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Why restricting AstraZeneca vaccines in Canada means balancing 'vaccine risk vs. disease risk' – CBC.ca

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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 decision to suspend the use of the AstraZeneca-Oxford vaccine in Canadians under 55 during a surging third wave and a slow vaccination rollout is a calculated risk.

The National Advisory Committee on Immunization (NACI) updated its guidance to provinces and territories against the use of the vaccine for younger Canadians on Monday, following reports of rare but potentially fatal blood clots in Europe connected to the shot.

Health Canada says the benefits of the vaccine to protect against COVID-19 still outweigh the potential risks, with more than 300,000 doses of the shot administered and no cases of the serious clotting condition, known as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT), in Canada. 

But the decision to restrict the use of one of four approved vaccines at a time when COVID-19 levels are rising again in Canada’s hardest hit provinces is a tough pill to swallow for some.

“It can be a very powerful tool when we’re at this stage of the pandemic where we’re talking about, in hotspots at least, the system getting to a point of potential collapse,” said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto. 

“There are humans behind that story, and when you’re in a hospital where you’re seeing an exponential rise in the number of COVID-positive patients coming in, and your staff to help manage these patients is the same pool of staff — then those numbers aren’t adding up.”

But on an individual level, experts say the lack of data on the risk of VIPIT to Canadians from the AstraZeneca vaccine is concerning and NACI was right to err on the side of caution in order to avoid putting lives unnecessarily at risk. 

Pharmacist Abraam Rafael administers a COVID-19 vaccine to Maureen Doyle at his pharmacy in Toronto on March 14 as Ontario starts administering the AstraZeneca vaccine for COVID-19 to residents aged 60-64. (Cole Burston/The Canadian Press)

Race between vaccines and variants

Ontario has more ICU admissions than at any other point in the pandemic, B.C. has had its highest single-day number of new cases to date, and Quebec saw its biggest one-day spike in almost two months as more transmissible variants are spreading rapidly across Canada.

The good news is that vaccines work; eight provinces and territories reported no new deaths in a single day this week, and the decision to prioritize COVID-19 vaccines in long-term care has led to a dramatic drop in deaths in residents. 

The bad news is that the race between vaccines and variants is taking on new urgency; the majority of vulnerable Canadians are still unvaccinated and the third wave is hitting younger adults harder and showing no signs of slowing down. 

“It’s so complicated, because I look at it as being two things: What is the absolute risk of this potentially related severe side effect versus the absolute risk of the disease?” said Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta faculty of medicine in Edmonton.

“The other consideration is, what is the public backlash to potential outcomes of any particular course of action?”

WATCH | AstraZeneca now only recommended for Canadians over 55:

Canada’s vaccine advisory committee has changed its advice and now says the AstraZeneca COVID-19 vaccine should only be given to people aged 55 and up following concerns it could be linked to a rare blood clot. 2:21

Health Canada says VIPIT occurs at a rate of about one in 100,000 people vaccinated, with a mortality rate of about 40 per cent, although more research is needed and that risk is reduced if treated early enough. The total number of people in Europe who got the rare blood clots after vaccination is small — as of Thursday, dozens of cases have been reported compared to millions who received the shot.

But crucially, the people who appear to have an elevated risk of the rare blood clots are not the same age group most at risk from COVID-19.

“If you look at the average 30 or 40-year-old Canadian, their risk of getting severely ill from COVID based on our current experience is substantially less,” said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto.

“You’re asking them for the good of the country to take on a risk that they wouldn’t even get with COVID. So why would you give them a vaccine that is more likely to give them harm then COVID is? It makes no sense.”

Canada has had close to 23,000 COVID-19 deaths in the year since the pandemic began, but fewer than a thousand of those have been in people under 60 and just over 300 in Canadians under 50.

“What happens to NACI if they say that everything is fine, despite the European experience which really brings it into question, and then we have even one death in Canada from this?” said Morris. “NACI would be just absolutely raked over the coals.”

‘Vaccine risk versus disease risk’

Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, said the debate over whether suspending the vaccine in younger Canadians was the right decision is due to a miscalculation of risks for that age group.

“I think what you see is a bit of wire crossing around vaccine risk versus disease risk,” he said.

There is also a risk of clots from getting COVID-19, but that’s conditional on getting the disease first, and there are other vaccines to protect against it, he said, rather than using a vaccine linked to adverse events in this age group.

“The adverse effect here is rather devastating,” he said. “[VIPIT] seems to be killing about half the people who suffer these consequences, and is highly likely to cause permanent neurological damage in survivors.”

