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.
Emerging research from around the world has sparked new fears about the declining protection COVID-19 vaccines provide over time against infection from the highly contagious delta variant, prompting some countries to move aggressively toward booster shots.
But the research these decisions are based on isn’t definitive, and CBC News spoke to several Canadian and international experts who raised concerns with the controversial move to roll out third doses widely before more data is available and while much of the world remains unvaccinated.
“We’re planning to hand out extra life-jackets to people who already have life-jackets, while we’re leaving other people to drown without a single life-jacket,” Dr. Mike Ryan, the World Health Organization’s top emergencies expert, said during a news conference Wednesday.
The WHO has recently called for a moratorium on boosters until at least the end of September. But despite the concerns raised by health officials and other experts, countries are forging ahead with plans for additional doses now — including parts of Canada.
WATCH | WHO calls for temporary pause on COVID-19 booster shots:
Rapid shift to boosters worldwide
Israel extended booster shots to everyone over 40 on Friday, while France, Germany and the U.K. have announced third doses only for vulnerable populations at heightened risk of declining COVID-19 immunity.
The U.S. went a massive step further this week by announcing third doses for all Americans beginning next month, to bolster immunity against the much more contagious delta variant amid early signs the effectiveness of the vaccines could be dropping.
Several Canadian provinces have also made the decision to break away from the pack and pre-empt upcoming guidance from the National Advisory Committee on Immunization (NACI) on when booster shots may be needed and for whom.
Ontario will offer third doses to vulnerable populations, such as those in long-term care, First Nations elder care lodges and “higher risk” retirement homes, as well as for transplant recipients, certain cancer patients and other immunocompromised individuals.
Saskatchewan and Quebec previously announced plans to offer additional doses of mRNA vaccines — not because of waning immunity or the threat of delta, but for people who want to travel to countries that may not recognize mixed-vaccination status.
The tides have shifted rapidly on this issue over the past week and many Canadians may now be left wondering whether they’ll need an additional shot — and when they’ll get it.
WATCH | Ontario to offer 3rd COVID-19 shot to vulnerable groups:
Vaccine effectiveness data ‘all over the place’
What prompted the sudden shift in favour of widespread booster shots?
The answer is largely based on conflicting emerging data from highly vaccinated countries around the world that signal a potential drop in immune protection in the population over time amid surges in cases driven by the delta variant.
But the data is anything but clearcut.
“The vaccine effectiveness data that we’re getting are all over the place,” said Deepta Bhattacharya, an immunologist at the University of Arizona.
“It’s really hard to know what to make of all this, in part because all of these things are being estimated outside of the context of a clinical trial where you have a lot of control.… Now it’s a mess.”
In a country where delta is the dominant strain, Israel’s Ministry of Health released data late last month that implied two doses of the Pfizer-BioNTech vaccine was just 39 per cent effective against COVID-19 infection, a drop from 95 per cent seen in clinical trials and 64 per cent in real-world data earlier this year.
But experts have raised concerns about the quality of Israel’s data, suggesting it should be taken with caution before being used to justify the widespread use of boosters.
“Much of the Israel data can be explained by the fact that with delta waltzing onto the scene, those who have been vaccinated longest are also those more likely to experience severe illness than others — in other words, the elderly,” said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.
“It is confusing because in some analyses, age is corrected for, but in others, not all.”
While it is reasonable to expect there is some waning protection from vaccines, especially with the spread of delta, Hanage said it’s not to the extent that’s being “bandied about” from the Israeli data and isn’t necessarily seen in younger age groups.
Dvir Aran, a biomedical data scientist at Technion — Israel Institute of Technology in Haifa, told CBC News he’s “very skeptical” about the Israel estimates.
“The vaccine effectiveness that was calculated by the Israeli Ministry of Health is from a mix of early and late vaccinated individuals,” he said, pointing to a lack of adjustment for confounders, or other factors, in the data. “So it’s not clear what it even means.”
Because of the different vaccines, rollout strategies and populations in each country, Hanage said it’s reasonable to suspect the Israel data is skewed — especially because one would expect to see the dramatic results replicated elsewhere.
“If you are relying on them as the grounds for a huge decision like boosters, that’s not as strong a foundation as you’d like.”
