This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
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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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.
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