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Canada’s reluctance to follow evolving real-world data has led to potentially confusing COVID-19 vaccination guidelines that some experts say leave vulnerable seniors at risk in the community and could fuel vaccine hesitancy.
The National Advisory Committee on Immunization (NACI) recommended last week that Canadians over 65 not receive an AstraZeneca-Oxford vaccination despite emerging evidence from countries around the world demonstrating its ability to prevent severe COVID-19 in older adults.
The recommendation led provinces to reorganize their vaccination plans for seniors. The result was people aged 60-64 could receive AstraZeneca-Oxford shots ahead of older age groups, who are at greater risk of hospitalization and death from COVID-19.
Other countries such as France and Germany initially advised those 65 and older not to receive the shot, but overturned their decisions earlier this month after new evidence showed the vaccine significantly reduced hospitalizations in that age group.
One Shoppers Drug Mart location in Toronto’s east end started catering to walk-ins for AstraZeneca-Oxford shots for those aged 60 to 64, which prompted a long lineup near Danforth and Coxwell Avenues on Thursday. (Michael Charles Cole/CBC Toronto)
But the NACI recommendations were based largely on AstraZeneca-Oxford’s clinical trial data and didn’t examine real-world evidence past Dec. 7 — months before the effectiveness of the vaccine was fully realized in other countries for older age groups.
“We are trying to do the best that we can with the data that we have,” NACI chair Dr. Caroline Quach told The National‘s Andrew Chang this week.
She said the volunteer national advisory committee isn’t able to pivot to emerging data quickly.
“We are not a committee that is able to make a recommendation on Monday to be published on the Tuesday.”
Quach confirmed to CBC News on Friday that NACI met this week to discuss revising the AstraZeneca guidelines for those over 65, and said they would likely be updated “in the next few days” as shots continue to roll out across the country for younger age groups.
That decision was based on real-world data from Quebec, B.C., Israel, the U.K. and the U.S. that showed “good effectiveness” of between 70 and 80 per cent from a single dose of the vaccines in preventing severe illness “for up to two months in some studies.”
“People would see a bit of a disconnect,” said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s COVID-19 vaccine task force. “You’ve got to have the trust of the general public.”
Despite some European countries temporarily halting use of the AstraZeneca-Oxford vaccine after 30 cases of blood clots, experts maintain it is still safe to use in Canada. 2:01
Bogoch said NACI needs to be “very careful” with its messaging around vaccination recommendations in an “open, honest and transparent way” with Canadians, in order to avoid eroding trust in vaccines.
“How we word things matters…. If you’re going to make those recommendations, you’ve got to stand up in front of the country and explain why,” he said.
“We’re already getting issues with people who are saying, ‘I’m not going to take the AstraZeneca vaccine, I’m going to wait.’ It’s going to be a challenge.”
Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, said the recommendation against the AstraZeneca-Oxford vaccine for seniors sends the “wrong message” to Canadians.
“I’ve got people telling me they don’t want AstraZeneca, so they’ll rather wait until they can get a Pfizer dose,” he said. “We need to get sufficient numbers of doses in the right people so that herd immunity happens and case numbers drop.”
Alyson Kelvin, an assistant professor at Dalhousie University in Halifax and virologist at the Canadian Center for Vaccinology, says there are no safety concerns with AstraZeneca-Oxford for older individuals and that its effectiveness is on par with other vaccines such as Pfizer-BioNTech and Moderna.
Monique Prud’homme, one of the first Albertans to receive the Covishield/AstraZeneca-Oxford vaccine, on Thursday, told Alberta Health Services she is ‘so excited’ and looks forward to someday having her grandchildren stay over, hosting family meals at home, visiting friends and her father. (Alberta Health Services)
“If a vaccine is available to you, it’s really important that you’re taking it,” she said.
And that’s especially true for people over 60, she said.
“This group of individuals makes up about 97 per cent of our COVID-related deaths in Canada, and to keep a vaccine from them … hurts my heart.”
Bogoch said that each of the four vaccines approved in Canada will significantly reduce the risk of hospitalization and death for older Canadians, so it’s important to keep that in context when considering national recommendations.
