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Logistical 'nightmare' for AstraZeneca 2nd doses as Ontario seeks vaccine mixing recommendation

Last Updated May 4, 2021 at 6:59 am EDT

Almost 1.2 million Canadians have received their first shot of AstraZeneca through their local pharmacies, but now there are rising concerns about second doses.

Ontario pharmacies are expected to notify people when it is time for their second dose, unlike in the provincial booking system when second dose appointments are given out at the same time as the first.

It is being called an “administrative nightmare” with one east end Toronto pharmacist telling the CBC he has to go into each patients profile and manually send each patient an email a thousand times over.

Adding to the issue, will there be enough AstraZeneca for that second dose?

In an effort to make its vaccine roll out a little more flexible, Ontario has asked the National Advisory Committee on Immunization (NACI)to make a recommendation by mid-May that would allow citizens to receive a second shot of Pfizer-BioNTech or Moderna after getting treated with AstraZeneca first.

Speaking on Monday, Associate Chief Medical Officer of Health Dr. Barbara Yaffe says provincial health officials are waiting for guidance from NACI before moving forward with the process.

“We’ve asked for NACI to come back with expert opinion recommendations in mid-May with respect to what vaccines can be mixed in terms of the first and second shots,” said Yaffe.

“Likely they will recommend that it is safe and effective to use a different vaccine for the second shot if you cannot get the same that you got for the first one.”

Yaffe says the UK and other countries have combined vaccines as health experts generally agree that the mixing and matching of the vaccines should be safe.

Trials held in the UK have so far determined that linking vaccines might give broader, longer-lasting immunity against the virus and new variants of it.

More than 800 people across the UK are taking part in the research and have received two doses of either Pfizer, AstraZeneca or a mix.


Results of the first stage of the study are expected next and the enlarged trial should have some findings by June or July.

The clinical trial is expected to run for a year.

In early April, Canada’s deputy chief public health officer, Dr. Howard Njoo, touched on the likelihood of mixing shots, saying Canada could see “vaccine dose combining” in its future.

“It’s possible, but at the present time, I would say that Health Canada is looking at the data that they’ll certainly take that into account in terms of what is best in the Canadian context,” he said at the time.

Vaccine hesitancy has followed after growing concern around the possible link between the AstraZeneca shot and a rare blood clotting disorder, resulting in NACI and Health Canada recommending the shot only be given to those over the age of 55.


Ontario’s medical officer of health Dr. David Williams says that while there is hope for vaccine mixing in the future, the province is confident in the current results and availability of mRNA vaccines (Pfizer and Moderna).

“They [mRNA vaccines] have been performing very well, even on one dose,” said Williams on Monday.

“… That’s encouraging. Over the next while our main product is going to be the Pfizer one… Fortunately, in a week or so that’s going to really pick up so that is going to be the one to go to. We don’t have much more AstraZeneca coming so it [vaccine mixing] may be a moot point.”

Williams says Moderna shipments could also pick up in the coming weeks after the province’s rollout of the shot was delayed for weeks.

This comes on the heels of NACI recommending that Canadian provinces give the single-dose Johnson & Johnson – a non mRNA shot – vaccine to adults 30 years of age and older.

NACI also suggests provinces can use the single-dose vaccine on people who may have more difficulty booking a second dose of another vaccine.

“mRNA vaccines are preferred, however, you need to look at what vaccines are available to you at this time,” Yaffe added.

“… If you’re going to get an mRNA today, great, but if you have to wait and you can get another vaccine then get the other vaccine. Any vaccine that is approved and regulated as safe and approved in Canada is the one you should be getting if it’s available to you.”

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