In a pandemic, confusing government messages about COVID-19 vaccines aren’t helpful

A lot of Canadians are confused this week by the contradictory messaging about COVID-19 vaccines coming out of the federal government. Who could blame them?

On the one hand, Prime Minister Justin Trudeau and Chief Public Health Officer Theresa Tam have repeatedly said that Canadians should take the first vaccine offered to them, be it Pfizer, Moderna or AstraZeneca, because all of them are approved for use, available, safe and effective.

On the other hand, the National Advisory Committee on Immunization (NACI), a volunteer group of doctors and researchers that provides Ottawa with guidance on vaccines, said on Monday that the mRNA vaccines made by Pfizer and Moderna “should be preferentially offered”[1] to Canadians.

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This guidance, which NACI describes as a “strong recommendation,” is based on the fact there is a minuscule risk that people who get AstraZeneca, a nonreplicating viral vector vaccine, could develop rare blood clotting that can be fatal if not quickly treated.

The risk is estimated to be between one in 100,000 and one in 250,000. In Canada, seven people have developed the clotting, out of about one million who have received a dose of AstraZeneca. One died, and the others recovered.

NACI is also making the “discretionary recommendation” that AstraZeneca be given to people over the age of 30 who are unwilling to wait for an mRNA vaccine, or who live and work in places where there is a high risk of contracting COVID-19.

The news of this discrepancy, between what the government is saying and what the people advising it are saying, has caused a great deal of concern.

It was made worse when NACI chair Caroline Quach-Thanh said on television[2] that some people should pass up AstraZeneca if it’s offered to them.

“If you are in an area where there’s no COVID, then waiting for mRNA is okay,” she said. “If you’re in an area where there’s tons of COVID, the transmission is high, then I absolutely agree, the first vaccine that comes is the one that you take.”

All this has given some people the impression that there are good vaccines, and not so good ones. It has also raised questions about fairness, in that it suggests that people who live in high-risk areas somehow deserve a lesser protection.

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And it has left those who’ve received the AstraZeneca vaccine wondering if they made the right choice, and asking whether they want to take a second shot when it’s offered.

There is without question a need to inform Canadians of the risk associated with AstraZeneca, so that people who get that vaccine are on the lookout for symptoms of those extremely rare instances of clotting. And most people can understand the logic of advising the government to prefer, all else being equal, vaccines that have no known dangerous side effect.

But all else is not equal. Canada is in the grips of a national health crisis, and NACI has managed to leave the average person confused and doubtful at the very moment when it is urgent that they have faith in the vaccines they are being offered, and in the people asking them to take them.

That’s a huge mistake. NACI itself says AstraZeneca is a safe and effective vaccine against COVID-19, and that it offers protection against the B.1.1.7 variant first discovered in Britain and now rampant in Canada. In the real world, tens of millions of AstraZeneca vaccines have been safely administered; it has been especially effective in Britain, where it has helped to bring down case counts and hospitalizations dramatically and quickly.

By telling Canadians that AstraZeneca is simultaneously safe and to be avoided, NACI has pointlessly cast doubt on a highly valuable vaccine.

As David Naylor, chair of the national COVID-19 Immunity Task Force, said Tuesday, “It is an unsettling message[3], because it suggests you got the second-best vaccine.”

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What is even more unsettling is that NACI is at odds with governments across the country that are desperately trying to bring the pandemic under control with the best tool they’ve got: vaccines.

During a public-health crisis, consistent messaging is vital. Canadians have shown a great willingness to line up and get a needle, but hesitancy is always lurking. In future, NACI needs to make sure it’s helping the fight against COVID-19, and not hindering it.

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References

  1. ^ “should be preferentially offered” (www.canada.ca)
  2. ^ said on television (youtu.be)
  3. ^ It is an unsettling message (twitter.com)
  4. ^ Sign up today (www.theglobeandmail.com)