Overseas Canadians doubling up on COVID-19 vaccines despite health unknowns

While most Canadians are celebrating after their second COVID-19 vaccine doses, many expatriate Canadians living and working overseas are opting for third and fourth jabs.

They say they've been left with little choice but to re-vaccinate if they want to return to Canada in future and avoid Canada's 14-day hotel and quarantine provisions.

"I don't want to hotel quarantine again," said Monique Horvath, a 49-year-old Canadian teacher from Nanaimo, B.C., who has lived and worked in Moscow for the last 14 years.

She and her husband Brendan each got two doses of a COVID-19 vaccine in the spring but they were the Russian Sputnik V vaccine, the only shot available to them, which is not approved for use in Canada. That means they would still have to quarantine if coming home.

"If there's an emergency and we need to come back to Canada that's a big thing in my mind when you're overseas and away from family," Horvath said of their decision to undergo another two doses of vaccines each.

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As of today, fully vaccinated Canadians entering the country can forgo the 14 day quarantine. But Prime Minister Justin Trudeau is standing by a scaled approach to easing border restrictions and non-essential travel between the U.S. and Canada remains restricted until July 21.

After making the trip back to B.C. in June, Horvath said she and Brendan rolled up their sleeves for Moderna once they were done with their two weeks of isolation.

They expect to get the second shot of Moderna before they return to Moscow.

The rules

Earlier this week, the Canadian government dropped its controversial hotel quarantine and 14 days in isolation for "fully vaccinated" Canadians entering the country.

But that means having a vaccine approved by Health Canada and the list is limited to Pfizer-BioNTech, Moderna, AstraZeneca-Oxford, COVISHIELD,or Johnson & Johnson's one-dose vaccine.

Russia's Sputnik V, China's Sinopharm, and India's Covaxin are not on the list even though hundreds of millions of people around the world have either taken them already or are in the process of doing so.

Horvath said more than 20 of her co-workers now on their breaks in the United States, Canada and Europe posted photos of themselves on Facebook getting their additional vaccinations opting to re-vaccinate even though there is virtually no research on the implications of doing so.

"People I know checked with their doctors and they said it's fine," she said.

'It's probably ok'

Several Canadian vaccine experts agreed taking extra vaccine doses probably is "fine" but with caveats.

"From a health standpoint it's hard to know what the benefit or drawback is it's probably OK, but I can't look you in the eye and tell you with any degree of confidence that it is," said Dr. Isaac Bogoch, an infectious diseases specialist at Toronto General hospital.

Bogoch, who's a member of Ontario's COVID-19 Science Advisory Table, said so far, there is no official guidance from any of the key international health bodies on the implications of taking additional COVID-19 vaccines. The issue is only beginning to emerge.

Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta, said this is an important issue that is going to grow exponentially as more expatriates travel and repatriate.

"I think there's a real need to straighten this out because it's creating a condition where people are embarking on completely untested doubling up regimens to fill regulatory requirements," she said.

Saxinger said she was recently asked for advice on getting re-vaccinated by a Canadian living in the Middle East after he had already taken two doses of a vaccine not approved in Canada.

The topic is widely discussed on expat social media sites, including a Facebook page where Canadians share stories about trying to navigate the border restrictions.

The latest census taken in 2009 shows 2.8 million Canadians live and work outside of Canada and many if not most do not have access to COVID-19 vaccines approved by Health Canada.

Thousands of international students headed for Canada could face challenges if they have receivedvaccines that aren't approved here.

"The people [Canadians abroad] who took these vaccines did the right thing at the time," said Bogoch.

"COVID was running rampant and you've got to take whatever vaccine is available in a time of crisis. That was at that time what do you do now?"

An experiment

Kirsten and Todd Welbes faced a similar dilemma.

They too received both doses of Russia's Sputnik V at home in Moscow, where they are teachers.

But faced with the Canadian border restrictions and other travel restrictions in Europe, the dual Canadian-U.S. family designed their summer around getting two doses of the Pfizer vaccine in the United States, which would allow them to travel to Canada later.

"New situations are put in our path and then we have to figure it out," said Welbes, 45.

"Would I have chosen to get two different vaccines in two different countries? Probably not."

Like Horvath, Welbes said getting re-vaccinated means they will hopefully now be able to visit family in Canada and Europe without restrictions, especially in emergencies.

It also means they will be able to take their 16-year-old daughter to visit a prospective university in British Columbia on a short Christmas break.

But while they are comfortable with the health implications of their decision, Todd Welbes said he does feel a little like a human lab experiment.

"There's a very real possibility that I'm completely wrong and that this is a terrible idea and I've jeopardized our health."

Risks

Health Canada has yet to weigh in on the re-vaccination question.

In an emailed statement, the department said "it has not issued any recommendations on this matter at this time."

Saxinger, the University of Alberta infectious diseases expert, said taking two different vaccine regimens may create a stronger immune response as the second course acts as a booster.

But she said there have been very rare situations where taking a particular booster vaccine in too short a timeframe can actually "blunt" the immune response.

Some of the re-vaccinated Canadians who gave interviews for this story also complained of intense reactions after their first dose of the second round of vaccines.

"I had more side effects with Moderna than my second Sputnik shot," said Horvath.

"Headache, nausea, chills, fever, muscle aches, just feeling horrible. Brendan was exactly the same."

Saxinger said that type of reaction is not surprising.

"It's entirely possible you might be having a more vigorous immune response because of antibodies in your system," she said.

Another immunology expert, Rod Russell, said the vaccines are "safe by themselves." But the professor of virology at Newfoundland's Memorial University said it might be better to mix mRNA vaccines, such as Pfizer and Moderna, with viral vector vaccines such as Sputnik V.

Issac Bogoch, the Toronto General hospital expert, said it's understandable people would want to get re-vaccinated to avoid "being on the losing end of vaccine passports."

But he said it's likely countries will and should eventually accept World Health Organization-approved vaccines so the need to re-vaccinate may eventually become unnecessary.

Too slow

Canada's government has been shipping out vaccines to its embassies around the world where Health Canada approved vaccines aren't available, which helps diplomats and other staff avoid this dilemma. But not for other Canadians working abroad.

Kirsten Welbes, the Moscow teacher, said the world isn't moving fast enough to find a global solution. So she had to find one in the meantime.

"I just have to be pragmatic," she said. "What is coming at me and what is the best decision I can make based on that small amount of information? You just do your best."