Skip to main content
opinion

A health care worker from Humber River Hospital administers a second dose of the Pfizer COVID-19 vaccination to Sylvana Creglia inside Caboto Terrace on April 1, 2021, in Toronto.Cole Burston/Getty Images

Because of Canada’s rickety vaccine rollout, it was important for national morale (and for saving political face) that governments got as many first doses of the two-shot vaccines into people as quickly as possible.

Now that we’re sort of hitting our stride – 6.3 million doses have been administered to date, with more than 2 million more vaccines arriving this week – we need to refine our approach.

Quantity matters, but so does using vaccines as effectively as possible. That means not only getting shots into arms, but into the right arms at the right time.

Prioritizing the vaccination of elders in institutional care and front-line health workers, as most provinces did, was the right move. Of the more than 23,000 pandemic deaths Canada has recorded to date, more than 16,000 have occurred in institutional settings like nursing homes, a number that is likely an under-estimate, according to new research.

The carnage has stopped abruptly thanks to vaccination. Yet for the most part, residents of long-term care homes have received only one dose so far.

Moderna, Pfizer, AstraZeneca or Johnson & Johnson: Which COVID-19 vaccine will I get in Canada?

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).

PFIZER-BIONTECH

  • 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.

MODERNA

  • 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.

OXFORD-ASTRAZENECA

  • 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.

JOHNSON & JOHNSON

  • 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.

Is that good enough?

Canada has adopted a controversial policy of extending the time lag between the first and second dose to 16 weeks, or 112 days. This is very different from the recommendations of vaccine makers: 21 days for Pfizer, 28 days for Moderna and 84 days for AstraZeneca.

The science is evolving, so there are no easy answers. Stretching the time between doses makes sense on a population level; if we can get twice as many people vaccinated and still confer 80-per-cent protection with a single dose, that is clearly sound policy.

Of the 6.3 million Canadians vaccinated to date, fewer than 705,000 have been fully vaccinated with both shots; that’s 11 per cent.

In the U.S., which has vaccinated far more people per capita, almost 60 per cent are fully immunized. But Americans are having the opposite debate of the one here in Canada. There is a push below the border to delay second shots, rather than, as we’re now talking about here, reversing course and giving them closer together.

The great unknown is how far can you safely stretch the lag between shots without people’s immunity waning.

Just as important is how crudely these dose-sparing strategies should be applied. There is emerging evidence that the wait cannot be too long, especially for the most vulnerable, such as frail elders, and others with immune deficiencies, like cancer patients.

In other words, many people can afford to wait, but some cannot.

This is a reminder that, as vaccination campaigns evolve, policies need to become more nuanced and sophisticated.

At the outset, our vaccination priorities were principally age-specific, starting with centenarians and working our way down in five- or 10-year increments.

Now, instead of offering the jab to healthy 50- and 60-year-olds, we need to vaccinate members of high-risk groups, such as essential workers in food-processing plants and warehouses, teachers and people in specific neighborhoods where cases are soaring.

There are some great pilot projects (oh, how Canada loves its pilot projects!) showing that bringing vaccines to neighborhoods where blue-collar workers live is an effective mitigation strategy.

As the number of vaccines available grows substantially, we also need to be more aggressive and innovative in how we deliver them. Teams of vaccinators need to be dispatched to factories. Mobile teams need to get to housebound elders.

Clearly, we need to work on improving uptake among health care workers too, especially those who toil in long-term care houses and home care. But simply threatening to fire unvaccinated workers is not a viable solution, given dire shortages of personnel. The best way to overcome hesitancy is with sensible policies like paid sick days, so people have time to recover from any side effects, and peer-to-peer education.

The sight of empty clinics is infuriating, but also speaks to poor organization and communication, not lack of public interest.

Clinic hours and locations need to be improved. That means staging clinics in mosques and temples, not just convention centres. It means offering shots to elders early in the morning, not at suppertime.

Finally, what we really need is an injection of passion into the vaccine campaign.

Canada has received 8.6 million vaccine doses to date; only 6.3 million of them have gone into arms.

Why, as variants are starting to run rampant, are one in every four doses of vaccine Canada has received sitting in freezers?

The same question needs to be asked today as when the vaccination campaign began in December of last year: Where is the sense of urgency?

We didn’t have it at Christmas, and we still didn’t have it at Easter. If continue with this languorousness, the pandemic will still be with us on Canada Day, on Labour Day – and beyond.

Health columnist André Picard answers reader questions about COVID-19 variants, how effective the various vaccines are and the impact of on-again, off-again lockdowns.

The Globe and Mail

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters and editors.