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11/23/2021

Do I really need to be making the case for a third dose?

Hopefully the recent COVID-19 news will result in serious and immediate changes in Canada’s COVID-19 vaccine rollout.

We just learned that Canada has wasted at least one million COVID-19 vaccines.

Further, as of late September, Canada paused further vaccine deliveries because, “Canada is already sitting on a stockpile of 18.7 million doses.”

This wastage and surplus is occurring while much-coveted third doses of the vaccine are being restricted in most jurisdictions, including Ontario, where they are only available to a few groups and the elderly and only six months after the second dose.

Read: 45% prepared to ditch social distancing at holiday gatherings: poll

Meanwhile, in Israel, third doses of COVID-19 vaccines were provided for everyone over 12 years old, five months after their second dose and, “Three weeks after the booster campaign began, a clear shift was apparent in the country’s COVID data. The number of cases among vaccinated people began to drop”

This drop is clearly seen in a graph tweeted by the medical journalist, Pamela Fayerman.

Prof. Eyal Leshem, the director of the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center outside Tel Aviv, said the most important lesson that Europeans can learn from Israel’s experience is that the protection provided by the vaccine wanes. Countries with high vaccination rates “may have been able to prevent the current wave of infections by offering the booster to the entire population rather than focusing on the elderly.”

So why is Canada restricting third doses with one hand, throwing out vaccines with the other?

The answer is largely because the NACI has given two reasons for a more limited rollout of third doses.

The first reason is that NACI believes prolonging the interval between first and second doses of the COVID-19 vaccines in Canada resulted in a longer period of protection before vaccines wane, but admit that, “It is currently uncertain how a longer interval between first and second vaccine doses in a primary series might affect the duration of protection.”

Read: Two charged in alleged COVID-19 security breach of Ontario's immunization system

 I have discussed the lack of definitive evidence previously, so no need for a redo. What we need is a way forward.

If NACI is correct, we should at least be giving all adults a third dose, at some point after their second dose and that isn’t happening. 

Further, we should see definitive, publicly available evidence that there are very few infections, hospitalizations and deaths in those who have two vaccines with prolonged intervals and are about 6 months out from their last dose. 

In October, 179 people died of COVID in B.C., half of them had two doses of COVID-19 vaccine and of those, fewer than 60% were over 80 years old. Where is the publicly available data on the other 40% who died? What changes should result from this data? 

Dr. Kwan, a family doctor in Ontario and a COVID-19 data powerhouse, says, “Additional information showing the breakdown for death info such as ages for those fully vaccinated (or in ICU) would help us to understand the efficacy of vaccines. It would also be helpful to have data showing when infections are occurring based on time from second doses, to assess timing for boosters.”

Read: Canada aims to keep COVID 19 vaccine waste below 5% PHAC

As Dr. Iannattone, a professor of dermatology and another powerful COVID-19 advocate, agrees, “We need the hospitalization and case fatality rates for double vaccinated Canadians. Public Health England had released these and the residual risk is higher than many realize. We have enough data to calculate it I’m sure, but the official channels haven’t released this information.

“Much like the resistance to declaring unequivocally that COVID-19 is airborne like measles, some leaders in Canada seem to value providing Canadians with a (false) sense of security over actual security.”

Canadians certainly would agree: actual security far outweighs a false sense of security. Also, in a democracy like Canada, the public expects transparency in a pandemic that impacts their lives and the lives of those they love. 

The second reason that NACI limited the rollout in Canada is the, “WHO called for a global moratorium on booster doses until at least the end of 2021, to enable every country to vaccinate at least 40% of its population”

Read: Research links COVID-19 in pregnancy with stillbirths

I have the utmost respect for the WHO. Since 1948, their international work on health provision, protection and vaccinations is legendary. After traveling to Africa, Asia and South America—and spending long periods of time living in countries there—I know first hand how much their provision of healthcare access impacts lives. 

That said, I disagree with this recommendation because of the logic it is based on. There was no call to delay second doses because there was an understanding that second doses were necessary. The delay on third doses is based on the assumption that they aren’t needed, that they are merely a bit more protection in people already protected by two doses of the COVID-19 vaccine. We’ve had many spokespeople speak up in Canada for halting third doses and not one of them has said there will be more infections and deaths as a result.

However, “Israel and other countries have pressed ahead with booster plans despite opposition from the World Health Organization, which said more of the world should be vaccinated with a first dose before people receive a third,” because of the data showing a waning of second doses and the risks their citizens faced.

Read: Rash or resourceful? Uproar over Ontario's go-ahead for pharmacies to test those with COVID symptoms

Dr. Anthony Fauci put it very well: booster shots for all adults will help “keep people out of the hospital” and “keep people from dying.” 

Can there be domestic third doses and also global distribution of vaccines?

Dr. Kashif Pirzada, a Toronto emergency physician and another of our crucial advocates during this pandemic, summarized this by saying, “While global vaccination distribution has been far from equitable, supply is quickly catching up and 1.5 billion doses are now being produced monthly around the world.

“We have a population in the West that is much older and comorbid than any other part of the world, and we have to pay close attention to waning immunity if we are to prevent excess mortality and our health systems from being overwhelmed.”

If our health systems will get overwhelmed, it may start soon, as the majority of adults are approaching 6 months past their waning second dose and we are heading to holiday gatherings en masse.

If Canada continues to limit necessary third doses, then the federal government of Canada, and provincial and territorial governments, will be responsible for every infection, long covid case, ICU patient and dead Canadian who got both doses of their COVID-19 vaccine but were denied their third dose. 

Read: Canadian doctors debate booster shots

Canada has led the world in lifting up our citizens in so many ways, let’s not be laggards in giving them the most basic human rights: health and life.

This is my fourth article on COVID-19 third doses since September. I sincerely hope it will be my last and we will finally see widespread distribution in Canada of necessary third doses.

Dr. Mary Fernando is a physician in Ottawa.

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