Canada has a new COVID-19 vaccine at its disposal — one that relies on different technology than the other two doses that have been approved for use in this country.
The federal regulator announced Friday it has authorized the vaccine created in a collaboration between AstraZeneca and Oxford University. At the same time, the regulator also approved the version made by the Serum Institute of India, known by the name Covishield.
The federal government has already procured 20 million doses of the vaccine, and now says it has procured an additional two million doses from India, with the first shipment to arrive within weeks.
The AstraZeneca/Oxford vaccine has had a more winding journey to authorization than the previous two vaccines, with the European regulator at one point saying there wasn’t enough evidence to show it was effective in seniors. South African officials have also raised questions about its usefulness against the variant that emerged in their country.
But the approval of this shot is significant, experts say, because of the edge it has in terms of the speed at which it can be manufactured and the ease with which it can be shipped around the country.
“The transportability is really important — it offers more options, and more flexible vaccination planning at a health unit level,” Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta, said in an email.
Federal officials also reiterated Friday that it will be just one weapon in their public health arsenal.
“The idea is to have a suite of vaccines that are available,” said Dr. Supriya Sharma, a senior medical adviser with Health Canada. “I think Canada is hungry for vaccines; we’re putting more on the buffet table to be used.”
The regulator made its decision based on four human trials — conducted in the United Kingdom, Brazil and South Africa; and the federal department said the two-shot regimen has an efficacy of 62.1 per cent. It added there have been no deaths or life-threatening events related to the vaccine.
“Based on the available data, the vaccine at the indicated dose was considered safe and well-tolerated,” Health Canada said in its decision.
Here’s what we know about the new dose.
How is it given?
Like the two vaccines currently on the market, the AstraZeneca/Oxford vaccine is a two-dose regimen, given between four and 12 weeks apart.
The vaccine dose is 0.5mL of a colourless to slightly brown solution that is injected intramuscularly, normally into the arm.
Who can take it?
People 18 and up.
Who should not take it?
Anyone allergic to the ingredients in the vaccine, anyone who had an allergic reaction to the first dose, or anyone with COVID-19 symptoms. For other questions, ask your doctor.
Does it work in older people?
The trials included relatively few older adults, leading the European regulator to conclude there wasn’t enough information to definitely conclude the vaccine worked in seniors, but that protection was expected.
Health Canada said there is “limited information” from clinical trials on the efficacy of the vaccine in those over the age of 65.
However, they also say that “emerging real world evidence” from countries where the vaccine is being used suggests “a potential benefit and no safety concerns.”
How is it different from the Pfizer and Moderna vaccines Canada has previously approved?
AstraZeneca’s vaccine uses a different technique than the two vaccines developed by Moderna and Pfizer, which relied on new mRNA technology.
Its approach is called a viral vector, which uses a virus normally found in chimpanzees to sneak the DNA for a coronavirus spike protein into your body, which then teaches your immune system how to fight off a future potential infection from the actual coronavirus.
Doses are expected to be cheaper and can be stored in a normal fridge, which would be a win for poorer countries.
“It’s more nimble,” as Saxinger puts it.
“It’s fairly inexpensive and easy to mass produce and store, comparatively, so you can get it to remote places much more easily, and it can possibly be given in doctors’ offices, as just usual refrigeration is needed.”
How well does it work?
According to Health Canada, getting two full doses of vaccine is between 62.1 and 59.5 per cent effective.
Isn’t 62.1 per cent a little low?
While this isn’t quite as high as Moderna and Pfizer, experts say it’s still higher than the 50 per cent efficacy rate vaccine makers were aiming far, and isn’t far off from the usual efficacy rate of the annual flu vaccine.
“(If) you look back, for example, just to last year, the effectiveness of the flu vaccine against the most common strain was about 64 per cent; across the next common strain it was about 54 per cent,” Sharma said. “These vaccines do have a use.”
In addition, this vaccine has also proven to be effective in reducing serious illness and death.
Saxinger cautioned people not to get hung up on efficacy numbers here: “A few months ago, people would’ve been clamouring for a 70 per cent effective vaccine,” she said.
“It’s important for everyone to realize that protection from severe disease is excellent for all of the vaccines so far.”
Why did it take so long to get approved?
While both Pfizer and Moderna got the green light not long after submitting their final trial results, AstraZeneca has been in limbo for weeks.
Observers point to some confusion about the efficacy of this vaccine early on, based on a dosing error during testing that saw some volunteers get a half dose for their first shot.
Back in November, AstraZeneca said its vaccine was about 72 per cent effective overall, but ranging from as low as 62 per cent to as high as 90 per cent.
In a news release, the company revealed it had mistakenly tried out two different doses in one of its trials — and that had led to two different results.
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While two full doses was about 62 per cent effective, the mistaken half dose appeared to raise that number to 90 per cent, but only in a small sample, and researchers aren’t sure why.
As a result, the regulator’s job was “a bit more complicated” this time around, Sharma told reporters in January.
Given the need to make sure the data was clear, Saxinger called the delay here “appropriate.”
In the end, Health Canada followed in the footsteps of regulators in the European Union and Britain by authorizing two full doses, because that’s the regimen tested on more people to date.
What about the variants?
Earlier this month, South Africa halted the rollout of this vaccine because of concerns it would be less effective against B. 1.351, the virus variant now dominant there.
A relatively small trial of 2,000 people suggested the vaccine offered “minimal protection” against mild and moderate cases, though research continues and experts haven’t ruled out the vaccine’s effectiveness against serious cases.
Right now, there are relatively few cases of the variant in Canada, but experts say this will have to be watched.
However, the vaccine seems to be just fine when faced with B. 117, the variant that emerged in the U.K. AstraZeneca has been a major pillar of vaccination efforts there.
The World Health Organization is still recommending the use of AstraZeneca’s vaccine, even in countries where variants emerged as dominant.
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What about transmission?
All of the vaccines were designed to do one, big thing — stop someone exposed to the coronavirus from getting the illness we now know as COVID-19.
But in order to achieve herd immunity, the vaccines will need to do something else — stop a person exposed to the coronavirus from giving it to others.
Determining how good these vaccines are at stopping transmission takes time, so for many doses, this was a question we just couldn’t answer yet.
However there’s some possible good news on that front for AstraZeneca. Research done by British researchers — which still needs to be peer-reviewed, or vetted by other scientists — suggests that vaccinated people may be less infectious.
The study didn’t look at transmission directly (for example, it didn’t test the family members of those who had been vaccinated) but it took nasal swabs from study participants and found that the rate of positive PCR results fell by half after two doses.
What are the side effects?
According to the United Kingdom, where the shot is already in use, very common side effects include tenderness, pain or bruising at the injection site, as well fatigue, headache or joint pain.
It’s also common to experience a fever or flu-like symptoms.
More uncommon symptoms include feeling dizzy, decreased appetite, abdominal pain and enlarged lymph nodes.
According to Health Canada, the most commonly reported adverse infections were tenderness (75.3 per cent) and pain (54.2 per cent) at the injection site, fatigue (62.3 per cent), headache (57.5 per cent) and myalgia, or muscle pain (48.6 per cent).
Most reactions were mild or moderate.
How is it transported?
According to the company, the vaccine can be stored, transported and handled at “normal refrigerated conditions,” meaning between two and eight degrees Celsius for at least six months.
It can be given in “existing health-care settings.”
This will make it easier to transport that the existing vaccines, both of which are transported frozen, or in the case of Pfizer, in ultra cold temperatures, according to Health Canada.
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.