WATCH | Official explains why 3rd booster shot is being recommended in the U.S.:
Conflicting research raises more questions
Israel’s vaccine effectiveness estimates are also significantly lower than research released in May from the U.K., which found they were 88 per cent effective against symptomatic disease from delta.
A similar study from Scotland published in The Lancet medical journal in June also found the Pfizer-BioNTech vaccine was still 79 per cent effective.
And Canadian researchers released data last month that found two doses of the Pfizer-BioNTech vaccine were 87 per cent effective against delta, similar to that of the alpha variant, at 89 per cent, and the beta variant, at 84 per cent.
Adding to the confusion, the U.S. Centers for Disease Control and Prevention (CDC) published three new studies this week that were used by federal officials as justification for mRNA boosters for all Americans in the weeks ahead.
One study analyzed thousands of nursing homes across the U.S. between March and August — covering a time frame both before delta emerged and when it became a dominant strain — and found vaccine effectiveness at preventing infections dropped from 75 to 53 per cent.
Another study focused on New York state between early May and late July, as delta rose to more than three-quarters of new cases, finding a decline in vaccine effectiveness from 91 per cent to 79 per cent.
A third CDC-published study looked at severity of disease across the U.S., a key figure missing from other research, and found mRNA vaccines were overall 90 per cent effective at preventing hospitalizations — and only slightly lower in the immunocompromised.
What approach should Canada take with boosters?
Given the conflicting, contradictory and outright confusing nature of the emerging data on vaccine effectiveness in the past few weeks, the question remains: What Canada should do when it comes to boosters in the midst of a fourth, delta-driven wave?
Canadian researchers at the University Health Network (UHN) in Toronto recently published a correspondence in the New England Journal of Medicine that showed evidence of “significantly higher immunogenicity” in transplant patients after a third dose.
And a recent preprint study from UHN analyzed 119 Ontario long-term care residents and 78 staff over four months, finding much lower levels of neutralizing antibodies in the elderly patients — suggesting a possible need for a third dose in that group as well.
WATCH | Why this doctor says it’s too soon to talk boosters:
“It’s very clear that older adults, and in particular frail older adults, don’t mount the same immune response that younger adults do,” said Dr. Allison McGeer, a lead study author and a medical microbiologist and infectious disease specialist at Mount Sinai Hospital.
“And while that’s not unexpected, it does raise the issue of whether those levels are now low enough to reduce vaccine efficacy.”
Given that research, and the smorgasbord of other data from around the world, Ontario’s move to offer third doses to older, vulnerable groups makes sense for the rest of Canada.
But experts say we shouldn’t extend boosters to the general public just yet.
“It becomes a slippery slope,” said Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton and an associate professor at McMaster University.
“For sure, in the immunocompromised, long-term care residents and elderly, the stakes are high enough this is good to accept. But for regular, healthy folks — is this really going to lead to gains, or simply lower mild illnesses in otherwise healthy people, or nothing at all?”
Bhattacharya says at the end of the day, we need to look at where a dose will make the most impact — especially as COVID-19 continues to ravage other countries with extremely low vaccine coverage.
“There is not a shred of doubt that the bang for the buck in getting an unvaccinated person vaccinated — wherever they are in the world — is far greater than giving someone a booster shot,” he said
“Even within the wide range of possibilities as to how much a booster shot may help, it’s definitely not going to be as beneficial as giving it to someone who’s never had it. There’s no question about that.”
Canadian literary figures double down on free speech following Salman Rushdie attack – CTV News
Canadian writers, publishers and literary figures doubled down on the right to freedom of thought and expression on Saturday, one day after an attack on award-winning author Salman Rushdie that left him hospitalized and on a ventilator.
Rushdie, whose 1988 novel “The Satanic Verses” drew death threats from Iran’s leaders in the 1980s, was stabbed in the neck and abdomen Friday by a man who rushed the stage as the author was about to give a lecture in western New York.
Louise Dennys, executive vice-president and publisher of Penguin Random House Canada, has published and edited Rushdie’s writing for over 30 years. She condemned the attack on her longtime friend and colleague as “cowardly” and “reprehensible in every way.”
“He is without doubt one of the greatest proponents of freedom of thought and speech and debate and discussion in the world today,” Dennys said in a telephone interview. “I have hopes of his recovery. He’s a great warrior and fighter, and I hope he is fighting back.”
