Ruminations: Striving Toward Normal

Dr. Howard Njoo, Deputy Chief Public Health Officer at Public Health Agency of Canada; Dr. Supriya Sharma, chief medical advisor for Health Canada; and Dr. Marc Berthiaume, director of the bureau of medical sciences for Health Canada, give an update on the COVID-19 situation in Canada during a press conference at the Sir John A. Macdonald Building in Ottawa on Wednesday, Dec. 23, 2020. THE CANADIAN PRESS/David Kawai

"We have to take a step back and remember that the goal is to get our society back to normal as quickly as possible."
"We don't do it by ensuring a small amount of people have a large amount of immunity, but by ensuring a large amount of people have acceptable immunity quickly."
"But the dynamics have shifted and there is new information. We are now looking down the barrel of the dominance of more transmissible variants. When you don't have sufficient supply [of vaccines] to ensure that a large number of people will get their doses on the manufacturer's recommended schedule, what do you do to avoid a potentially damaging third wave while at the same time sticking to as much of the science as you can?"
"[Public health is] about doing what is possible with less than ideal information."
Raywat Deonandan, epidemiologist, University of Ottawa

"It's really important that people know that this going to be changing."
"We're in this place now where we have multiple vaccines that are authorized, we have huge mass vaccination campaigns that are ongoing around the world, and the responsible thing to do is to make sure that we get all that information and incorporate that into our decision-making."
Dr.Supriya Sharma, chief medical adviser, Health Canada

"While Canada was spared the worst ravages of the disease, our response to it has brought significant misery, largely attributable to quite strong restrictions in behaviour and a lagging vaccination program."
"The economic misery has been severe, and the projections are that Canadian taxpayers will be paying this bill for some time to come."
"[High unemployment and public borrowing levels in particular made Canada] significantly worse than average, indicating an inefficient, costly response."
Report, Macdonald-Laurier Institute, Ottawa

A woman receives her COVID-19 vaccine at a vaccination clinic in Montreal's Olympic Stadium on Tuesday, February 23, 2021. THE CANADIAN PRESS/Paul Chiasson

Canadian health regulators have approved the fourth of the vaccines that will begin delivering doses to Canada. The four vaccines approved by Health Canada are Pfizer-BioNTech, Moderna, AstraZeneca-Oxford and Johnson and Johnson. Eight million doses overall are anticipated for arrival by the end of March, for a population of 38 million people. However, in the interests of extending coverage, and in view of what is happening elsewhere in the world of COVID vaccine deliveries, Canada's COVID-19 Immunity Task Force has given its approval and recommendation for withholding the second vaccine shots complementing the first for an extended period beyond what the manufacturers advise.

The extended dosing timeline is not universally considered safe and effective even as experts feel that the goal of vaccinating greater numbers of people with one dose overrides the uncertainty of delaying second doses. Theirs is an unassailable argument, that vaccinating more people with the first dose that renders a healthy amount of immunity in the 80 -- 92 percent range -- will have the effect of reducing rates of infection, serious illness and death. The looming spectre of a third wave of the pandemic gaining impetus with the introduction of more transmissible variants also lends a note of emergency reaction.

The second Pfizer dose was originally authorized by Health Canada at 21 days, the Moderna around 28 days and the second AstraZeneca dose between four and 12 weeks following the administration of the first dose. The current vaccine rollout plan envisions mass vaccination for the general population once those at higher risk have been inoculated. Canadians have chafed over the slow pace of rollout. Anxiety levels are high within the general population, in particular among the elderly demographic representing the age group most deleteriously affected by the virus, in serious illness, ICU admissions and deaths.

According to the National Advisory Committee on Immunization, the decision to extend administering COVID-19 vaccines' second dose to four months was based on "the public health principles of equity, ethics, accessibility, feasibility, immunological vaccine principles and the perspective that, within a global pandemic setting, reducing the risk of severe disease outcomes at the population level will have the greatest impact". A rational argument few could find fault with. Particularly at a time when case numbers appeared to have stabilized over a few weeks' time, but are now edging back up again, presaging that feared 'third wave'.

It is the limited data available as to how long protection from a first dose lasts, allied with the direction from the manufacturers based on clinical trials being set aside that concerns some medical professionals. University of Ottawa's Raywat Deonandan, among those who initially opposed delaying the second dose based on the lack of clinical trial evidence has since changed his mind, given the level of public risk as control of the SARS-CoV-2 virus causing COVID-19 remains elusive.