Rural physician decries tight rules for vaccine eligibility Doctor annoyed Manitoba sticks with age limit on AstraZeneca shots
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Hey there, time traveller!
This article was published 17/03/2021 (1671 days ago), so information in it may no longer be current.
A rural doctor says he’s frustrated he can’t use all of the AstraZeneca vaccine he’s received on people who need it the most.
“We have a really old population, and the cutoff point is age 64 for the AstraZeneca vaccine,” said Dr. Gerry Clayden in Carman. “The average age is way over 65,” he said of the retirement community, which is a 45-minute drive south of Winnipeg.
Who’s eligible for AstraZeneca vaccine in Manitoba?
Manitobans aged 50 to 64 years (First Nations people aged 30 to 64) with a high-risk condition will be the first group eligible to receive the AstraZeneca/Covishield COVID-19 vaccine.
Manitobans aged 50 to 64 years (First Nations people aged 30 to 64) with a high-risk condition will be the first group eligible to receive the AstraZeneca/Covishield COVID-19 vaccine.
Anyone who is now eligible for the Pfizer/Moderna COVID-19 vaccine (such as health care workers) and is aged 18 to 64.
People with high-risk conditions (as determined by their doctor or pharmacist) will be prioritized, with those who have a condition in Priority List 1 being offered immunization before those with a condition in Priority List 2.
Priority List 1 – those with:
end stage renal disease undergoing hemodialysis OR peritoneal dialysis
cirrhosis due to any cause OR portal hypertension
heart failure (class III/IV ), ventricular assist device OR adult congenital heart disease stage C and D
severe COPD, pulmonary hypertension, pulmonary fibrosis, interstitial lung disease OR cystic fibrosis
history of cerebral vascular accident with residual deficits
malignant hematologic disorders including leukemia and lymphoma OR clonal blood disorder
malignant neoplasms (solid tissue) who will receive or are currently receiving immunosuppressive therapy including chemotherapy
severe obesity (BMI ≥ 40)
receiving one or more of the following immunosuppressive therapies: B cell therapies (e.g., rituximab, ocrelizumab), cyclophosphamide, alemtuzumab, calcineurin inhibitors, chronic dose prednisone >=20mg/day, mycophenolate, sulfasalazine and JAK inhibitors (e.g., tofacitinib)
solid organ or hematopoietic stem cell transplant (candidate or recipient)
trisomy 21 (Down syndrome)
asplenia or hyposplenism (including sickle cell disease)
Individuals receiving home care ≥ 4 times/week OR receive 24/7 support from Community Living Disability Services.
Pregnant individuals (18 to ≤ 64 years of age) with one of: aged ≥ 35 years, BMI ≥ 30, pre-existing diabetes, pre-existing hypertension, cardiac or pulmonary disease.
Priority List 2 – those with:
Chronic cardiovascular disease including heart failure (class I/II), coronary artery disease, malignant tachyarrythmia OR cardiomyopathies
chronic liver disease
chronic neurologic OR neurodevelopmental conditions including cerebral palsy, Parkinson’s disease, multiple sclerosis, ALS OR dementia (including Alzheimer’s disease)
chronic pulmonary disease including COPD OR severe and/or uncontrolled asthma
chronic renal disease
HIV (CD4 cell count ≥ 200 x 106/L and CD4 percentage ≥ 15%)
severe systemic autoimmune disorders (e.g., systemic lupus erythematosus, scleroderma, myocarditis, rheumatoid arthritis)
type 1 or 2 diabetes mellitus (poorly controlled and/or with complications)
active tuberculosis (current or previous) OR current latent tuberculosis (LTBI)
receiving immunosuppressing therapy
Individuals receiving homecare ≤ 3 times/week OR any level of Community Living Disability Services supports (or as per family physician determination of equivalent levels of family support).
Household contacts of individuals with Priority 1 chronic health conditions OR designated support person(s) for personal care home residents (in the authorized age category).
His medical group received 50 doses of the AstraZeneca vaccine and could find only 30 out of its 2,500 patients who are eligible to receive it under Manitoba’s top two priority groups. The vials the Carman clinic received will expire on April 2, the doctor said.
“I’m very frustrated and would like to be able to help my people,” said Clayden.
He learned on Wednesday that Manitoba isn’t prepared to follow new National Advisory Council on Immunization guidelines, which were issued on Tuesday, to allow people 65 years of age and older to receive the AstraZeneca vaccine. Clayden said he was outraged by Manitoba’s decision.
“What we need to do is lean on Manitoba Health to let us use what we have” for those who need it most, Clayden said.
Manitoba received 18,000 doses of AstraZeneca/Covishield vaccine on March 11, which have been distributed to 190 clinics and pharmacies throughout the province.
At that time, the national advisory committee had recommended Canadians over 65 not receive the AstraZeneca shot, even though emerging real-world evidence indicated its ability to prevent severe COVID-19 illness in seniors.
Then on Tuesday, NACI began recommending that it be given to those over age 65.
“Over the long term, this is great news,” Dr. Joss Reimer, medical lead for the Manitoba vaccine task force, said Wednesday. “We want to have more flexibility about how we can provide vaccine to Manitobans,” she said at a news conference.
“But right now, that doesn’t change the fact that we only have 18,000 doses of AstraZeneca available. So for now, we’ll be sticking with the current eligibility criteria.”
Currently, Manitobans age 50 to 64, and First Nations people age 30 to 64, who have specific health conditions that place them at risk for serious COVID-19 outcomes, are eligible for the AstraZeneca vaccine. Anyone who is already eligible for the Pfizer/Moderna COVID-19 vaccine — such as health care workers — and is aged 18 to 64, is also eligible to receive the AstraZeneca vaccine.
Clayden isn’t alone in expressing frustration at not being able to use his clinical judgment to decide which patients should receive the AstraZeneca vaccine, especially since the national advisory committee revised its guidance.
“He’s understandably frustrated,” Doctors Manitoba spokesman Keir Johnson said Wednesday. “He doesn’t want to use it on a healthy person,” he said.
“These are concerns we’ve heard from some physicians, but the overwhelming message is they want more (of the AstraZeneca vaccine) because they don’t have enough,” said Johnson.
A spokesman for the province said they are unaware of any clinic or pharmacy that has too much of the vaccine, but there are options available to them if they do.
“Doctors and pharmacists can ask for patient referrals from other clinics (and) pharmacies in their region that may not have been given an allocation of the vaccine,” the spokesman said in an email. “They can also advertise they are taking appointments for those people who fall into the age eligibility (between the ages of 50 to 64 and First Nations people aged 30 to 64) or meet provincial eligibility to be immunized.”
He encouraged Clayden to reach out to the province to “further discuss options.”
carol.sanders@freepress.mb.ca
Carol Sanders
Legislature reporter
Carol Sanders is a reporter at the Free Press legislature bureau. The former general assignment reporter and copy editor joined the paper in 1997. Read more about Carol.
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