Rushdie, a native of India who has since lived in Britain and the U.S., is known for his surreal and satirical prose style. “The Satanic Verses” was regarded by many Muslims as blasphemous for its dream sequence based on the life of the Prophet Muhammad, among other objections. The book had already been banned and burned in India, Pakistan and elsewhere before Iran’s Grand Ayatollah Ruhollah Khomeini issued a 1989 fatwa, or edict, calling for Rushdie’s death.
Investigators were working to determine whether the attacker, born a decade after the publication of “The Satanic Verses,” acted alone. Police said the motive for Friday’s attack was unclear.
After the publication of “The Satanic Verses,” often-violent protests erupted across the Muslim world against Rushdie. At least 45 people were killed in riots over the book, including 12 people in Rushdie’s hometown of Mumbai. In 1991, a Japanese translator of the book was stabbed to death and an Italian translator survived a knife attack. In 1993, the book’s Norwegian publisher was shot three times and survived.
The death threats prompted Rushdie to go into hiding under a British government protection program, though he cautiously resumed public appearances after nine years of seclusion, maintaining his outspoken criticism of religious extremism overall.
“We all depend on the storytelling, power and imagination of writers. He came out of hiding because he realized he wanted to play a role in the world we live in, defending those rights,” said Dennys.
“He couldn’t be silenced by fear, and I think that point is something he will continue to make if, as we all hope, he survives,” she said.
Dennys said the attack is already having the opposite effect of its suspected intentions given the outpouring of support from the international literary community, as well as activists and government officials, who cited Rushdie’s courage for his longtime free speech advocacy despite risks to his own safety.
“It’s brought everyone together to realize how precious and fragile our freedoms are and how important it is to speak up for them,” Dennys said.
The president of PEN Canada, an organization defending authors’ freedom of expression, condemned the “savage attack” on their “friend and colleague” Rushdie, who is a member.
Canadian writer John Ralston Saul, who has known Rushdie since the 1990s, said the author was always aware that someone might attack him but he chose to live publicly in order to speak out against those trying to silence free expression and debate.
“(Rushdie’s) work and whole life are a reminder of what the life of the public writer is in reality,” he said. “This would be the worst possible time to give in or show any sense that we must be more careful with our words. We’re not really writers if we give in to that kind of threat.”
Rushdie’s alleged attacker, Hadi Matar, was arrested after the attack at the Chautauqua Institution, a non-profit education and retreat centre. Matar’s lawyer entered a not guilty plea in a New York court on Saturday to charges of attempted murder and assault.
After the attack, some longtime visitors to the centre questioned why there wasn’t tighter security for the event, given the threats against Rushdie and a bounty on his head offering more than US$3 million to anyone who killed him.
Saul, who spoke at the Chautauqua Institution years before Rushdie’s attack, said it has an “open tradition” of debate, free expression and anti-violence going back over 100 years.
“It’s one of the freest places to take advantage of our belief in freedom,” he said.
Director of the Toronto International Festival of Authors Roland Gulliver tweeted Saturday that literary festivals and book events are “spaces of expression, to tell your stories in friendship, safety and respect.”
“To see this so violently broken is incredibly shocking,” he wrote.
Expressions of sympathy came from the political realm as well, with Prime Minister Justin Trudeau condemning the attack as a “cowardly … strike against freedom of expression.”
“No one should be threatened or harmed on the basis of what they have written,” read a statement posted to Trudeau’s official Twitter account. “I’m wishing him a speedy recovery.”
The 75-year-old Rushdie suffered a damaged liver, severed nerves in his arm and is likely to lose an eye as a result of the attack, Rushdie’s agent Andrew Wylie said Friday evening.
A physician who witnessed the attack and was among those who rushed to help described Rushdie’s wounds as “serious but recoverable.”
With files from the Associated Press. This report by The Canadian Press was first published Aug. 13, 2022.
What you need to know about Canada's divisive ArriveCAN app – CBC News
Ottawa is making plans to expand the capabilities of its ArriveCAN app even as criticism continues to mount over the mandatory online data-entry system for travellers entering the country.