“Given that these are young people working in healthcare, it is likely that vaccination is conferring damage or death that they would not have suffered otherwise.”

Dr. Menaka Pai, a clinical hematologist at McMaster University and a member of Ontario’s COVID-19 Science Advisory Table, says the risks associated with VIPIT in younger adults are dangerous enough to warrant halting its use in those under 55.

“The clots that we see with VIPIT — they’re serious. If you’re not aware of them they can be hard to diagnose, they can be hard to treat,” she said. 

“If you’re older and likely to experience all the other horrible things that COVID does, including killing you, then your decision about urgency and needing any vaccine frankly is really different from somebody who is younger and probably better able to weather the storms of COVID.” 

WATCH | Should people who’ve had the AstraZeneca vaccine be concerned?

Infectious disease experts take questions about the changing advice for the AstraZeneca COVID-19 vaccine including if those who’ve had a shot should be concerned. 4:22

Pai says critics of NACI’s decision are inaccurately drawing comparisons with the risk of VIPIT to the risk of birth control pills, which also carry an increased risk of blood clots.

“The reality is that every year a little under one in 3,000 women will get a blood clot on the combined oral contraceptive pill and every year one in 300 pregnant women will get a blood clot,” she said. 

“But the clots that you get on those hormones are very different from the clots that we’re seeing related to the AstraZeneca vaccine.” 

Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, says if the risk from the AstraZeneca-Oxford vaccine to younger Canadians can be mitigated with another COVID-19 shot, then the decision to halt the use of it makes sense.

“This is not the same as going to a place like Brazil where the disease is rampaging out of control,” he said. 

“Whereas this is the only vaccine you have available to you — take it now or I can’t guarantee you will be alive in a month. It’s a different scenario entirely.” 

But Deonandan says he can sympathize with critics of NACI’s recommendations to suspend the vaccine because of the damage the decision may do to the public perception of COVID-19 vaccine safety overall. 

“If you are saving any lives, you’re saving one or two lives [from VIPIT],” he said.  “On the other hand, you’re creating such distrust of the vaccine you may be causing hundreds, possibly thousands of deaths from people not taking the vaccine.” 

“But given what NACI’s job is, which is to advise how best to deploy vaccines, they used the best evidence and came upon the right decision for their mandate.” 


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Molson Coors’ JV Truss launches 6 pot-infused drinks in Canada

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(Reuters) – Miller Lite beer-maker Molson Coors Beverage Co’s cannabis joint venture Truss Beverage Co on Wednesday launched six pot-infused beverages in Canada, as it hopes that summer demand will offset recent sales hits from COVID-19 lockdowns.

Coronavirus restrictions in major provinces including Ontario have forced weed stores to shut for extended periods, and are expected to hit cannabis companies’ results for the March quarter.

The summer season, which tends to represent peak demand for beverages, will be crucial for companies to undo the damage.

Truss, jointly run by Canadian pot producer Hexo Corp, launched five CBD-infused beverage brands in August last year and claims to have already won a 43% market share in the category in Canada. (https://bit.ly/3wThh2D)

“Summer … is the biggest opportunity for the beverage category; it is the inflection point for consumers to try out our products,” Truss Beverage’s Chief Executive Scott Cooper told Reuters in an interview.

“Cannabis-infused beverages are still new and tend to be an impulsive purchase, so having the store open is important to the trial and awareness of the category,” he added.

Truss said its latest beverage line included watermelon, lemonade, sparkling tonic and honey green iced tea flavors, and are expected to be rolled out to retailers over the next few months.

 

(Reporting by Rithika Krishna and Shariq Khan in Bengaluru; Editing by Ramakrishnan M.)

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Canadian retail titan W. Galen Weston dies at 80

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(Corrects April 13 story to remove references to Primark in paragraph 3 and what had been paragraph 6, to reflect that Primark is actually owned by a different Weston family)

By Moira Warburton

(Reuters) -W. Galen Weston, patriarch of one of Canada‘s wealthiest families and retail titan, has died at age 80, according to a statement by the family on Tuesday.

Weston was the third generation of his family to lead George Weston Limited, an already-prosperous retail empire founded by his grandfather, which he expanded significantly.

The family company, now run by his son, Galen Weston, owns Selfridges in the United Kingdom, as well as the Canadian grocery chain Loblaw Co Ltd, pharmacy chain Shoppers Drug Mart, and real estate company Choice Properties.

Weston passed away peacefully at home after a long illness, the statement said.

