Quebec to wait up to 90 days to give second dose of COVID-19 vaccines

The province that has the highest infection and death rates, comparable to some of the worst hit G7 countries, is taking this risky approach. This will generate some good comparative data regarding following the Pharma companies advice and not doing so. But as someone who follows the instructions on my meds, question the wisdom: 

Quebec will wait up to 90 days before giving a COVID-19 vaccine booster to people who have received a first shot, Health Minister Christian Dube said Thursday.

That delay goes far beyond the recommendations of vaccine manufacturers Pfizer and Moderna, which propose intervals of 21 and 28 days respectively, and is more than double the 42-day maximum proposed by Canada’s national vaccine advisory committee.

Dube told a news conference that the decision was made in order to vaccinate as many vulnerable people as possible and to reduce the pressure on the health system.

“In our context, this is the best strategy, because we have to contend with (having) very few vaccines, and we’re in a race against the clock,” Dube said at a news conference.

Dube said the province had discussed the decision with both vaccine manufacturers and federal public health officials. He said the latter acknowledged that the 42-day recommended maximum can be extended depending on the disease’s progression in a particular province.

He said the high rate of community transmission, hospitalizations and deaths in Quebec justified the change.

“In Quebec we don’t have the same situation as in New Brunswick or British Columbia,” he said.

Richard Masse, a senior public health adviser, said the change would allow up to 500,000 seniors who are most at risk of complications — including those in private residences and those aged 80 and up — to receive their vaccine several weeks earlier than originally thought.

He said the justification to extend the interval was based on the “experience of working with many vaccines through time,” which shows that vaccine immunity does not suddenly drop off within a month or two.

However, he said the province was carefully monitoring the efficacy of the shot and would immediately give second doses if it saw evidence of decreased immunity in certain groups, such as the elderly.

Both Masse and Dube said the province would work to shorten the interval between first and second doses once the province begins to receive larger quantities of vaccine.

Meanwhile, the province was reporting some regions of the province have few or no doses of COVID-19 vaccine remaining as the vaccination effort outpaces the speed of delivery.

Quebec says as of Thursday morning, the Gaspe region, Iles-de-la-Madeleine, Nord-du-Quebec and the James Bay Cree Nation territories are out or almost out of vaccine; the province expects new deliveries Friday or Saturday.

Four other regions had almost used up all their doses but received new supplies Tuesday.

The province reported 2,132 new cases of COVID-19 Thursday and 64 more deaths attributed to the novel coronavirus, including 15 that occurred in the previous 24 hours.

One death previously attributed to COVID-19 was removed from the total after it was determined to be unrelated. Quebec has reported a total of 236,827 infections and 8,878 deaths linked to the virus.

Jean Morin, a spokesman for the Gaspe region’s health authority, said the vaccination campaign was going “exceedingly well” despite the fact nearly all the doses have been used.

Morin said there are logistical challenges to vaccinating people in the vast and thinly populated region, including having to transport people to clinics to receive their shots.

He says he expects the highest-priority groups in the region will be vaccinated by the end of January.

Source: Quebec to wait up to 90 days to give second dose of COVID-19 vaccines

What good are COVID-19 vaccines if people are afraid? We need to build trust with racialized communities, specifically PSWs facing vaccine hesitancy

Good practical suggestions;

Never in history have we gone from identifying a pathogen to creating and disseminating a safe and effective vaccine in under a year, however, we have not done a good job of explaining how we have been able to utilize scientific innovation without compromising on safety. Terms such as ‘Operation Warp Speed’ have not helped with hesitancy. Decades of mistrust towards pharmaceutical companies have also exacerbated this.

So, we must discuss vaccine hesitancy. What is it? It describes people who are not flat out against vaccinations, but who are anxious and afraid of vaccines, or sometimes one specific vaccine. Over the past few years, it’s a term that has gained traction even before the COVID-19 pandemic. These are individuals who may be continuously bombarded with fear-based and conflicting misinformation on vaccines.

In a Nov. 2020 poll from Ipsos and Radio-Canada surveying 3,000 Canadians on whether they were willing to take the COVID-19 vaccine when available, a large per cent reported they would get the vaccine, but less than 40 per cent said they would be willing to get it immediately.

This speaks to ongoing underlying hesitancy that must be addressed. Importantly, hesitancy involves not just refusal of vaccines, but delay despite availability.

