As It Happens·Q&A

NACI advice to wait for 'preferred vaccine' sends bad message to essential workers: doctor

Dr. Zain Chagla says the National Advisory Committee on Immunization's guidance needs to be weighed against the risk of catching COVID-19, and that bad communication can lead to confusion and vaccine hesitancy.

The National Advisory Committee on Immunization said Canadians less at risk could wait for 'preferred' vaccine

People line up outside an immunization clinic to get their Oxford-AstraZeneca COVID-19 vaccine in Edmonton on Tuesday. (Jason Franson/The Canadian Press)

Story Transcript

The National Advisory Committee on Immunization's recommendation that Canadians who are less likely to contract COVID-19 may want to wait for a Pfizer or Moderna vaccine is bad messaging, says an Ontario doctor. 

Prime Minister Justin Trudeau reassured Canadians on Tuesday that viral vector vaccines including AstraZeneca and Johnson & Johnson are safe and effective, a day after NACI said that they are not the "preferred vaccine."

NACI, an independent body of volunteer experts, said that Canadians may want to wait if they can for an mRNA vaccine from Pfizer or Moderna, because they do not carry the same risk of very rare blood clots. Trudeau said Canadians should take the first vaccine available to them, echoing the advice of many public health leaders and medical experts across the country.

Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare in Hamilton, Ont., spoke with As It Happens host Carol Off about NACI's recommendations. Here is part of their conversation.

What damage do you worry that this NACI press conference has already done?

One, that people that were already kind of on the fence at whether or not they wanted AstraZeneca or wanting to wait, that they've been pushed to wait a little bit more. Which, you know, if COVID wasn't a great issue and our health care was operational and we weren't dealing with the calamity we've been dealing with in the third wave, then fair, so be it. 

But in reality, we're getting people admitted to the hospital that could have very well had a vaccination, including AstraZeneca, two weeks ago to prevent that outcome, need a ventilator, and unfortunately, passed away. 

I think, secondly ... they made a lot of people who got the vaccine in the last two weeks kind of sit there and say, "Hey, did I get an inferior vaccine?"

But it also speaks to, I guess, who is able to wait. And as you point out ... some people urgently should be getting this vaccine ... so what does it say about a message that ... if you live in a sparsely populated place and you can work from home and you've got good health outcomes, that you should wait for the preferred one, but all the rest of you get whatever you can?

I understand with the science that they're trying to convey, but from an equity lens, that is a horrible statement.

You're telling the people that are at the highest risk, that are putting themselves at the highest risk so that many of us can live in a low-risk setting and have our groceries dealt with ... can wait for the right vaccine, the one that has the lowest risk of side effects. But you, that are out in the field, you know what? You should probably get the one that has the highest rate of side effects. 

Vaccine advisory group says Pfizer and Moderna COVID vaccines are the preferred type

2 years ago
Duration 2:33
Dr. Shelley Deeks of NACI discussed with reporters the merits of receiving one type of COVID-19 vaccine over another.

This advisory committee is not government. They advise government, but they're not stupid people, right? They're informed. And so we've heard from the health minister today. ... She said in the House that if you have any doubts, you should contact your doctor and see what's best for you. And that was the message today from Patty Hajdu. What do you make of that?

I know a number of the individuals on NACI. They're at the top of their field in infectious diseases, immunology, virology, geriatrics and other practices. And so, absolutely, I have a deep respect for what they do. 

They have to make guidance for Charlottetown to Vancouver. And so there is going to be solid guidance there, but it's going to have to meet nuance and context.

Nothing that they said was unscientific. But that communication, that piece of demonstrating to the public, yeah, if you live in Charlottetown, fine, you might want to wait for your vaccine. But if you're living in Mississauga right now, you are at higher risk of what's going on outside of your front door as compared to the risk of these clotting reactions.

I think being able to have the nuance and the communications to convey it is important. It is an incredibly publicly facing role. And NACI was never [been] this in the past. But the reality is that people are listening to their statements. 

You have to build in that communication strategy of being consistent and being vaccine promoting to your population, is just as important as the advice you give. 

Dr. Zain Chagla is an infectious disease physician at St. Joseph's Healthcare in Hamilton, Ont. (St. Joseph’s Healthcare Hamilton)

There is perhaps a more potentially influential statement made by the chair of NACI, Dr. Caroline Quach-Thanh, who said on CTV ..."If, for instance, my sister got the AstraZeneca vaccine and died of a thrombosis when I know it could have been prevented and that she is not in a high-risk area, I'm not sure I could live with it." What message are we to take from there?

You're talking about a theoretical risk of an individual that hasn't happened. And we've had one fatality in Canada of date of a vaccine-associated thrombosis

We're hearing 25 to 30 deaths a day in Ontario, day by day. And I think those numbers need to be balanced against that one death, right? 

[We're] seeing people between the ages of 40 and 50 — that were eligible for an AstraZeneca vaccine — that are being admitted to hospital day by day. It's one thing if this happened in April of 2020. It's another thing if it's happening in May of 2021, where there's a vaccine that could prevent this outcome two weeks before. 

I think that really does need to be balanced against a message of a potential side effect that is exceptionally rare in a hypothetical individual. 


Written by Sarah Jackson with files from CBC Politics. Interview produced by Katie GeleffQ&A has been edited for length and clarity.

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