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.
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.
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.
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