“We’re in the middle of a public health crisis,” he said. “So the strategy should be to vaccinate as many people over the age of 60 with any of the available vaccines in as short a time frame as possible.”
‘No indication’ AstraZeneca-Oxford vaccine tied to blood clots
Adding to the confusion around the AstraZeneca-Oxford vaccine this week were reports of an undisclosed number of blood clot cases after vaccinations in Europe, which ultimately led Denmark, Norway and Iceland to stop using the vaccine out of an abundance of caution.
Health Canada released a statement Thursday night, more than eight hours after CBC News requested comment, saying “there is no indication that the vaccine caused these events” and the “benefits of the vaccine continue to outweigh its risks.”
The U.K.’s drug regulatory agency said that of the 11 million doses of the AstraZeneca-Oxford vaccine that have been administered, reports of blood clots were no greater than expected in the general public.
WATCH | ‘No cause for alarm’ after Denmark pauses AstraZeneca vaccinations, says doctor:
There’s no reason to be overly worried after Denmark said it was temporarily stopping inoculations with the AstraZeneca COVID-19 vaccine to investigate a small number of blood clots, says infectious disease specialist Dr. Isaac Bogoch. 2:16
Bogoch told CBC News that while it’s important to watch the situation carefully in order to instill confidence in the vaccine’s safety, Canadians have to keep it in context.
“This vaccine has been given to millions and millions of other people globally, including in the United Kingdom,” he said.
“We have not yet heard of any signal amongst the noise for blood clots in any other jurisdiction and there have been other places that have been giving this vaccine for … months.”
Age ‘greatest risk’ factor for COVID-19
Experts say the confusion around vaccine safety recommendations this week is unfortunate, especially given the number of seniors in Canada at risk of severe COVID-19 complications who have yet to be vaccinated.
While long-term care home residents were prioritized in Canada’s vaccine rollout after the first shipments arrived in mid-December, seniors living in the community have only recently been offered a vaccine across much of the country.
“When you actually look at the data about who’s the greatest risk from getting seriously ill and dying from COVID-19, the No. 1 factor is age,” said Dr. Samir Sinha, director of geriatrics for the Sinai Health System and the University Health Network in Toronto.
Carmelo Bolpe, 67, gets his first dose of the Pfizer-BioNTech COVID-19 vaccine at Caboto Terrace in Toronto on Thursday. Nurses from Humber River Hospital were on site as part of an initiative to vaccinate seniors in congregate living settings. (Evan Mitsui/CBC)
Sinha says Canada should have better prioritized community-dwelling seniors in its initial rollout, especially given the significant drop in hospitalizations and deaths among long-term care residents after vaccination.
More than 14,000 long-term care residents have died of COVID-19 in Canada since the pandemic began. Sinha says about 4,000 of those residents were in Ontario, while another 2,000 of the province’s deaths were seniors living in the community.
“We have to remember that, yes, 70 per cent of our deaths in Ontario have been amongst those living in our long-term care retirement homes,” he said. “But another 26 per cent have been among community-dwelling seniors.”
Deonandan says he was “shocked” that age wasn’t more of a priority for initial COVID-19 vaccine rollouts across the country given that it is the single biggest risk factor by far.
“It comes down to, what is the goal that we’re trying to achieve here?” he said.
“The goal should be twofold: to keep the health-care system up and running, and to make the crisis go away, and you get that by focusing on age.”
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VANCOUVER – Contract negotiations resume today in Vancouver in a labour dispute that has paralyzed container cargo shipping at British Columbia’s ports since Monday.
The BC Maritime Employers Association and International Longshore and Warehouse Union Local 514 are scheduled to meet for the next three days in mediated talks to try to break a deadlock in negotiations.
The union, which represents more than 700 longshore supervisors at ports, including Vancouver, Prince Rupert and Nanaimo, has been without a contract since March last year.
The latest talks come after employers locked out workers in response to what it said was “strike activity” by union members.
The start of the lockout was then followed by several days of no engagement between the two parties, prompting federal Labour Minister Steven MacKinnon to speak with leaders on both sides, asking them to restart talks.
