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NACI advice on 'preferred vaccines' for COVID-19 sparks confusion, anger

Last Updated May 4, 2021 at 12:35 pm EDT

The National Advisory Committee on Immunization (NACI) is coming under fire after contradicting the advice Canadians have been receiving for weeks to take the first vaccine against COVID-19 that they’re offered.

NACI said Monday that the Pfizer-BioNTech and Moderna vaccines are “preferred” and that Canadians should weigh the risks of waiting for one of them before deciding whether to take a more immediate jab of either of the other two approved for use in Canada.

The Johnson & Johnson and AstraZeneca vaccines have been linked to a new and extremely rare blood-clotting syndrome.

Because of that, Dr. Shelly Deeks, vice-chair of the committee, said someone working from home in a province where there is not much disease might want to wait for a shot of the Pfizer or Moderna vaccines.

But she said it would be a very different risk-benefit analysis for someone working in a manufacturing plant without personal protective equipment in a province where COVID-19 is spreading like wildfire.


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NACI’s advice appears to contradict Health Canada’s long-standing recommendation that the best vaccine is the first one available.

The Canadian Pharmacists Association is worried that NACI’s latest advice on vaccines will make more Canadians hesitate to get vaccinated.

Veteran pharmacist Phil Emberley says he is disappointed with NACI’s statements and worries it will make Canadians who already got AstraZeneca afraid to get their second dose.

The risk of the new blood-clotting syndrome is estimated to be anywhere from one case in 100,000 doses given, to one in 250,000.

Infectious diseases physician, Dr. Isaac Bogoch, tells Breakfast Television it is important to look at a number of factors when getting a shot.

“We have to talk the benefits, this is a potentially deadly infection and the vaccines provide very good protection against it,” says Bogoch. “It also protects your family.”

Bogoch says the risks of blood clotting are real but extremely rare and the only alternative is waiting and risking exposure to the virus.

He says he still feels that Johnson & Johnson and AstraZeneca are good vaccines and people should be given all the information needed to make an informed decision.

Some doctors took to social media to denounce NACI’s latest advice, warning that the committee is sowing confusion and exacerbating vaccine hesitancy.

“It pains me to say this but it’s past time to take NACI’s recommendations with a grain of salt,” emergency physician Dr. Brian Goldman said on Twitter.

People who got inoculated with AstraZeneca also took to social media to express anger that they’d been hoodwinked into getting a second-rate vaccine while others questioned whether they should cancel planned first jabs of that vaccine or refuse a second dose of it.

One Twitter user noted acidly that NACI’s advice boils down to “people who are most at risk should settle for a vaccine with the most risk because they are most at risk.”

The risk of the new blood-clotting syndrome, known as vaccine-induced thrombotic thrombocytopenia, or VITT, is so new, there is still little known about what the real risk is, why it is happening, and who might be most likely to develop clots.

Seven cases have been reported to date in Canada, all in people who received the AstraZeneca vaccine. Some 1.7 million doses of which had been given out as of April 24.

As of April 23rd, 17 cases of VITT had been confirmed out of more than eight million doses of the J&J vaccine administered in the United States.

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 American facility involved in its production.

NACI suggests that provinces and territories might want to prioritize J&J, the only single-shot vaccine approved in Canada so far, for people who have difficulty scheduling a second dose. It recommends that J&J, like AstraZeneca, be given only to people over the age of 30.

Conservative MP Michelle Rempel Garner raised the confusion NACI’s latest advice has created in the House of Commons on Monday.

“This is a lot different than what we have been hearing. Does Health Canada advise taking the first vaccine offered or to wait, if one can, for an mRNA (Pfizer or Moderna) vaccine?” she asked.

Health Minister Patty Hajdu responded that Health Canada is responsible for approving vaccines for use while NACI provides independent advice on how best to administer them. She advised Canadians wondering which vaccine is right for them to ask their healthcare provider.

Both AstraZeneca and J&J are viral-vector vaccines, a technology that takes a common cold virus, manipulates it so it can’t replicate and make someone sick, and then attaches the spike protein of the SARS-CoV-2 virus that causes COVID-19.

The vaccine helps the body mount an immune response that will recognize and fight off a real SARS-CoV-2 virus if it is ever exposed to one.

Pfizer and Moderna use mRNA technology, attaching the spike protein to a molecule that delivers messages to the body to carry out certain functions. In this case the message is to mount an immune response to the SARS-CoV-2 virus.

So far in Canada, 12.8 million people have received at least one dose of a vaccine. About two-thirds of them received Pfizer, one-fifth received Moderna and the rest AstraZeneca.

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