If any among the millions of Canadians who received a dose of the Oxford-AstraZeneca COVID-19 vaccine are suddenly feeling duped – or confused, angry or some combination thereof – no one could blame them.
For weeks, Canadians were told that the best vaccine for them is the one available. Various political and health care leaders emphasized that all of the vaccines approved by Health Canada were extremely effective in preventing serious illness and death, and that taking time to “vaccine shop” would not just be selfish, but dangerous. A drowning man wouldn’t demand a specific type of lifeboat, after all. So a Canadian with the opportunity to take a potentially life-saving shot in the middle of a pandemic should thank science and/or whatever deity he believes in, and roll up his sleeve.
That message appeared to shift Monday, when Dr. Shelley Deeks, the vice-chair of the National Advisory Committee on Immunization (NACI) said that mRNA vaccines (such as those by Pfizer and Moderna) are preferred. “The viral vector vaccines are very effective vaccines, but there is a safety signal,” she said, referring to the risk of very rare blood clots associated with AstraZeneca. “What we’ve said all along is that the mRNA vaccines are the preferred vaccine,” adding that those who are able might want to wait until one comes available. NACI chair Caroline Quach-Thanh made things worse later when, during an interview on CTV, she said, “If, for instance, my sister got the AstraZeneca vaccine and died of a thrombosis when I know it could have been prevented and that she is not in a high-risk area, I’m not sure I could live with it.”
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This surely feels like something of a betrayal to Canadian boomers who were shamed for hesitating to receive their AstraZeneca shots, and to Generation Xers, who flocked to pharmacies when provinces began offering the vaccine to those age 40 and above. It is true that NACI wrote in its vaccine update on April 23 that it continues to “preferentially recommend authorized mRNA COVID-19 vaccines,” but the message emphatically repeated outside the insular bubble of NACI written materials was that if an AstraZeneca vaccine is offered to anyone, in any area, they should take it. That message has been muddled, probably irrevocably, by the head of NACI musing about the vaccine killing her sister.
It is, of course, difficult – especially for a body of experts in medicine and science, not communications – to adjust recommendations to changing evidence and articulate those changes in a way the public will understand. And the reality is that the incidence of this type of vaccine-induced thrombotic thrombocytopenia was originally thought to be rarer; in March, it was observed as infrequently as one in a million or less, but now is believed to occur more like once in every 100,000 doses administered, and the risk goes up as the age of the recipient goes down. But even then, by NACI’s own analysis, the risk of landing in the ICU from this type of post-vaccination blood clot is still considerably lower than the risk of contracting COVID-19 and landing in the ICU for those age 40 and older in areas where the daily reported incidence of COVID-19 spread is “moderate,” “high” or “very high” (which would include the entire Greater Toronto Area, plus plenty of other regions). Deferring vaccination quite clearly poses a significantly higher personal risk, as well as a considerable public-health risk, when compared with taking a vaccine associated with a rare, serious, but normally treatable complication.
The average person, however, isn’t going to read to page 109 of NACI’s recommendations to see how they personally fit into this cost-benefit analysis, nor will he or she find comfort in chief public-health officer Theresa Tam’s expression of sympathy, which she offered Tuesday, for those struggling to keep up. Those who got their first dose of AstraZeneca will be wondering what to do when it comes time for the second. (The U.K. is currently conducting a clinical trial on administering different types of vaccines for first and second shots.) Yet the only advice offered to them now is to sit tight.
What people need is clarity – instruction on how they’re supposed to navigate seemingly incongruous messages from governing, regulatory and advisory health care bodies, all of which speak with different voices. There’s Health Canada, which approved AstraZeneca for those 18 and older, and the NACI, which approved it with an asterisk for those over 30, and the Public Health Agency of Canada, plus provincial regulatory bodies, pharmacists and individual family doctors.
Canada desperately needs a single authoritative voice on its COVID-19 vaccine program who knows the science, can communicate effectively and can act as a liaison between the country’s various health care bodies and the public. After weeks of changing recommendations, Canadians are certainly justified in feeling duped, confused or misled, but what they shouldn’t feel – at least not any more – is on their own.
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Robyn Urback