AstraZeneca now recommended for people over 65: New advice on COVID-19 vaccine

The National Advisory Committee on Immunization still says the elderly should be prioritized for more effective mRNA vaccines from Pfizer and Moderna.

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Just as the COVID-19 vaccine drought is ending in Canada, there is growing focus on one of the vaccines now flooding into the country — Oxford-AstraZeneca.

On Tuesday, Canada’s National Advisory Committee on Immunization revised its earlier advice on the vaccine, saying that, based on real world evidence, it is now recommended for people over 65 — the most vulnerable to severe illness and death from COVID-19. Earlier, the committee recommended the vaccine for people under the age of 65, saying there was insufficient data to make a recommendation about older adults at the time. NACI still says the elderly should be prioritized for more effective mRNA vaccines from Pfizer and Moderna.

The updated advice comes a week after NACI revised its recommendations about dosage intervals for COVID-19 vaccines, saying the second dose could be stretched up to four months in order to increase the number of Canadians being vaccinated.

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That changing advice frustrated Premier Doug Ford on Tuesday. During a press conference, the premier said that NACI “is messing everything up.” Ontario has set up pilot programs in some regions where people between 60 and 65 can be vaccinated with AstraZeneca at pharmacies and doctors offices. Ford said the province would honour its commitment to people between those ages who have appointments, but it is unclear what will happen after that.

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Meanwhile, AstraZeneca is at the centre of scrutiny in Europe where a growing list of countries have now paused its use while reports of a small number of cases of blood clots are investigated. On Tuesday, European and international health officials said there is no evidence those cases of blood clots are related to the vaccine, but any potential adverse events should be investigated.

About 17 million people have been vaccinated with AstraZeneca in the EU and the U.K., with fewer than 40 cases of blood clots reported.

On Tuesday, Chief Public Health Officer Dr. Theresa Tam said Canada is monitoring the situation. The doses of AstraZeneca being used in Canada are manufactured in India and are not from the same batch as those that are being used in Europe.

The changing advice and reports of potential rare adverse events are causing confusion among some. But health experts say neither are surprising during a highly unusual vaccine rollout involving mass vaccination on a global scale and multiple vaccines.

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“We are in vaccine confusion territory,” said Dr. Kumanan Wilson a physician and researcher at The Ottawa Hospital who developed a leading immunization app. “This isn’t blaming anybody. This is a very unusual vaccine rollout.”

That is why it is crucial to have systems in place to track and quickly evaluate any potential serious adverse events related to vaccines, he said. Doing so helps maintain confidence in vaccines.

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Among issues to be investigated are whether the reported potential events are related to the vaccine and, if so, whether they are related to something in specific batches of the vaccine.

Researchers found, for example, that an antigen in some batches of the flu virus administered in parts of northern Europe in 2009, in rare cases, triggered an immune response leading to narcolepsy in people with a certain genetic makeup.

University of Ottawa epidemiologist Raywat Deonandan notes that all the vaccines approved for use in Canada are safe and effective at preventing serious COVID-19 disease.

Even if the reported cases of blood clots in Europe are determined to be related to the vaccines, he said, the risk is “vanishingly small.” And COVID-19 also causes blood clots.

AstraZeneca is currently mostly being administered in pharmacies and doctors offices in Ontario — in Toronto, Windsor and Kingston.

No doses have arrived in Ottawa, but some Ottawa residents between 60 and 64 have travelled to Kingston to get vaccinated at pharmacies there, something public health officials in Kingston and the Ministry of Health discourage because Ottawa’s case counts are higher and rising.

On Tuesday, Ottawa Chief Medical Officer Dr. Vera Etches said the city would welcome AstraZeneca vaccines to speed up mass vaccination here.

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“It is important for people to understand that these vaccines are all providing good protection,” she said.

Deonandan said getting vaccinated with whichever dose is available is important as a third wave begins.

“You have the goal, it is about getting society back to normal and weathering the storm in the third wave. If we get the death toll down in the third wave we all win.”

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