A nurse prepares a dose of the Moderna COVID-19 vaccine as part of the COVID-19 vaccination campaign, in Brampton, Ont., on March 4, 2021.CARLOS OSORIO/Reuters
Back in November, top public-health officials in Ottawa said they were working on a campaign to address COVID-19 vaccine hesitancy. It was an indulgent thought back then – before a single vial had landed on Canadian soil – and could arguably still be one now, as long as vaccine demand outweighs supply.
But the delivery of a couple million doses over the past several weeks has rendered questions about these vaccines less of a theoretical concern and more of a practical one. Canadians trying to book vaccination appointments for parents or grandparents are wondering about how the different types compare, why second doses are being delayed, why the refrigeration guidelines have changed, why some provinces are vaccinating younger cohorts faster than others and which vaccines are going to be offered to Canadians 65 and over. There is nothing by way of a centralized, fluid resource offering comprehensive answers to these and other questions.
Hesitancy about these vaccines – which were developed in record time and, in the case of mRNA vaccines, are a first for human use – was always going to be an issue, and not just among those who are normally skeptical of vaccinations. As of the end of February, only 55 per cent of long-term care workers in Ontario had received a COVID-19 vaccination despite it being available to them since December, according to Ministry of Health data provided to the CBC. There are now more than twice as many active cases among staff as there are among residents, which risks the health and welfare of both, seeing as the shots do not offer 100-per-cent immunity and research suggests these vaccines (like many others) may be slightly less effective in older demographics.
Tracking Canada’s COVID-19 vaccine rollout plans: A continuing guide
Vaccines are being offered to certain groups of Canadians outside of care homes, although the AstraZeneca shot will not be among them for people the age of 65 and older. Understanding why that is and how Canada reached that (likely impermanent) conclusion takes a bit of research: Health Canada approved the vaccine for use in all ages last Friday, but on Monday, the National Advisory Committee on Immunization (NACI) recommended against its use in individuals the age of 65 and up. The reason for caution is the limited clinical trial data on vaccine recipients in that age cohort, although real-world data – from Scotland and England, for example – show strong efficacy in older age groups, comparable with other COVID-19 vaccines.
Canada pre-purchased millions of doses of seven different vaccine types, and Health Canada has approved four so far for the various provincial and territorial rollouts. All the drugs are fully effective in preventing serious illness and death, though some may do more than others to stop any symptomatic illness at all (which is where the efficacy rates cited below come in).
- Also known as: Comirnaty
- Approved on: Dec. 9, 2020
- Efficacy rate: 95 per cent with both doses in patients 16 and older, and 100 per cent in 12- to 15-year-olds
- Traits: Must be stored at -70 C, requiring specialized ultracold freezers. It is a new type of mRNA-based vaccine that gives the body a sample of the virus’s DNA to teach immune systems how to fight it. Health Canada has authorized it for use in people as young as 12.
- Also known as: SpikeVax
- Approved on: Dec. 23, 2020
- Efficacy rate: 94 per cent with both doses in patients 18 and older, and 100 per cent in 12- to 17-year-olds
- Traits: Like Pfizer’s vaccine, this one is mRNA-based, but it can be stored at -20 C. It’s approved for use in Canada for ages 12 and up.
- Also known as: Vaxzevria
- Approved on: Feb. 26, 2021
- Efficacy rate: 62 per cent two weeks after the second dose
- Traits: This comes in two versions approved for Canadian use, the kind made in Europe and the same drug made by a different process in India (where it is called Covishield). The National Advisory Committee on Immunization’s latest guidance is that its okay for people 30 and older to get it if they can’t or don’t want to wait for an mRNA vaccine, but to guard against the risk of a rare blood-clotting disorder, all provinces have stopped giving first doses of AstraZeneca.
- Also known as: Janssen
- Approved on: March 5, 2021
- Efficacy rate: 66 per cent two weeks after the single dose
- Traits: Unlike the other vaccines, this one comes in a single injection. NACI says it should be offered to Canadians 30 and older, but Health Canada paused distribution of the drug for now as it investigates inspection concerns at a Maryland facility where the active ingredient was made.
How many vaccine doses do I get?
All vaccines except Johnson & Johnson’s require two doses, though even for double-dose drugs, research suggests the first shots may give fairly strong protection. This has led health agencies to focus on getting first shots to as many people as possible, then delaying boosters by up to four months. To see how many doses your province or territory has administered so far, check our vaccine tracker for the latest numbers.
If the NACI changes its recommendation on AstraZeneca, as France and Germany did after initially limiting use to individuals under 65, Canada will face the challenge of convincing older adults that the vaccine is safe and effective for them. Of course, it’s better to evolve with science and adapt policies to emerging evidence, but without detailed explanations (which media have tried to offer in the absence of accessible and multipronged government messaging) changing course just breeds skepticism and further hesitancy – which could mean wasted or expired doses or people putting off vaccination until they can access the type they want.
The average person, after all, isn’t poring over NACI statements or tuning into midday briefings, but they are watching TV, streaming podcasts or browsing social media. Yet public-health messaging is still not meeting them where they are, never mind directing them to a resource where the most common COVID-19 vaccine concerns could be addressed.
The need is urgent, particularly in light of the contradictory statements made by public-health leaders on Canada’s ever-evolving vaccine strategy. On Monday, Canada’s Chief Science Advisor Mona Nemer said extending the interval between doses to four months (from a maximum six weeks for Pfizer and Moderna and 12 weeks for AstraZeneca) would amount to a “population-level experiment.”
On Wednesday, the NACI green lit this experiment by adjusting its recommendations in support of the four-month interval to “maximize the number of individuals benefiting from the first dose.” The justification for the change is that real-world data – from Israel and Britain, for example – show a single dose can be as high as 85 per cent effective at preventing infection, and the unfortunate reality is we have been in the midst of a population-level experiment (with physical distancing, remote learning and the rapid rollout of new vaccines) for the better part of a year. Spacing out dose intervals based on early real-world data is not a leap.
These explanations, however, won’t reach all the people they need to if they are languishing on NACI publications, aired in media briefings or published in the odd news article or column. Vaccines are arriving in Canada, finally, but we still need to address concerns in an accessible way to make sure everyone who is eligible will decide to get one.
Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today.