Earlier this week, Transport Canada gave an update on its plans to improve the app, including by adding an optional, online advance CBSA declaration feature for people going to the Calgary, Edmonton, Winnipeg, Billy Bishop Toronto City, Ottawa, Québec City and Halifax international airports.
The feature, which Transport Canada says cuts the amount of time travellers spend at a Canada Border Services Agency kiosk by a third, is currently only available to those passing through Toronto Pearson, Vancouver or Montreal-Trudeau international airports.
“With the thousands of travellers arriving in Vancouver, Toronto and Montreal airports each day, the use of the optional advance CBSA declaration has the potential to save hours in wait time,” according to Transport Canada’s release.
With Ottawa signalling no plans to do away with the app, here’s a refresher on how it works, why it’s in place — and who’s for and against its continued use.
Why was it put in place?
Though the app was introduced earlier in the pandemic, the version of ArriveCAN people are familiar with today launched in July 2021, when Canada began easing public health restrictions on people coming into Canada. Fully vaccinated Canadians and permanent residents crossing the border were no longer required to quarantine upon their return.
But Canada still wanted a way to account for people’s vaccination statuses and COVID-19 results from a recent test. The app allowed travellers to take a photo or upload a snapshot of their vaccine documentation into the app before going through customs.
How does it work today?
Canada has lifted most of its travel restrictions for fully vaccinated travellers, including the need for domestic travellers to show proof of vaccination while travelling by train or plane.
But regardless of vaccination status, all travellers coming into Canada are required to submit their information to the ArriveCAN app — or the website version if they don’t have a smartphone — up to 72 hours before entering Canada.
When travellers finish inputting their information, they’re emailed a receipt to show a Canadian border officer upon arrival, along with their COVID-19 test results and any vaccination documents.
The app has not been without its issues. Last month, Public Safety Canada acknowledged a glitch incorrectly informed some travellers to quarantine when in fact they didn’t have to.
What are the potential penalties for non-compliance?
Travellers who fail to provide the required information won’t be denied entry but may face a 14-day quarantine, the need to take a COVID-19 test on arrival and a followup test eight days later.
They may also be fined $5,000 and face “additional delays at the border for public health questioning,” according to Canada’s main ArriveCAN information page.
In anyone exempt from using ArriveCAN?
Yes, including people who can’t access the app or website because of cognitive or physical impairments.
Instead, they may provide the information verbally at the border or by completing a paper form.
The exemption also applies to people who can’t fill out the information online because of a natural disaster, censorship, lack of access to internet or an ArriveCAN outage.
There is a degree of leeway for some people at land border crossings too.
As of May 24, “to allow for more flexibility,” the Canada Border Services Agency began letting fully vaccinated Canadian land travellers off with a warning the first time they neglect to fill out the app if they had no prior history of non-compliance.
The union representing border workers told CBC News last month that between 30 and 40 per cent of travellers entering into Canada in Windsor, Ont., weren’t completing the app before arriving.
Who’s against it?
Border city mayors have said the app is a barrier for tourists looking to enter Canada, and for trade.
Other politicians — including Conservative Party of Canada leadership candidates Jean Charest, Pierre Poilievre, Leslyn Lewis and Scott Aitchison — have called for the app to be scrapped, saying it creates headaches for some travellers and and contributes to delays at airports.
In a tweet last month, Poilievre called on Canada to “stop forcing ArriveCAN on people” and “restore sanity to our airports.” The tweet included video, which CBC News has not verified, of an elderly person without a cell phone calling the app “bureaucracy run amok” while at a Toronto airport.
This is how stupid things have gotten with this Liberal government.<br><br>Rules for the sake of rules. Rules that don’t make sense. Rules that leave people upset and angry.<br><br>Stop forcing ArriveCan on people. Restore sanity to our airports. <a href=”https://t.co/hUepm7fhJC”>https://t.co/hUepm7fhJC</a>
Lewis more recently called the app a “surveillance experiment” that needs to end.
This terrible ArriveCan App surveillance experiment needs to end. The government cannot continue to infringe on the rights and freedoms of Canadians. <a href=”https://t.co/5rcDHOtzHi”>https://t.co/5rcDHOtzHi</a>
Who wants the app to stay?
