Manitobans anxious to reconnect with loved ones abroad or plan a getaway will have to navigate the quickly evolving set of international pandemic rules made more complex for travellers with a mixed COVID-19 vaccination record.

Manitobans anxious to reconnect with loved ones abroad or plan a getaway will have to navigate the quickly evolving set of international pandemic rules made more complex for travellers with a mixed COVID-19 vaccination record.

"It’s such a complicated area, it’s so dynamic and it’s changing all the time," said Prof. Kelley Lee, who holds the Canada Research Chair in global health governance at Simon Fraser University in B.C., and leads an international group of researchers evaluating how border restrictions can control pandemics.

What authorities outside Canada say

• According to the World Health Organization, its Strategic Advisory Group of Experts on Immunization has only given a permissive recommendation for the use of Pfizer as a second shot following AstraZeneca, due to supply constraints or other concerns.

• The U.S. Centers for Disease Control and Prevention has not endorsed the practice of interchanging vaccine types or brands, but the United States does not currently have a policy in place requiring visitors to the country to present proof of COVID-19 immunization.

• According to the World Health Organization, its Strategic Advisory Group of Experts on Immunization has only given a permissive recommendation for the use of Pfizer as a second shot following AstraZeneca, due to supply constraints or other concerns.

• The U.S. Centers for Disease Control and Prevention has not endorsed the practice of interchanging vaccine types or brands, but the United States does not currently have a policy in place requiring visitors to the country to present proof of COVID-19 immunization.

However, the CDC also states it considers people who have taken two doses of mRNA vaccines to be fully vaccinated against COVID-19 two weeks after the second dose, in exceptional circumstances.

Only people who have received all recommended doses of an U.S. Food and Drug Administration-authorized or a WHO-listed COVID-19 vaccine are considered fully vaccinated for the purposes of public health guidance, the CDC said. AstraZeneca has not been approved by the FDA, but it is listed by the WHO.

• According to the WHO, more than a dozen European countries have said they will consider people who took Covishield to be fully vaccinated despite the European Medicines Agency not yet having approved the shot.

The Covishield vaccine has been widely deployed across the globe through COVAX, an international vaccine sharing initiative that assists in procuring vaccines for lower- and middle-income countries.

• A number of European destinations also recognize the vaccination status of people who mixed vaccine brands or types. However, travel restrictions and vaccination policies change regularly and should be confirmed with local public health and travel authorities.

"Our group has been studying travel measures since the beginning of the (COVID-19) pandemic, and we know that every country has done something slightly different," Lee said.

"So it’s no big surprise when it comes to using vaccines, and using it in relation to travel, you’re going to see a continuation in this kind of variation in policy."

Nearly 200,000 Manitobans have a mixed COVID-19 vaccination schedule, including about 71,000 people who mixed AstraZeneca/Covishield and either Pfizer or Moderna mRNA vaccines, and another 127,000 who took a combination of the two mRNA shots. Across Canada, a total of 3,139,559 people have mixed vaccine types and brands.

Depending on a person’s travel destination, the immunity of those doubly dosed with a combination of vaccine types and brands may not be recognized.

Recently, at least three cruise lines disembarking out of the United States informed potential passengers if they took a mix of vaccines, they would not be permitted aboard the fully vaccinated cruise.

Meanwhile, some countries will not recognize the vaccination status of people immunized with products that have not been approved by local drug regulators or listed by the World Health Organization for emergency use.

In the case of Covishield — a vaccine identical to AstraZeneca but manufactured at the Serum Institute of India — the European Medicines Agency has not yet approved the shot, leaving European Union member states to decide whether people who received the vaccine are fully immunized.

The Manitoba government estimates about 18,000 doses of Covishield were given in the province.

"It’s such a complicated area, it’s so dynamic and it’s changing all the time." – Prof. Kelley Lee

Lee said many countries prefer to independently review vaccine safety and efficacy data, rather than rely exclusively on the WHO’s list of approved brands. In the case of mixed schedules, new data is emerging on a near daily basis as the body of research grows.

It could take up to six months before there is widespread, international acceptance of mixed vaccination schedules, Lee added, but she remains confident the issue will be resolved as federal governments continue to negotiate the reopening of borders.

"There will be pressure to find an agreed system, but it won’t be at the speed that perhaps the travel industry or perhaps holiday makers want the speed to be," Lee said, noting Canada continues to be ahead of the rest of the world in vaccinating its population.

"We’re very privileged in that sense, and I think the Canadian government would be remiss to put pressure on other countries to put that at the top of their priorities because some people want to go on cruises, or whatever," Lee said.

"But the sooner that we can push out those vaccines around the world, then the sooner we can get to a point where there’s a lot of people vaccinated and eventually there will be some sort of international standard."

"There will be pressure to find an agreed system, but it won’t be at the speed that perhaps the travel industry or perhaps holiday makers want the speed to be." – Prof. Kelley Lee

Like Canada, some European countries have allowed residents to take mRNA vaccines interchangeably and accept the immunization status of foreigners with a mixed regime. The WHO has yet to sign off on mixing, putting the onus on governments to decide which combinations of shots are acceptable.

The U.S. Centers for Disease Control and Prevention has not endorsed the practice of mixing mRNA vaccines, though the United States does not currently have a policy in place requiring visitors to the country to present proof of COVID-19 immunization.

On Thursday, federal Conservative health critic Michelle Rempel Garner wrote Health Minister Patty Hajdu, urging the Canadian government to release a plan to have a mixed vaccination status recognized internationally. Earlier in the week, Ontario Health Minister Christine Elliott also asked Ottawa to work with the WHO to ensure mixed vaccinations are internationally accepted.

The Manitoba government could not say Friday whether it had made a similar request of Ottawa.

At this time, Manitoba will not offer a third dose of the COVID-19 vaccine for the purpose of satisfying vaccination policies of other countries or travel and tourism operators — as Quebec has done for people travelling for essential purposes to destinations where their immunization status is not recognized.

"Certainly, it's frustrating to have challenges in being able to travel but for the most part, most countries are not refusing entry based on what we've offered here in Manitoba." – Dr. Joss Reimer

"So far, we're not seeing it as a barrier in most countries for entry, but it is something that we're watching," said Dr. Joss Reimer, medical lead of the province’s COVID-19 vaccine task force. "Certainly, it's frustrating to have challenges in being able to travel but for the most part, most countries are not refusing entry based on what we've offered here in Manitoba."

The task force will revisit the subject if mixed vaccine schedules are deemed to be a barrier to international travel, Reimer said.

While policies may cause headaches for some travellers in the short term, Lee said people who took the first vaccine offered to them and followed provincial and federal guidance on mixing should feel confident in their choice.

"We’re trying to get as many people vaccinated as possible, so that was the right thing to do," Lee said. "It’s undoubtedly saved a lot of lives."

"The reason why people are able to go on a cruise now is probably because they were protected by all these people taking different vaccines, so we can’t lose sight of that."

with files from The Canadian Press

danielle.dasilva@freepress.mb.ca

Danielle Da Silva

Danielle Da Silva
Reporter

Danielle Da Silva is a general assignment reporter.

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