He was born in Buckinghamshire, England, and moved to Dublin at 21 to escape a domineering father, the Irish Times reported in 2014, where he met his wife, Irish model Hilary Frayne. They married in 1966.

In the 1970s Weston returned to his family’s base of operations, Canada, to revive the family’s struggling Loblaws supermarket chain, and helped turn it into one of the largest food distributors in the country.

“In our business and in his life he built a legacy of extraordinary accomplishment and joy,” Galen Weston, chairman and CEO of George Weston Ltd, said in a statement.

“The luxury retail industry has lost a great visionary,” Alannah Weston, Weston Sr.’s daughter and chairman of Selfridges Group, said.

The Weston family is among the wealthiest in Canada, with Forbes estimating their total wealth at $8.7 billion.

(Reporting by Moira Warburton in VancouverEditing by Matthew Lewis)

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Canada’s migrant farmworkers remain at risk a year into pandemic

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By Anna Mehler Paperny

TORONTO (Reuters) – Pedro, a Mexican migrant worker, knew he had to leave the Ontario cannabis operation where he worked when so many of his coworkers caught COVID-19 that his employer began to house them in a 16-person bunk house alongside the uninfected.

Pedro moved in with friends in the nearby farming town of Leamington, Ontario, at the end of October. He asked to be identified under a pseudonym because he fears that speaking out will affect his chances of employment.

“I didn’t know where to go, where to get help. So I was left behind, hopeless,” he said, speaking through a translator. About a week later, Pedro landed another job, working with peppers in a greenhouse. Conditions are better, he said.

But he added: “To be honest, I don’t think all employers are taking precautions.”

Pedro is one of about 60,000 migrant farmworkers – many from Central America and the Caribbean – who come to Canada as part of an annual migration of people that ramps up in spring. They grow and harvest the country’s food supply and have continued to work in the midst of a pandemic.

They feed the country and are a crucial part of a C$68.8 billion ($54.8 billion) sector, making up about one-fifth of the country’s agricultural workforce, according to the Canadian Federation of Agriculture.

As the pandemic crippled travel last year, agricultural employers were unable to fill one-fifth of the temporary foreign worker positions they needed, costing Canadian farmers C$2.9 billion due to labour shortages, according to research commissioned by the Canadian Agricultural Human Resource Council.

These workers are also uniquely at risk. They live and work in crowded settings, and language barriers coupled with precarious immigration status tied to their employment prevent them from speaking out about unsafe conditions.

Last year they were hit hard by COVID-19, with 8.7% of migrants in Ontario testing positive. This year they are returning as Canada is in the grip of a third wave. While governments and employers say they are taking steps to keep these workers safe, advocates and workers contacted by Reuters say the dangers remain – except that now, those dangers are known.

Graphic on COVID-19 global tracker: https://graphics.reuters.com/world-coronavirus-tracker-and-maps/

SAME CRISIS

Syed Hussan, executive director of the Migrant Workers Alliance for Change, argues the same factors that made workers more vulnerable to COVID-19 last year – crowded workplaces, congregate living, visas that tie them to an employer and make them fearful of speaking out – still exist.

“We are walking into the same crisis yet again, the only difference being that we already know how bad it is.”

Keith Currie, vice-president of the Canadian Federation of Agriculture, said employers are doing their best, but some transmission of the virus will occur.

“Because they’re living on the farm, they’re in contact with each other when they’re working … despite all our efforts, it spreads. Just like it does elsewhere in society.”

Some 760 farmworkers have been infected so far this year in Ontario, Canada‘s most populous province, according to provincial data. Ontario put agriculture workers in Phase 2 of its COVID-19 vaccinations, which begins this month, and has set up a clinic at Toronto’s airport offering vaccines to migrants on arrival.

But advocates worry migrant workers might lack requisite identification, especially if they are undocumented.

Advocates argue not enough is being done to keep these workers safe from the pandemic. They say rules such as the requirement to get – and pay for – a COVID-19 test within 72 hours of coming to Canada place an undue logistical and financial burden on migrants.

Last month the federal government announced new measures meant to protect migrant agricultural workers, including beefed-up inspections.

But the migrants interviewed by Reuters argued what will protect them is more stable status that does not tie them to an employer.

“Hopefully this year, the government of Canada gives us status,” said Teresa, a migrant worker from Baja California.

($1 = 1.2559 Canadian dollars)

 

(Reporting by Anna Mehler Paperny in Toronto; Editing by Denny Thomas and Matthew Lewis)

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