Which COVID-19 vaccine should you get? Canadian expert panel says ‘it depends …’


OTTAWA- You will be forgiven for thinking that this entire vaccine rollout business is misleading, because it is. Chaotic, confused and contradictory.

Question about COVID-19 vaccination – where to get first shot? How long to wait for the second shot? Should your second dose be the same as your first vaccine? What restrictions will you find after getting vaccinated? – All new urges are on the way as the pace of national rollout increases this week.

Adding to the confusion, the National Immunization Committee (NACI) said on Monday that Johnson & Johnson’s single-dose Jensen vaccine, such as AstraZeneca’s double-dose vaccine, is safe for use by 30 people if they wait for one can not do. Two “favorite” vaccines, mRNA, produced shots by Pfizer and Modern.

Based on evidence from clinical trials, all four vaccines have been identified by Health Canada as safe and effective for people 18 and older.

But as millions of vaccines were clutched in arms, the “real-world” picture was slightly shifted by AstraZeneca and Johnson & Johnson for the viral vector vaccine.

Reports of very rare blood clots for AstraZeneca appeared in Europe, then with Jensen in the US, first at a rate of one in a million, now at an approximate rate of about 1 in 100,000 cases, with NACI Vice President Dr. Shelley said. cheek.

“What we are saying – and what we are all saying – is that mRNA vaccines are the preferred vaccines.”

After reviewing the latest data, NACI recommends that the provinces be vaccinated with the Jensen and AstraZeneca vaccines if the risks are mitigated: it says that both are less likely to have serious illness, hospitalization, and death Will do it. And in a country where COVID-19 is still prevalent, vaccines were slow to arrive and variants have taken hold, the benefit reduces the risks of developing a rare but severe blood clot called vaccine-induced immune thrombotic thrombocytopenia or Called VITT, NACI concluded. .

It is cautioned that in the under-30 age group, “the benefit of offering a viral vector COVID-19 vaccine rather than waiting for the mRNA vaccine is certainly not the case in areas with very little COVID-19 activity.”

“On the other hand, the advantages of the highly efficacious mRNA COVID-19 vaccine, to date, with no safety signals of concern, do not clearly overcome any potential pitfalls for the majority of the population, and NACI preferentially mRNA COVID-19 There is a strong recommendation for use. Vaccines in all authorized age groups. “

NACI says that now it is up to whom to decide which vaccines should be given priority, it should be decided that DK and NACI President Drs. Caroline Quach-Than is.

But individuals should also conduct an “informed choice” or individual risk assessment, based on the prevalence of the virus in their communities and its risk, along with an assessment of “their risk tolerance for an adverse event” – a blood means Clot, said cheek.

He said that individuals can decide whether they would like to be vaccinated as soon as possible or wait to receive the mRNA vaccine.

“For example, if someone is working from home, not really moving to a province or region that doesn’t have a lot of disease, then they are in a very different situation from someone who works, Suppose a manufacturing plant has difficulty wearing. PPE and so much of the province that there is a very high burden of disease. So the risk benefit is very provincially dependent as well as dependent on the group. “

This public health message is a definite change heard by Canadians last December: from, “Offer the vaccine first,”, “It would be nice to wait for the mRNA vaccine if you can – and if you can’t, Others are fine too. “

“There is a lot of confusion. this is a nightmare.

Deonandan said that by giving advice without a clear and consistent message about how the provinces would follow, NACI is contributing to a “messaging nuisance”.

Members of the Vaccine Advisory Committee said that it seems that it is not their job to manage the public’s expectations or behavior or reaction. “And I understand it, but we are in a new dynamic where everyone’s work now has to be taken into consideration.”

NACI stated that it considers the two mRNA vaccines “preferred” because they have not shown a “safety signal”.

Devanandan stated that the risk with mRNA vaccines is not zero. “It’s just that the other two have enough big signs to warrant this concern.”

Many doctors and epidemiologists say whether Canadians want to take the first vaccine on offer or wait for the “favorite” can contribute to even more vaccinations, especially among some vulnerable populations who are quickly excluded Vaccination should be a priority.

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Deonandan said, “I really wonder if they will walk this path, to be honest, mRNA is better.” “The thing about Johnson & Johnson is that it is so important that it is a one-shot vaccine, it is easily stored and easily transported. And for populations like the homeless, or nomadic people, or migrant workers, this is our best shot because it would be very difficult to determine a follow-up dose for that population.

“And now there is going to be a hiccup in that population if they are being told that they are getting a second-class vaccine,” he said. “So this is also an equity issue.”

For now, it doesn’t matter – the mixture will soon have more than several million mRNA vaccine doses. Since this week, Pfizer-BioNTech is increasing its weekly Canadian delivery to two million doses, and increasing them to 2.4 million doses a week in June.

Modernity has promised to resume large shipments, which, after a delay last month, are trying to reach their planned target of 12.3 million doses for the second quarter, which is expected to exceed one million next week was.

Meanwhile, questions remain regarding the shipment of vaccines from AstraZeneca and Johnson & Johnson.

On Friday, the federal government put its grip on Canada’s first shipment of 300,000 Jansen vaccine doses because of concerns that the batch may contain an ingredient that came from a US facility where officials see a red flag of production-production problems.

More than two million AstraZeneca doses have already been delivered in Canada – and at least 1.7 million are administered – but Canada’s supply is currently constrained by export restrictions in both India and the US, and it is unclear whether millions more doses When is the order of? Really arrive.

In Queens Park, Health Minister Christine Elliott said major doses of the Pfizer vaccine could reduce the estimated four-month delay between the first and second shots, and those with second appointments will be notified in person that become a reality .

“We are ready to do that,” she told reporters.

Province of Health Associate Medical Officer Drs. Barbara Yaffe said Ontario has asked NACI for a recommendation by mid-May whether Pfizer and Modern Vaccine can be used for a second dose on people who have received the first shots of the AstraZeneca vaccine.

“They would recommend that using a different vaccine for a second shot is safe and effective if you can’t find exactly what you got before,” the Empire and other countries.

NACI said on Monday that echoing Prime Minister Justin Trudeau’s deadlines would provide enough mRNA vaccine doses for all Canadians to be fully vaccinated.

It states that pregnant women should be offered a full range of an mRNA vaccine after reviewing the data and should worry about the difficulties of blood clotting treatment in pregnancy. NACI points to a preliminary analysis of 35,691 pregnant women in the United States who received the mRNA COVID-19 vaccine, which “did not reveal any clear safety signals.”

NACI stated that if a blood clot begins to form upon receipt of the viral vector vaccine, it would mean a “complication in medical care” of the pregnant woman.

With Rob Ferguson’s files

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