People over 80 or who received only AstraZeneca should be offered third COVID doses, advisory panel says
Those over 80, adults living in long-term-care homes, and people who only got AstraZeneca shots should be offered a third COVID-19 vaccine dose, Canada's national advisory body said Friday.
The first national recommendations for so-called booster doses set out guidelines for a practice already being undertaken by some provinces, whose health officials have said those at highest risk of a breakthrough case of COVID should be offered another shot.
The new statement from the National Advisory Committee on Immunization (NACI) says third doses should be offered - a minimum of six months after a person's second - to seniors, but also opens the door to shots for other groups at high risk of illness or waning protection, including those who only got AstraZeneca doses, some front-line health care workers and adults in First Nation communities.
NACI is a panel of experts tasked with providing advice on immunization, though the final decision about who will be offered which vaccine rests with the provinces.
The case for booster shots, also sometimes referred to as third doses, is straightforward - with some fearing immunity will begin to ebb over time, another shot of vaccine acts as a helpful reminder to your immune system to stay vigilant.
The country also has millions of vaccine doses sitting in storage as demand wanes for first and second doses - shots that are difficult to then send overseas.
Some provinces, Ontario among them, have already made the shots available to the elderly or immunocompromised, while others have allowed those with mixed shots to get a third to fulfil requirements for travel. But British Columbia has joined countries like Australia in opening the floodgates and offering another shot to anyone over 18 whose second shot was at least six months in the past.
In some ways, the debates over who should get another shot and when evoke a sense of deja vu, as health professions revive conversations about who should be prioritized when vaccines started rolling out.
But heading into a second pandemic winter, the goalposts have moved.
It's a very different algorithm now," said Dr. Zain Chagla, an infectious diseases physician and associate professor at McMaster University in Hamilton.
Last year, prioritization decisions were made based on who was at risk of complications or being exposed to the virus. While that general principle still holds, Chagla noted that the vaccinated people at greatest risk of breakthrough infections tend to be those who are older or immunocompromised, whose bodies may not have responded as well to the first two shots.
But when you start talking about people like community workers, those with two doses in their system, who are relatively healthy and young, their risk of serious complications goes down significantly," he said.
This is a little bit murkier."
In Ontario, roughly 250,000 people are already eligible for a third dose, as the province has begun offering it to people considered high-risk, including residents of high-risk congregate settings like long-term-care homes or are undergoing treatment for tumours or advanced HIV, or other conditions that suppress immune response.
Almost 150,000 Ontarians have already rolled up their sleeves for a third time.
Earlier this week, Health Minister Christine Elliott told reporters that officials were in regular conversation with Health Canada and the National Advisory Committee on Immunization and were continuing to look at the needs of other groups.
The concern about waning immunity is that, over time, the antibodies in your nasal passage start to drop off, Chagla said. However, the ones in your bloodstream and elsewhere largely remain.
In other words, your body's first line of defence becomes weaker, though the bulk of your immune's system army remains able to fight off serious infection.
What that means is there is some evidence that some countries are starting to see more breakthrough infections - meaning, COVID vaccines in fully vaccinated people, particularly seniors - though people still remain mostly protected against serious illness, Chagla said. He stressed that the vaccines are still very good at protecting against serious disease, even if the time may have come to talk about a bit of a top-up for people who are particularly vulnerable.
Still, as the possibility of expanding third doses becomes increasingly likely, global health advocates have pointed out another factor that has only become more urgent this time around - the fact that people in many countries are still waiting for even their first dose.
Speaking at a meeting of aid groups Thursday, the World Health Organization's chief scientist, Soumya Swaminathan, said vaccination rates remain low, and that will be difficult to change if rich countries start buying up booster doses.
Nearly a million booster jabs are being given each day, three times the amount of vaccines being administered in low-income countries," she said, according to Reuters news agency.
NACI's new recommendation acknowledges the importance of global equity" but points out that global vaccine supply is outside its purview.
The issue of wealthy countries snapping up a disproportionate chunk of the global vaccine supply is also a replay of earlier this year, experts say.
It's so disheartening. It seems like it's the same stories, told a different way," said Jillian Kohler, a professor at the University of Toronto's Leslie Dan Faculty of Pharmacy, whose research is in global access to essential medicines.
Despite several weeks of furor last spring, from Canadians worried that the country wasn't first in line for vaccines, the federal government has actually locked in deals for more doses per capita than almost anywhere in the world.
According to an online tracker maintained by the Duke Global Health Innovation Center, Canada has prepurchased 11.47 doses of vaccine for every person in the country - or, enough to fully dose everyone roughly six times.
That's more than any other country, and now, Canada is one of the most heavily vaccinated countries in the world.
That said, some of Canada's deals are for doses that haven't been authorized yet, like the shots developed by Novavax or Medicago. There are also millions of doses sitting in storage around the country, and doses that have already arrived in another country aren't preferred by global donation programs.
According to an online tracker, Canada had an excess of over 10 million doses by late summer, as demand began to dip. The federal government paused deliveries of new vaccine last month and the number of surplus doses has since shrunk to about six million.
This is all in addition to the 11 million doses Canada keeps in a central inventory for future use.
About 3.6 million doses are currently sitting in storage in Ontario, according to a ministry spokesperson, earmarked for first and second doses and now, for boosters.
That excess supply is likely part of the conversation about rolling out boosters, Chagla said.
It's much easier to roll out a campaign like this when the vaccine is on the ground, than it is when you're thinking about how much vaccine you have to import."
But if those run out, that conversation may shift yet again, he says.
The elephant in the room as we talk about boosters is that taking doses to a place like Canada, which makes zero doses of vaccine, clearly has implications on global supply."
Alex Boyd is a Calgary-based reporter for the Star. Follow her on Twitter: @alex_n_boyd