Anyone looking for evidence that Canada’s public-health system is being tested to the limits by the COVID-19 pandemic didn’t need to find a hospital this week. Instead, they could have hopped on the nearest social-media platform and looked up the National Advisory Committee on Immunization (NACI).
The committee, which is made up of an independent expert panel that reports to the Public Health Agency of Canada, is tasked with providing non-binding advice to federal, provincial and territorial governments about how best to allocate vaccines that are authorized by regulators.
But once a medical rarity crashed headlong into Canada’s uneven vaccine rollout, that simple job description turned into a recipe for communication chaos, leaving observers to wonder if there might be a better way for the committee to get its information across.
At issue is what Canadians should do if their personal risk of getting COVID-19 is low enough that it would effectively make no difference if they wait for an mRNA vaccine made by Pfizer-BioNTech or Moderna instead of receiving the one made by AstraZeneca, should that one be offered sooner. The latter vaccine is associated with a slight risk of blood clots – a condition known as vaccine-induced immune thrombotic thrombocytopenia, or VITT. Three people in Canada have so far died from VITT, and the chance of being affected by it is estimated to range from about 1 in 100,000 to 1 in 50,000 – whereas the country’s overall death rate owing to COVID-19 is more than one thousand times higher.
“What we are asking is for people to evaluate their individual risk of catching COVID-19 over the next few weeks,” said Caroline Quach-Thanh, the committee’s chairperson and a clinician scientist at the University of Montreal.
Leaving aside the question of how one might conduct such an evaluation beyond simply guessing, the nuanced guidance appears to undercut a long-standing public-health message that people should take the first vaccine they are offered. Some who only just recently received the AstraZeneca shot were quick to vent their ire in online posts. However, as Dr. Quach-Thanh points out, the recommendations are not about them.
“[They] did the right thing,” she said in a written statement on Wednesday. “They protected themselves and their families against COVID-19 complications.”
David Naylor, who chairs the federal Immunity Task Force, said he does not take issue with the substance of the committee’s recommendations, but said that confusion over the advice could lead some to conclude they received an inferior vaccine. Dr. Naylor added that in his interactions with federal officials, he has repeatedly recommended NACI be provided with communications support.
“I think a strategic communications expert would have helped enormously by getting NACI to focus on its different audiences. One audience was over a million Canadians who’d taken the [AstraZeneca] vaccine some weeks or months ago. They needed assurance primarily about effectiveness of the vaccine, and how boosters would be handled given the VITT issue,” Dr. Naylor said.
Part of the challenge is that NACI was not intended to be a public-facing body. The committee’s terms of reference require it to provide recommendations to PHAC for use by health care professionals, rather than Canadians at large.
Even committee members have agreed that alternatives should be considered for how their work is communicated – but not while they are up to their eyeballs in evaluating vaccine science as rapidly as possible. Dr. Quach-Thanh, whose four-year voluntary role expires in less than a month, told The Globe and Mail that the discussion needs to be held at the PHAC level.
One possibility would be to appoint a permanent spokesperson who can decode what the committee has decided, akin to how Dr. Supriya Sharma has become the face and voice of Health Canada regulators in recent months. The rub is that the advice NACI provides is meant to be given at arm’s length – a feature that is central to the best practices for such national advisory groups as laid out by the World Health Organization. Having a public-health agency employee speak for the committee, particularly if its recommendations are politically sensitive, could well be viewed as a conflict of interest.
NACI’s counterpart in the United States is both better resourced and more closely intertwined with its government agency, the Centre of Disease Control and Prevention. Unlike NACI, however, its deliberations are public. Anyone curious to know what happened last month when the U.S. committee debated the Johnson & Johnson vaccine – which has also been linked to VITT – can simply watch a recording of the virtual meeting on YouTube to know what the experts really think.
Allison McGeer, an infectious disease specialist at Sinai Health System in Toronto and a past NACI member, said that while she appreciates that approach, the effort required to enable committee meetings to be live and open to anyone doesn’t come cheap. NACI currently has nothing like the budget or staff that would be needed for such options. And while communications support would be nice, she added, what really matters is whether NACI can gather and evaluate the available data relevant to vaccines with depth and speed in order to facilitate good public-health decisions.
“There are so many things they need more than a media-relations team,” Dr. McGeer said. “We need science from NACI, and they are not adequately resourced for rapid and comprehensive scientific assessment.”
Dr. McGeer added that she takes no issue with the recommendations that NACI made this week, but said the committee’s efforts to keep up with a rapidly changing situation – including the many unknowns that still surround VITT – have left it open to second-guessing by others. The only remedy, she said, is a body that is sufficiently empowered through a level of investment that ensures people know and trust the consistency and quality of their work.
The committee, which has 12 voting members, is soon set to add two more to broaden its pool of experts. That could help with the questions that still remain to be decided as the pandemic continues – from new vaccines still to come, to vaccines for children and other specific population groups, and the potential need for booster shots against COVID-19 in the future.
But however challenging any of those decisions become, Dr. McGeer said, “I do think we need to hold on to the fact that it’s a much better problem than not having vaccines.”
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