The debate continues: what is the fate of AstraZeneca's controversial vaccine in Canada?
Several Canadian provinces have refused to use AstraZeneca. But not all hold this view.
AstraZeneca's vaccine has been in the news headlines for weeks. The drug was rejected by a number of European countries on the grounds that the vaccine could allegedly provoke thrombosis. Later, Health Canada declares that the AstraZeneca drug is safe, so the country will continue to use it.
However, on Monday, March 29, Canada's National Committee on Immunization (NACI) recommended suspending vaccination of people under the age of 55 with AstraZeneca. Cases of vaccine-induced prothrombotic immune thrombocytopenia (VIPIT), a rare blood clotting disorder, have been reported in vaccinated people in Europe.
NACI is not advising use of the vaccine until these cases have been sufficiently investigated. The recommendation comes weeks after NACI did not advise use of AstraZeneca for people over 65 in early March because of a lack of efficacy data.
"We are taking precautions while Health Canada reviews the risks and benefits of AstraZeneca's drug based on new data," said Dr. Howard Nju, deputy chief medical officer at the Public Health Agency of Canada.
Several Canadian provinces have already followed NACI's recommendations. Alberta, Ontario, British Columbia, Quebec, Saskatchewan, Newfoundland and Labrador, New Brunswick and Manitoba have stopped using the vaccine for people under age 55. Prince Edward Island has discontinued use of the drug for the entire population. Public health officials in Nova Scotia said the NACI recommendations will not affect use of the vaccine in the province because it is being given to people 60-64 years old.
Vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) is associated with the appearance of blood clots, including in the brain, after vaccination. Symptoms include severe headache, seizures, blurred vision and shortness of breath. These usually develop on day 4-16 after vaccination.
"These are not just blood clots, they can cause very serious brain disease and can be fatal," said infectious disease specialist Dr Abdu Sharkawi.
No such cases have been reported in Canada, but in other countries the symptoms have mainly occurred in women under 55 years of age, less frequently in men. Reportedly, 40% of cases end up being fatal, but NACI believes this rate can be reduced if doctors and those vaccinated themselves are made aware of the possible consequences. VIPIT was previously thought to occur in one in a million vaccinated people, but a recent report by the Paul Ehrlich Institute in Germany showed that the disease can occur in one in 100,000 people.
For people over the age of 55, NACI recommends continuing to vaccinate them with AstraZeneca because at this age, VIPIT is very unlikely to develop, but the risk of complications from COVID-19 is high. However, people should be vaccinated with this particular vaccine with their consent.
Not everyone agrees with the immunization committee's opinion. For example, Dr. Gerald Evans, an infectious disease specialist at Queen's University in Kingston, Ontario, called the NACI recommendations "overly acute. Evans believes the risk of thrombosis from AstraZeneca is very low compared to the risk of thrombosis from COVID-19. Other health experts recommend that people who have already received the first of two doses of AstraZeneca without consequences should also be vaccinated a second time.
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Christine Elliott, Ontario's Minister of Health, is also encouraging people to get vaccinated, including with the AstraZeneca vaccine. She received her first dose of AstraZeneca the same day NACI published its recommendations, and she did so on camera to encourage others to follow her example. However, it should be noted that Elliott does not fall into the category of those recommended to stop using the vaccine — the minister will turn 66 in April.
