray, executive director at Planned Parenthood Toronto, pointed out that medical abortion has very uncomfortable effects. It causes a lot of cramping, bleeding and pain, and is very debilitating for about a week or so, she said.
Given the few protections migrant workers have around their health, and how little it can take to deport them for an illness, disability or other scenario that makes them less valuable in the eyes of the employer, “it’s just not the solution that you would think at first glance, if you’re not in caught in this very impossible situation,” said Datta-Ray.
If the federal government cares about abortion access, it could grant “status for all,” a campaign to grant permanent residency for all temporary migrant workers and families with precarious legal status, said Frederique Chabot, director of health promotion at Action Canada for Sexual Health and Rights.
Action Canada supports the call because it knows without that, people will continue to go without abortion, Chabot said.
Encalada Grez echoed this and added that the government must reform temporary foreign worker programs so that employees are not tied to one employer and can have the freedom to go elsewhere, reducing the likelihood of exploitation.
“We need to be more accountable to the people that Canada brings in,” she said.
The office of Carla Qualtrough, minister of employment and workforce development, has not yet responded to a request for comment.
This report by The Canadian Press was first published May 28, 2022.
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.
That’s what Cheryl-Anne Labrador-Summers thought, anyway. It was October 2020, not long after she’d moved to the tranquil lakeside Ontario community of Georgina, and instead of relaxing with her family like she’d planned, the mother of three was struggling to figure out why she kept experiencing strange, unexplained stomach cramps.
Labrador-Summers tried to visit her family physician, but the office was shuttered because of the COVID-19 pandemic. So she searched for another clinic — only to be offered a phone appointment rather than an in-person assessment. She wound up being told that her grumbling digestive system was likely caused by a mild gastrointestinal illness.
By January, the 58-year-old had a distended stomach, looking — in her own words — “about nine months pregnant.” Again, she reached out to a physician, went for some tests, then headed to the nearest emergency department.
After finally seeing a doctor face to face for the first time in months, she learned the real cause of her discomfort: an intestinal blockage caused by cancer.
“It ended up being a nine-centimetre tumour, and it had completely blocked off my lower bowel,” she said.
An emergency surgery left Labrador-Summers with 55 staples along her torso and a months-long recovery before she could begin oral chemotherapy. Her question now is unanswerable but painful to consider: Could that ordeal have been prevented, or at least minimized, by an earlier diagnosis?
“Had I maybe been able to see the doctors earlier, I would not be in Stage 3,” she said. “I might have been a Stage 2.”
951,000 fewer cancer screenings in Ontario
More Canadians could experience late-stage cancer diagnoses in the years ahead, medical experts warn, forecasting a looming crisis tied to the ongoing COVID-19 pandemic.
“We expect to see more advanced stages of presentation over the next couple of years, as well as impacts on cancer treatments,” said oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen’s University in Kingston, Ont.
“We know that time is of the essence for people with cancer. And when people are waiting for a diagnosis or for treatment, this has been associated with increased risks of advanced stage and worse survival.”
One review of Ontario’s breast, lung, colon, and cervical cancer screening programs showed that in 2020 there were 41 per cent — or more than 951,000 — fewer screening tests conducted compared with the year before.
Screening volumes rebounded after May 2020, but were still 20 per cent lower compared to pre-pandemic levels.
WATCH | Late-stage cancer being diagnosed in Canadian ERs:
Hospital emergency rooms are seeing a wave of patients being diagnosed with late-stage cancer after the COVID-19 pandemic forced many doctors’ offices to close or pivot to virtual appointments, leading to fewer cancer screenings.
That drop in screenings translates into fewer invasive cancer diagnoses, including roughly 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, an assistant professor in the department of family medicine at the University of Ottawa,in a May commentary piece for the journal Canadian Family Physician.
“The impact of COVID-19 on cancer is far-reaching:screening backlogs, delayed workup of symptomatic patients and abnormal screening results, anddelays in cancer treatment and research, all exacerbated by patient apprehension to be seen in person,” she wrote.
“It is clear that there is not only a lost cohort of screened patients but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment,” leading to those cancers being diagnosed at a more advanced stage.
