There is growing confusion and uncertainty in Canada about which COVID-19 vaccine to get.
The National Advisory Committee on Immunization (NACI) said on Monday that the mRNA vaccines by Pfizer-BioNTech and Moderna are “preferred”, but if an individual does not wish to wait they can get the AstraZeneca or the Johnson & Johnson shots — given that the benefits outweigh the risks of waiting.
This contradicts Health Canada’s stance, which for weeks, has been encouraging Canadians to get the first vaccine they were offered. NACI makes recommendations for the use of vaccines currently or newly approved for use in humans by Health Canada.
The updated recommendations took into consideration concerns around reports of a rare blood clot linked to the AstraZeneca and J&J vaccine.
“NACI continues to preferentially recommend authorized mRNA COVID-19 vaccines due to the excellent protection they provide and the absence of any safety signals of concern,” the updated guidelines on May 3 read.
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Amid the heightened confusion, experts say there should not be any preferences when it comes to the type of vaccine, and that the mixed messaging will only erode vaccine confidence among Canadians.
“The take-home message for most Canadians … is that there’s an A and B list for vaccines and there’s really not,” said Kerry Bowman, a bioethicist at the University of Toronto.
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Anita Ho, an associate professor of bioethics at the University of British Columbia, agreed, saying it was difficult to draw comparisons between the different vaccines as each has its own benefits.
“It’s really difficult to say that this one class of vaccine is better than the other class when all the vaccines that have been approved in Canada show a very, very high efficacy rate and very good safety records.”
“The risk of having any kind of blood clots or serious problems is so much lower than people getting infected or getting seriously ill from COVID-19,” she added.
NACI is recommending that the AstraZeneca and J&J may be offered to individuals 30 years of age and older without contraindications “if the individual prefers an earlier vaccine rather than wait for an mRNA vaccine.”
Some might think that there is less urgency to get vaccinated, Bowman said.
“The interpretation for some people is, yes, I can be vaccinated tomorrow, but I’m going to wait till June or July. We don’t need this. We need to bring numbers down as quickly as we can,” Ho concurred.
“When we have mixed messages, people who are already a little bit uncertain about whether to get vaccinated may get even more cautious about it,” she said.
What should Canadians do?
The risk of the new blood-clotting syndrome, known as vaccine-induced thrombotic thrombocytopenia, or VITT, is estimated to be anywhere from one case in 100,000 doses given, to one in 250,000.
Seven cases of blood clots, including one death, have been reported to date in Canada, all in people who received the AstraZeneca vaccine.
Some 1.7 million doses of the AstraZeneca vaccine had been given out as of April 24.
As of April 23, 17 cases of VITT had been confirmed out of more than eight-million doses of the J&J vaccine administered in the United States.
Bowman, who received his first shot of the AstraZeneca vaccine back in March and is awaiting the second dose said he found NACI’s latest announcement on preferred vaccines as “almost offensive.”
“They’re kind of saying, I’m on a B list and I don’t see it that way.”
According to NACI, the public health benefit-risk analysis for the use of the vaccine may vary between jurisdictions.
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Ho said if people are trying to weigh the risks, they should look at the infection rate in their particular province and recognize that the risk is much higher than any kind of risk that they may get from the vaccine.
She also suggested seeking advice from health-care providers if there were any vaccine-related concerns.
Health Canada has approved J&J for use in Canada but no Canadian has yet received it as the first batch delivered last week is still being investigated following reports of safety and quality control violations at the U.S. facility involved in its production.
On Tuesday, Prime Minister Justin Trudeau reiterated his call for people to get vaccinated as quickly as possible, reassuring Canadians that every vaccine administered in Canada is safe and effective.
“We have seen the tragic impacts of COVID-19 all across the country, and vaccines are one of the key tools to reduce the deaths and the vulnerability of Canadians to COVID-19,” he said during a news conference in Ottawa.
“That’s why we are continuing to recommend to everyone to get vaccinated as quickly as possible so we can get through this.”
Canada’s Chief Public Health Officer Theresa Tam said was she “very heartened” that NACI was taking the data that Health Canada was gathering in real-time into account and evolving advice based on that.
“We all want transparency. We all want that the data is carefully analyzed as we’re going along,” she said.
“That doesn’t make it easy for people to understand.”
— With files from The Canadian Press.
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