Given that our health care workers are part of our communities, we can extrapolate that hesitancy may also be prevalent among those employed in vulnerable sectors such as our long-term care (LTC) homes. Several factors may impact their decision making, from concerns and fears around safety and effectiveness of the vaccines, to social, cultural and political influences, as well as logistical barriers that decrease access. Moreover, we must acknowledge that personal support workers (PSWs) in Ontario LTC homes largely belong to racialized communities that may harbour mistrust in the health care system, impacting vaccine uptake. Therefore it is not surprising that in many LTCs, anecdotally, around a third have refused or delayed vaccination. A poll undertaken at Windsor Regional Hospital found that more than 20 per cent of staff from seniors’ facilities are refusing or delaying vaccination.

As part of the scientific community, it is our job as the vaccines roll out to discern these workers’ concerns, fears and to acknowledge their mistrust or skepticism in a compassionate manner. Filling knowledge gaps and busting myths will only go so far. Black and Indigenous communities have had long-standing histories of abuse within our system and if we are to reach these communities, which are disproportionately affected by COVID19, we need to involve community leaders to engage and encourage widespread vaccination.

There is a long legacy of racism and discrimination resulting in significant mistrust in health care by BIPOC communities. And with good reason. If you feel you or your life is not valued, then how can you trust them? This is where tailored trauma-informed messaging is critical. Telling a racialized minority that Health Canada has reviewed the efficacy and safety of the vaccine and considers it safe is almost meaningless to a community that has mistrust across several systems of government whether it be educational, judicial or health care.

Currently, visible minorities are overrepresented among PSWs, making up 42 per cent in Ontario based on a CRNCC/PSNO survey, of which 18 per cent self-identify as Black and 5 per cent as Indigenous. Looking at the broader group of nurse aides, orderlies and patient service associates in Toronto, almost 79 per cent are immigrants. So it really should come as no surprise that this group has been hesitant to be the first in line to get vaccinated. However, little is being done to alleviate their fears and concerns.

We must prioritize collection of data. If we don’t see the problem, we cannot fix it. We have minimal data in Canada on vaccine hesitancy in general, and also no data on vaccine hesitancy in BIPOC communities. We know that the number of people refusing the vaccine is not insignificant, but we are not collecting this data.

What is driving their concerns? We know that PSWs are often racialized women; in fact, women account for the majority of nurse aides, orderlies and client service associates. Many are in their child-bearing years and are concerned about impact on fertility. There has been reluctance because the National Advisory Committee on Immunization guidelines as well as the Ontario Ministry of Health did not recommend the COVID-19 vaccine in those who are pregnant, breastfeeding or trying-to-conceive. While our obstetricians and gynecologists are rightfully advocating for this group to be able to receive the vaccine, as historically trials have excluded this population, changing messages without adequate discussions may not instill confidence.

We need to increase education, but encourage this information to also come from someone they trust. That could be their primary care providers, a partner community health organization or leaders they work closely with at their LTC homes. We need to be proactive and increase access to culturally sensitive, multi-language trauma informed educational materials.

We also need to break down barriers to vaccine distribution. Much light has been shed on PSWs needing to work multiple jobs as their positions are often part-time without benefits. Vaccine administration cannot just be during the day. Accessibility to on-site vaccinations in our LTCs homes is necessary. Paid sick time in the event of side effects should be mandated.

Lastly, we cannot be dismissive of fears. We must be empathetic, and provide factual information in an easy to understand manner, without any sensationalism or jargon. We must be respectful and compassionate. There is so much work yet to be done to ensure a successful uptake of the COVID-19 vaccine. Because after all, what good is a highly efficacious vaccine if people are too afraid to take it?

Sabina Vohra-Miller is the co-founder of the Toronto-based Vohra Miller Foundation, which aims to make health care equitable and accessible for all. Follow her at @SabiVM.

Dr. Anjali Bhayana is a family physician and staff hospitalist in geriatric rehabilitation at UHN TRI. Follow her at @AnjBhayana.

Source: What good are COVID-19 vaccines if people are afraid? We need to build trust with racialized communities, specifically PSWs facing vaccine hesitancy

HASSAN: Pakistan’s particular second wave challenge

Given Pakistan one of our top five immigration source countries,  of interest, with similarities with some of the fringes in Western countries:

Pakistan’s management of the pandemic was initially lauded even by the World Health Organization. Not so, the second wave.

The latest outbreaks have wrought havoc across the world, and Pakistan is no exception. COVID-19 appears to be spreading rapidly in many parts of the country. The rest of the world is beginning to see the hope of ending the pandemic in the development of various vaccines.

But Pakistan poses a special challenge toward fighting the pandemic within its borders. According to Younis Dar, Pakistan’s situation is “far more dangerous” as a significant number of Pakistanis refuse to embrace the idea of inoculation because of rampant suspicion against the vaccines.

Source: HASSAN: Pakistan’s particular second wave challenge