Tough accessing care in a ‘timely way’
The slowdown in colonoscopies may already be leading to more serious cases of colorectal cancer in Ontario, for instance,suggests a paper published in the Journal of the Canadian Association of Gastroenterology.
“Patients who were treated after the COVID-19 pandemic began were significantly more likely to present emergently to hospital. This means that they were more likely to present with bowel perforation, or severe bowel obstruction, requiring immediate life-saving surgery,” said the study’s lead author, Dr. Catherine Forse, in a call with CBC News.
“In addition, we found that patients were more likely to have large tumours.”
In some cases — like Labrador-Summers’s situation — Canadians learned alarming news about their health in hospital emergency departments after struggling to receive in-patient care through other avenues.
Shuttered family physician offices, a shift to telemedicine, and some patients’ fears surrounding COVID-19 may all have played a role.
“It became harder for patients to access care and to access it in a timely way,” Hanna said.
“At the same time, there were real risks — and there are real risks for leaving home to go anywhere, particularly to go to an outpatient clinic or a hospital in order to get checked out.”
Dr. Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she’s now diagnosing more patients with serious cancers, including several just in the last few months.
“So previously, it may have been localized or something small, but now we’re actually seeing metastatic cancer that we’re diagnosing,” she explained.
Lessons for future pandemics
Health policy expert Laura Greer is dealing with Stage four, metastatic breast cancer herself after waiting more than five months for a routine mammogram she was initially due for in the spring of 2021 — a precautionary measure given that her mother had breast cancer as well.
Unlike an early-stage diagnosis, Greer’s cancer is only treatable, not curable.
“It was an example of what happens when you don’t have the regular screening, or those wellness visits,” said the Toronto resident and mother of two.
“I most likely would have had earlier-stage cancer if it had been sooner.”
Pausing access to care and screenings for other health conditions can have dire impacts on patients, according to Greer, offering lessons for how policy-makers tackle future pandemics.
“We need to make sure that we’ve got enough capacity in our health system to be able to flex, and that’s what we really didn’t have going into this,” she said.
For Labrador-Summers, it’s hard to forget the moment her life changed while she was alone in an emergency department, learning a terrifying diagnosis from a physician she’d just met. Her mind raced with questions about the future and concerns for her family.
“My older son had just told us they were expecting a child, and I just wanted to be there for them. And I didn’t know what next steps were. And we had lost my mom to cancer a few years back — to us, cancer was always terminal,” she recalled.
“So again, I’m alone, trying to process all of this.”
A screening following Labrador-Summers’ surgery and chemotherapy treatment wound up finding more cancer.
The U.S. Centers for Disease Control and Prevention (CDC) on Friday published recommendations by its group of independent experts on a smallpox vaccine that limit its use to only people who work closely with viruses such as monkeypox.
The Jynneos vaccine, made by Bavarian Nordic, will be available for certain healthcare workers and laboratory personnel at a time when monkeypox infections has spread in Europe, United States and beyond.
The vaccine was approved in the United States in 2019 to prevent smallpox and monkeypox in high risk adults aged 18 and older.
CDC officials earlier this week said they were in the process of releasing some doses of the Jynneos vaccine for people in contact with known monkeypox patients.
Officials said there were over 100 million doses of an older smallpox vaccine called ACAM2000, made by Emergent BioSolutions , which has significant side effects.
Monkeypox is a mild viral infection that is endemic in certain parts of Africa, but the recent outbreak in countries where the virus doesn’t usually spread has raised concerns.
So far, there are about 300 confirmed or suspected cases in around 20 countries where the virus was not previously circulating. The World Health Organization has called for quick action from countries to contain the Monkeypox spread.
The CDC said its experts’ recommendations are meant for clinical laboratory personnel performing diagnostic tests for orthopoxviruses such as smallpox and monkeypox, laboratory people doing research on the viruses and healthcare workers who administer the ACAM2000 vaccine or care for patients infected with orthopoxviruses.
The publication of the vote by the CDC’s Advisory Committee on Immunization Practices, which took place in November last year, formalizes the recommendations.
Both ACAM2000 and Jynneos are available for prevention of orthopoxvirus infections among at-risk people, the CDC said on Friday. (Reporting by Manas Mishra and Amruta Khandekar in Bengaluru; Editing by Krishna Chandra Eluri and Shailesh Kuber)
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