The Morning Brief – 05.05.21

By Bruce Carson


The National Advisory Committee on Immunization (NACI) and the art of communication

Do we now have a two-tiered vaccination system in Canada?

Do we now have a two tiered health care system delineated by Canadians with family doctors and Canadians without family doctors?

Is there a process by which difficult medical or vaccine announcements can be managed to cause as little anxiety as possible at a time of heightened anxiety brought on by COVID-19?

It is not a secret, in fact it has been known for a while now that there are risks, albeit minimal, in taking either the AstraZeneca or Johnson and Johnson vaccines because there is a connection to blood clots resulting from the vaccine injection, as small as that risk may be.

Monday’s announcement by NACI as far as its advice went on the J and J vaccine was concerned was not controversial. NACI recommended that the vaccine be given to people over the age of 30.

The problem came with the use of the word “preferred” with reference to two mRNA vaccines, Pfizer and Moderna as opposed to AstraZeneca and J and J vaccines. NACI co-chair Dr. Shelley Deeks trying to explain what had been announced said what we are saying now is what we have said all along is that the mRNA vaccines are the “preferred” vaccines. Of course putting this statement another way would mean the non mRNA vaccines are not “preferred.”

Deeks stated that clots are rare, but extremely serious and Canadians need to know the risk. “They (Canadians) need to make an informed choice as to whether they would prefer to get vaccinated sooner with a Janssen or AstraZeneca vaccine or wait to receive a mRNA vaccine.

Dr. Zain Chagla, an infectious disease expert and associate professor at McMaster quoted in a National Post article by Ryan Tumilty said for most Canadians the right vaccine is the one in front of them. “In places where the risk is ongoing in Canada, it would make sense to get the first vaccine provided. Healthcare is in demand; you’re seeing high levels of transmission, the variants are causing young people to be sick.”

Dr. Howard Noo, Canada’s deputy chief public health officer is quoted as saying “all of the four approved vaccines in Canada have shown through trials to be effective in preventing serious consequences, serious illness and death.”

But with the use of the word “preferred” NACI set off a debate which is still ongoing.

Dr. David Naylor, co-chair of Canada’s COVID-19 Immunity Task Force, interviewed yesterday morning on CBC by Heather Hiscox admitted that in this announcement by NACI “there are contradictions here.” One question is whether the announcement has created “buyer’s remorse” among those who have received the AstraZeneca vaccine. Dr. Naylor quoted work done by the FDA which found AstraZeneca to be effective.

Unfortunately, the J and J vaccine which requires only one dose to be effective is not presently available as the doses are being held back due to potential quality control issues at a factory where a key ingredient is made.

The interview with Dr. Naylor ended with him saying that the air is going to have to be cleared over this, but his advice is “take the first jab you get.”

Dr. Deeks pronouncement simply put, is that a person working from home in a province where there not much disease, might want to wait for a shot of Moderna or Pfizer. There is 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.

Just to put an exclamation point on this discussion the Chair of NACI, Dr. Caroline Quach- Thanh commented on both CBC and CTV on Monday that “if for instance my sister got AstraZeneca vaccine and died of a thrombosis when I know it could have been prevented and she is not in a high risk area, I’m not sure I could live with that.”

Conservative Party Health critic Michelle Rempel Garner in question period on Monday, shortly after the announcement y NACI asked the Minister of Health Hajdu how Canadians were to sort out this new two tiered vaccine system. The answer was that if they were in doubt they could contact their family physician. Hajdu seemed unaware of the chronic shortage of family doctors.

In an article in Line news published yesterday Rempel Garner set out a thesis that “the federal government should have a clear binary choice on vaccines; approved and safe or not.”

She also highlighted that the announcement by NACI would lead to further vaccine hesitancy. Also those susceptible to normal risks, working at home, in an area not considered to be a “hot zone” could wait for one of the preferred vaccines, but not if one works in a “hot zone.”

At his usual Tuesday media availability, Prime Minister Trudeau, in damage control, held the line that every vaccine that has been approved by Health Canada is “safe and effective.”

Dr. Tam, Canada’s chief public health officer at the same media avail stated that she believed Canadians were getting the best information to make the best decisions. She added Canadians are being provided with as much information as possible so they can make informed choices.

Also this is “an evolving process.” If in doubt she advised Canadians to consult the local public health authority. She did not back away from the NACI recommendations.

Perhaps the simplest way of sorting through the communication challenge created by NACI is to say that NACI attributed the risks improperly. The risk they should have emphasized is the risk of getting COVID-19 when not vaccinated and possible death as opposed to minimal risks when receiving COVID-19 vaccines.

The risk of death from vaccines is slight when compared to the risk of death from COVID-19. One only has to look across Canada and then to India to see COVID death and destruction.

NACI and other agencies dealing with the pandemic should be careful about the words they use. As noted earlier “preferred” also brings to mind “not preferred.”

And we can’t have NACI separating Canadians into two groups; those whose lives have been relatively untouched by COVID and those who are in the trenches daily, essential workers and then preferring vaccines for one group as opposed to the other.

At this delicate time in the advance of the pandemic, we don’t need our medical advisory teams categorizing groups of Canadians into preferred and not preferred.

To Come

May 7
  • Job numbers for April to be released
May 12
  • Deadline for Enbridge’s Line 5
May 19
  • CPI numbers for April to be released