Why Canada's confusing COVID-19 vaccine guidelines could be leaving seniors at risk

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Canada's reluctance to follow evolving real-world data has led to potentially confusing COVID-19 vaccination guidelines that some experts say leave vulnerable seniors at risk in the community and could fuel vaccine hesitancy.

The National Advisory Committee on Immunization (NACI) recommended last week thatCanadians over 65 not receive an AstraZeneca-Oxford vaccinationdespite emerging evidence from countries around the world demonstrating its ability to prevent severe COVID-19 in older adults.

The recommendation led provinces to reorganize their vaccination plans for seniors. The result was people aged 60-64 could receive AstraZeneca-Oxford shots ahead of older age groups, who are at greater risk of hospitalization and death from COVID-19.

Quebec is the only province so far to ignore the national recommendations. Officials there said this week they would administer the AstraZeneca-Oxford vaccine to seniors in direct contrast to what the province considers outdated NACI advice.

Other countries such asFrance and Germany initially advised those 65 and older not to receive the shot, but overturned their decisions earlier this month after new evidence showed the vaccine significantly reduced hospitalizations in that age group.

But the NACI recommendations were based largely on AstraZeneca-Oxford's clinical trial data and didn't examine real-world evidence past Dec. 7 months before the effectiveness of the vaccine was fully realized in other countries for older age groups.

"We are trying to do the best that we can with the data that we have," NACIchair Dr. Caroline Quach told The National's Andrew Chang this week.

She saidthe volunteer national advisory committee isn't able to pivot to emerging data quickly.

"We are not a committee that is able to make a recommendation on Monday to be published on the Tuesday."

Quach confirmed to CBC News on Friday that NACI met this week to discuss revising the AstraZeneca guidelines for those over 65, and said they would likely be updated "in the next few days" as shots continue to roll out across the country for younger age groups.

'Disconnect'between COVID-19 vaccine guidelines

NACI's decision to advise against AstraZeneca-Oxford shots for older Canadians in spite of emerging evidence is in direct contrast to another recent recommendation it made to delay second doses of COVID-19 vaccines by up to four months.

That decision was based on real-world data from Quebec, B.C., Israel, the U.K. and the U.S. that showed "good effectiveness"of between 70 and 80 per centfrom a single dose of the vaccines in preventing severe illness"for up to two months in some studies."

"People would see a bit of a disconnect," said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario's COVID-19 vaccine task force. "You've got to have the trust of the general public."

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Despite some European countries temporarily halting use of the AstraZeneca-Oxford vaccine after 30 cases of blood clots, experts maintain it is still safe to use in Canada.

Bogoch said NACI needs to be "very careful" with its messaging around vaccination recommendations in an "open, honest and transparent way" with Canadians, in order to avoid eroding trust in vaccines.

"How we word things matters.... If you're going to make those recommendations, you've got to stand up in front of the country and explain why," he said.

"We're already getting issues with people who are saying, 'I'm not going to take the AstraZeneca vaccine, I'm going to wait.' It's going to be a challenge."

Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, said the recommendation against the AstraZeneca-Oxford vaccine for seniors sends the "wrong message" to Canadians.

"I've got people telling me they don't want AstraZeneca, so they'll rather wait until they can get a Pfizer dose," he said."We need to get sufficient numbers of doses in the right people so that herd immunity happens and case numbers drop."

Alyson Kelvin, an assistant professor at Dalhousie University in Halifax and virologist at the Canadian Center for Vaccinology, says there are no safety concerns with AstraZeneca-Oxford for older individuals and that its effectiveness ison par with other vaccines such as Pfizer-BioNTechandModerna.

"If a vaccine is available to you, it's really important that you're taking it," she said.

And that's especially true for peopleover 60,she said.

"This group of individuals makes up about 97 per cent of our COVID-related deaths in Canada, and to keep a vaccine from them ... hurts my heart."

Bogoch said that each of the four vaccines approved in Canada will significantly reduce the risk of hospitalization and death for older Canadians, so it's important to keep that in context when considering national recommendations.

"We're in the middle of a public health crisis," he said. "So the strategy should be to vaccinate as many people over the age of 60 with any of the available vaccines in as short a time frame as possible."

'No indication'AstraZeneca-Oxfordvaccine tied to blood clots

Adding to the confusion around the AstraZeneca-Oxford vaccine this week were reports of an undisclosed number of blood clot cases after vaccinations in Europe, which ultimately led Denmark, Norway and Iceland to stop using the vaccine out of an abundance of caution.

Health Canada released a statement Thursday night, more than eight hours after CBC News requested comment, saying "there is no indication that the vaccine caused these events" and the "benefits of the vaccine continue to outweigh its risks."

The U.K.'s drug regulatory agency said that of the 11 million doses of the AstraZeneca-Oxford vaccine that have been administered, reports of blood clots were no greater than expected in the general public.

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There's no reason to be overly worried after Denmark said it was temporarily stopping inoculations with the AstraZeneca COVID-19 vaccine to investigate a small number of blood clots, says infectious disease specialist Dr. Isaac Bogoch.

Bogoch told CBC News that while it's important to watch the situation carefully in order to instill confidence in the vaccine's safety, Canadians have to keep it in context.

"This vaccine has been given to millions and millions of other people globally, including in the United Kingdom," he said.

"We have not yet heard of any signal amongst the noise for blood clots in any other jurisdiction and there have been other places that have been giving this vaccine for ... months."

Age 'greatest risk' factor for COVID-19

Experts say the confusion around vaccine safety recommendations this week is unfortunate, especially given the number of seniors in Canada at risk of severe COVID-19 complications who have yet to be vaccinated.

While long-term care home residents were prioritized in Canada's vaccine rollout after the first shipments arrived in mid-December, seniors living in the community have only recently been offered a vaccine across much of the country.

"When you actually look at the data about who's the greatest risk from getting seriously ill and dying from COVID-19, the No. 1 factor is age," said Dr. Samir Sinha, director of geriatrics for the Sinai Health System and the University Health Network in Toronto.

Sinha says Canada should have better prioritized community-dwelling seniors in its initial rollout, especially given the significant drop in hospitalizations and deaths among long-term care residents after vaccination.

More than 14,000 long-term care residents have died of COVID-19 in Canada since the pandemic began. Sinha says about 4,000 of those residents were in Ontario, while another 2,000 of the province's deaths were seniors living in the community.

"We have to remember that, yes, 70 per cent of our deaths in Ontario have been amongst those living in our long-term care retirement homes," he said. "But another 26 per cent have been among community-dwelling seniors."

Deonandan says he was "shocked" that age wasn't more of a priority for initial COVID-19 vaccine rollouts across the country given that it is the single biggest risk factor by far.

"It comes down to, what is the goal that we're trying to achieve here?" he said.

"The goal should be twofold: to keep the health-care system up and running, and to make the crisis go away, and you get that by focusing on age."

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