MP Taylor Bachrach, the New Democrats’ transport critic, said ArriveCAN continues to play “an important role” in helping screen international arrivals for new variants and for verifying that visitors to Canada are fully vaccinated to protect the country’s health care system.
“But the government must make the app work as intended so it can reduce wait times at airports and border crossings as promised,” Bachrach said in a statement.
The government also needs to better address people who can’t use the online app for accessibility reasons, he added.
“It is totally inappropriate for customs agents to be acting as IT technicians as they troubleshoot travellers’ technology challenges” he said.
Green Party MP Elizabeth May said she has found the app helpful and easy to use during her travels.
“The recent glitch, on the other hand, demonstrates a serious problem in terms of privacy breaches,” she said in a statement.
What does the government have to say about it?
In its release earlier this week, Transport Canada said 1,600 security screening officers with the Canadian Air Transport Security Authority have been hired across Canada since April, while 30 new customs inspection kiosks have been recently added at Toronto Pearson International Airport.
In its own statement to CBC News, the CBSA said 99.53 per cent of air travellers used ArrivedCAN in the week ending July 17, according to the most recently available data.
Millions of people have used the app without issue, the spokesperson added.
“Without ArriveCAN, processing times for travellers would increase significantly, as these public health functions would need to be completed manually for each traveller by CBSA officers at the port of entry.”
Medical assistance in dying given to 10K Canadians in 2021 – CTV News
More Canadians are ending their lives with a medically-assisted death, says the third federal annual report on medical assistance in dying (MAID). Data shows that 10,064 people died in 2021 with medical aid, an increase of 32 per cent over 2020.
The report says that 3.3 per cent of all deaths in Canada in 2021 were assisted deaths. On a provincial level, the rate was higher in provinces such as Quebec, at 4.7 per cent, and British Columbia, at 4.8 per cent.
“It is rising remarkably fast,” University of Toronto law professor Trudo Lemmens, who was a member of the Council of Canadian Academies Expert Panel on Medical Assistance in Dying, wrote in an email to CTV News. He noted that some regions in the country have quickly matched or surpassed rates in Belgium and the Netherlands, where the practice has been in place for over two decades.
Advocates say it isn’t surprising because Canadians are growing more comfortable with MAID and some expect the rising rates may level off.
“The…. expectation has always been it (the rate) will be something around four to five per cent, (as in) Europe. We will probably, in the end, saw off at around the same rate,” said Dr. Jean Marmoreo, a family physician and MAID provider in Toronto.
The report uses data collected from files submitted by doctors, nurse practitioners and pharmacists across the country involving written requests for MAID.
Among the findings:
- All provinces saw increases in MAID deaths, ranging from 1.2 per cent (Newfoundland & Labrador) to a high of 4.8 per cent (British Columbia);
- More men (52.3 per cent) than women (47.7 per cent) received MAID;
- The average age was 76.3 years;
- Sixty-five per cent of those provided with assisted death had cancer. Heart disease or strokes were cited in 19 per cent of cases, followed by chronic lung diseases (12 per cent) and neurological conditions like ALS (12 per cent);
- Just over two per cent of assisted deaths were offered to a newer group of patients: those with chronic illnesses but who were not dying of their condition, with new legislation in 2021 allowing expanded access to MAID.
Documents show that 81 per cent of written applications for MAID were approved.
Thirteen per cent of patients died before MAID could be provided, with almost two per cent withdrawing their application before the procedure was offered.
Four per cent of people who made written applications for medical assistance were rejected. The report says some were deemed ineligible because assessors felt the patient was not voluntarily applying for MAID. The majority of requests were denied because patients were deemed not mentally capable of making the decision.
But other countries with long-established programs reject far more assisted death requests, said Lemmens, citing data that shows 12 to 16 per cent of applicants in the Netherlands are told no.
“It ….may be an indication that restrictions (in my view safeguards) are weaker here than in the most liberal euthanasia regimes,” he wrote in his email to CTV News.
But Marmoreo, who has offered MAID since 2016, sees Canada’s low rejection rate differently.
“It is more like that the right cases are put forward,” she said.
“We have a very good screening process right from the get-go. So before people actually even make a formal request to have assisted dying, they have a lot of information that’s been given to them by the intake….here’s what’s involved in seeking an assisted death, you must meet these eligibility criteria.”
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