MacKinnon had said that the talks were “progressing at an insufficient pace, indicating a concerning absence of urgency from the parties involved” — a sentiment echoed by several business groups across Canada.
In a joint letter, more than 100 organizations, including the Canadian Chamber of Commerce, Business Council of Canada and associations representing industries from automotive and fertilizer to retail and mining, urged the government to do whatever it takes to end the work stoppage.
“While we acknowledge efforts to continue with mediation, parties have not been able to come to a negotiated agreement,” the letter says. “So, the federal government must take decisive action, using every tool at its disposal to resolve this dispute and limit the damage caused by this disruption.
“We simply cannot afford to once again put Canadian businesses at risk, which in turn puts Canadian livelihoods at risk.”
In the meantime, the union says it has filed a complaint to the Canada Industrial Relations Board against the employers, alleging the association threatened to pull existing conditions out of the last contract in direct contact with its members.
“The BCMEA is trying to undermine the union by attempting to turn members against its democratically elected leadership and bargaining committee — despite the fact that the BCMEA knows full well we received a 96 per cent mandate to take job action if needed,” union president Frank Morena said in a statement.
The employers have responded by calling the complaint “another meritless claim,” adding the final offer to the union that includes a 19.2 per cent wage increase over a four-year term remains on the table.
“The final offer has been on the table for over a week and represents a fair and balanced proposal for employees, and if accepted would end this dispute,” the employers’ statement says. “The offer does not require any concessions from the union.”
The union says the offer does not address the key issue of staffing requirement at the terminals as the port introduces more automation to cargo loading and unloading, which could potentially require fewer workers to operate than older systems.
The Port of Vancouver is the largest in Canada and has seen a number of labour disruptions, including two instances involving the rail and grain storage sectors earlier this year.
A 13-day strike by another group of workers at the port last year resulted in the disruption of a significant amount of shipping and trade.
This report by The Canadian Press was first published Nov. 9, 2024.
The Royal Canadian Legion says a new partnership with e-commerce giant Amazon is helping boost its veterans’ fund, and will hopefully expand its donor base in the digital world.
Since the Oct. 25 launch of its Amazon.ca storefront, the legion says it has received nearly 10,000 orders for poppies.
Online shoppers can order lapel poppies on Amazon in exchange for donations or buy items such as “We Remember” lawn signs, Remembrance Day pins and other accessories, with all proceeds going to the legion’s Poppy Trust Fund for Canadian veterans and their families.
Nujma Bond, the legion’s national spokesperson, said the organization sees this move as keeping up with modern purchasing habits.
“As the world around us evolves we have been looking at different ways to distribute poppies and to make it easier for people to access them,” she said in an interview.
“This is definitely a way to reach a wider number of Canadians of all ages. And certainly younger Canadians are much more active on the web, on social media in general, so we’re also engaging in that way.”
Al Plume, a member of a legion branch in Trenton, Ont., said the online store can also help with outreach to veterans who are far from home.
“For veterans that are overseas and are away, (or) can’t get to a store they can order them online, it’s Amazon.” Plume said.
Plume spent 35 years in the military with the Royal Engineers, and retired eight years ago. He said making sure veterans are looked after is his passion.
“I’ve seen the struggles that our veterans have had with Veterans Affairs … and that’s why I got involved, with making sure that the people get to them and help the veterans with their paperwork.”
But the message about the Amazon storefront didn’t appear to reach all of the legion’s locations, with volunteers at Branch 179 on Vancouver’s Commercial Drive saying they hadn’t heard about the online push.
Holly Paddon, the branch’s poppy campaign co-ordinator and bartender, said the Amazon partnership never came up in meetings with other legion volunteers and officials.
“I work at the legion, I work with the Vancouver poppy office and I go to the meetings for the Vancouver poppy campaign — which includes all the legions in Vancouver — and not once has this been mentioned,” she said.
Paddon said the initiative is a great idea, but she would like to have known more about it.
The legion also sells a larger collection of items at poppystore.ca.
This report by The Canadian Press was first published Nov. 9, 2024.
