Fahad Razak, Arthur Slutsky and David Naylor are physicians and professors in the Department of Medicine at the University of Toronto. Drs. Razak and Slutsky are also on the medical staff of Unity Health Toronto.
As the third wave of the COVID-19 crests across most of the country, Canadians faces crucial decisions that will determine how effectively we are able to move past this phase of the pandemic.
The good news is clear. Case counts and deaths are dropping. Massive supplies of the two mRNA vaccines (Pfizer and Moderna) are flooding in and the pace of immunization is picking up across age brackets. And while focus is still needed on high-risk areas and vulnerable populations, there has finally been some progress in redressing vaccine inequities.
Vaccines can clearly work magic in preventing serious COVID-19, but a reality check is in order. Many provinces still face high caseloads, and no jurisdiction can rely solely on vaccination as an adequate defence. For the near term, smart public health measures are an essential complement to vaccinations in dispersing the third wave.
There’s another consequence to not definitively driving caseloads down. Remember the summer of 2020? Many provinces coasted into a terrible second wave in the autumn that was barely abating before an even worse third wave began. While wide vaccine coverage gives us a safety net for the fall of 2021, mutation risks are real, and complacency could lead to a repeat.
Consider the rapid growth in cases of the B.1.617.2 (the ‘Indian Variant’) in the UK, a worrying occurrence that threatens to derail a celebrated re-opening in its infancy. Our summer must be laser-focused on finishing immunizations and on control measures that drive case counts to levels where local health officials can consistently test, trace, and contain any outbreaks. Once that happens, prospects for ongoing control of COVID-19 are much brighter.
But before looking ahead, it’s worth acknowledging how far we have come.
Scientific research has delivered brilliantly with multiple effective vaccines, and Canada’s Vaccine Task Force offered sage advice on good prospects. The federal government was criticized for limited vaccine deliveries early in 2021 but has now delivered supplies of multiple vaccines that position Canada strongly for full immunization throughout 2021 and beyond. Remarkably, we currently lead the G20 in daily vaccination rates.
Credit for the accelerating rollouts goes not only to all levels of government, but to a range of local, institutional and community leaders. We’ve seen vaccine marathons that extended long into the night, vaccine lineups snaking through neighbourhoods that were once falsely claimed to be bastions of vaccine hesitancy, and celebratory photos joyously shared on social media as vaccination records are shattered. These are the highlights of the past weeks. Yet again, the resilience, kindness, and social solidarity of Canadians has been pivotal in the pandemic fight.
That said, Canada needs good policy-making and clear public communication to ensure a safe and sustainable re-opening. We see at least six issues here.
First, for vaccines, Canada’s universal first-doses-fast strategy made sense. What doesn’t make sense is maintaining a universal 4-month interval between doses given our escalating supply, and evidence that a single dose is less effective for some. Older Canadians and those with medical conditions associated with suboptimal immune responses should get faster access to a booster shot. In addition, emerging evidence suggests that booster doses are essential to ensure protection against some COVID-19 variants.
Second, mRNA vaccines will be the first available vaccine going forward for most Canadians, and use of AstraZeneca as an initial dose will be limited given the desirability of avoiding rare but severe clotting risks. What, then, of boosters? British Columbia is offering residents a second-dose choice. One option is AstraZeneca, for which U.K. data suggest the risk of severe clotting with a booster is dramatically reduced, perhaps on the order of one in 600,000. Another option is to receive an mRNA booster – a strategy that so far appears safe and effective, although more data are needed. Over two million Canadians have already received a first dose of this vaccine, and all provinces need to clarify their options in the days ahead.
Third, a diverse vaccine supply remains important. Dependency on the two mRNA vaccines alone is not ideal. Here Novavax is in play as an attractive addition. It does not use a viral vector, and, like the mRNA vaccines, can be tuned quickly for variants.
Fourth, young Canadians need coverage. The question is how soon. Our view is that priority be given to 2nd doses for those at highest risk – the elderly and the immunocompromised. Others may favour covering those aged 12 to 17 to reduce current caseloads and stem summer spread. Regardless, the good news is that we will soon have enough vaccines to immunize all eligible children, and prospects are bright for a safe re-opening of in-person schooling.
Fifth, now is the time to tune up pre-emptive measures in settings where people gather indoors. Improved air handling can help mitigate airborne spread, particularly in schools, factories and warehouses. Smart use of rapid antigen tests is also essential because a re-opened society means lots more colds and flu cases this fall. Those infections in turn must be distinguished from COVID-19.
Finally, Canada’s first dose fast strategy has paid off, but leaves many questions unanswered about vaccine status and summer gatherings. With about 50% of the adult population having at least one jab, we need explicit guidelines from health authorities on what we can safely do when partially or fully vaccinated. Recent advice from the Public Health Agency of Canada is population-focused and lacks specificity about small group interactions.
In sum, amidst encouraging signs of progress, SARS-CoV-2 remains a serious threat. Vaccines are doing all that was hoped of them. Let’s take the other steps needed to position Canada for a good summer and an even better fall.