As one of the roughly 1.7 million Canadians with AstraZeneca teaching our immune systems how to do immune system karate, my first instinct might be, what the hell, NACI? Now you tell me that AstraZeneca is a third-rate vaccine? In fairness, it is a third-rate vaccine approved by Health Canada and which is far, far, far more likely to save my life than it is to kill me. Also, the messaging wasn’t much of a change.
Still, Monday’s National Advisory Committee on Immunization update was just about as neat as throwing a watermelon at the windshield of a moving car. "What we’re saying — and what we’ve been saying all along — is that mRNA vaccines are the preferred vaccines," says Dr. Shelley Deeks, the vice-chair of NACI in an afternoon briefing. Ah. Well.
So some of the 1.2 million who got it may be thinking we could have waited for Pfizer, which like Moderna is an mRNA vaccine, versus the more traditional viral vector of AstraZeneca and Johnson & Johnson. Pfizer’s supply schedule is reliable and growing, while Moderna is uncertain. NACI’s advice creating a form of vaccine hesitancy, and buyer’s regret, is probably not the optimal solution, here.
Of course, it’s not that AstraZeneca was promised to be the gold standard, in any regard. The risk is real, and critically, the data is evolving fast. The associated risk of vaccine-induced rare blood clots, or VITT, have been found to be less rare as time goes on, and are now estimated at one in 100,000, or winning the 50-50 at a pre-pandemic University of Michigan football game. It may be lower. If you drive a lot, it’s statistically more dangerous. Johnson & Johnson has a similar, though less data-proven, issue. And NACI has recommended it not be used in people under 30.
But it’s more that we were fed the message that the first vaccine is the best vaccine, and that lacked nuance. The prime minister and his wife received AstraZeneca on April 23, the leader of the Official Opposition and his wife the next day, the leader of the federal NDP the day before. This came after the premier of Ontario, and his health minister. So NACI saying that mRNA is the A-plus student and AstraZeneca is the student with whiteout on his jean jacket, well, it felt like a bit of a bomb.
"At this time, and based on current evidence, NACI recommends that the AstraZeneca COVID-19 vaccine may be offered to individuals 30 years of age and older, without contraindications, if the individual does not wish to wait for an mRNA vaccine, and the benefits outweigh the risks," said Deeks on April 23. That was the day NACI recommended AstraZeneca for over-30s.
But she used the word "preferred" this time, and then Dr. Caroline Quach-Thanh, NACI’s chair, told CTV, "If, for instance my sister got the AstraZeneca vaccine and died of a thrombosis when I know it could have been prevented and that she is not in a high-risk area, I’m not sure I could live with it."
This is public health messaging as delivered in the dark with a flashlight under your chin, and a grinning skull over your shoulder. NACI is a heavily volunteer organization without a serious communications staff, and the federal Liberals not providing them with spare comms staff from, say, someone from tourism was probably a mistake.
But let’s go over this carefully. These vaccines save lives. "The best vaccine is the first vaccine" is true if it’s an emergency, and in many places in Canada, with variants running around, it has been, and still is.
"You need to talk about four things: Risk, benefit, alternatives and context," says Dr. Isaac Bogoch, infectious diseases specialist at the University of Toronto and a member of Ontario’s vaccine task force. "And sometimes we focus on one and ignore the other three, but you need all of those. And if you only focus on the risks and skimp on the benefit, alternatives and context, people may get the wrong impression.
"But at the end of the day, when you really talk about those four things you can help people make an informed decision. Sometimes we miss the context part, and context is important. March, April, May, where we recently have been and where we are now: it’s not every day you’ve got tents set up in front of Sunnybrook. It’s not every day you have adults in pediatric ICUs. It’s not every day that you’re calling in health-care providers from other provinces to help you out with astronomical levels of COVID-19. it’s not every day that you’re admitting more and more people who are in their 20s and 30s and 40s into the hospital and the ICU. Context is important."
NACI’s day was one picture of our pandemic. An underfunded NACI, plus Health Canada, the Public Health Agency of Canada and the feds, and the perception of muddled messaging; the disastrous decision-making at the provincial level; the vaccine chase, which has been politicized when it’s actually a relatively successful global pursuit of incredible and life-saving new products; and the inequity built into this whole goddamn thing. NACI said AstraZeneca and J&J should be used as part of a risk calculus: if you think your risk is high enough, you should take it.
Which means the same people who have been least protected in this pandemic: the homeless, migrant workers, new Canadians, essential workers, those in the poorest, most racialized neighbourhoods. That inequity is a big part of how Canada has truly failed in this pandemic, when the pandemic put a mirror up to our self-satisfied, entitled society. Remember when Ontario associate chief medical officer of health Dr. Barbara Yaffe said those who take the bus should consider the risk, as if people ride the bus to see the sights and meet new people? This is like that.
So NACI stepped in it, and NACI needs to either deal straight with Health Canada or get better PR, but it’s not about NACI, precisely. This was a piece of Canada in the pandemic, and all our faults. Well, except one. It’s pretty comforting, right now, that Canada bought a lot of different vaccines.
Bruce Arthur is a Toronto-based columnist for the Star. Follow him on Twitter: @bruce_arthur