Before Ontario announced a pause on first doses of the AstraZeneca vaccine on Tuesday, residents had already begun snubbing it in favour of Pfizer or Moderna.
A family health centre in Milton last month decided to offer the Oxford-AstraZeneca vaccine. It found hundreds of people drove in to be vaccinated from all over the province each week.
Uptake had been overwhelming — until now.
“Last week was relatively normal. We did 300 doses,” said Gina Mannella, the executive director of Prime Care Family Health Team, before the announcement Tuesday. “And then this week, it just died.”
After Ontario announced Friday that Pfizer and Moderna vaccines, which had mostly been distributed at city and hospital clinics, would be offered at more than 130 pharmacies, people called Prime Care asking what vaccines it offered.
“And they all wanted Pfizer or Moderna,” said Mannella.
And now, Ontario has announced a pause on all first doses of AstraZeneca out of an “abundance of caution” due to an increase in rare blood clots observed in residents, said Dr. David Williams, the province’s chief medical officer.
The decision was made as the estimated risk of vaccine-induced immune thrombotic thrombocytopenia (VITT) has risen from one in 100,000 doses to one in 60,000, said Dr. Jessica Hopkins of Public Health Ontario at the press conference.
There have been eight cases of VITT reported in Ontario as of Saturday. Three deaths related to AstraZeneca have been reported across Canada.
So far, over 900,000 doses of AstraZeneca have been distributed in Ontario. With 50,000 left, it’s unclear who will receive those shots. The muddied messaging around the shot has left pharmacists and public health experts concerned it could affect the vaccine rollout overall.
Hesitancy around AstraZeneca, which was already being fuelled by reports of a rare but serious side effect of blood clots, was further inflamed last week after the National Advisory Committee on Immunization repeated its recommendation that mRNA vaccines such as Pfizer and Moderna are “preferred” over viral vector vaccines such as AstraZeneca.
The press conference set off a firestorm of confusion around the safety profile of AstraZeneca, a vaccine that public health experts and Health Canada continue to emphasize is a good option for protection against COVID-19. It has been central to Britain’s ability to reopen.
However, on Monday, Alberta became the first provincial government to announce it would no longer administer first doses of AstraZeneca, except in rare cases.
Meanwhile, people are anxiously awaiting the imminent results of an Oxford trial on the efficacy of mixing doses. Provincial Health Minister Christine Elliott said Ontario will likely allow mixing, pending the study results and guidance from Ottawa.
Against this backdrop, patients are now “really shopping” for their vaccines, said Mannella.
Nearly 96 per cent of AstraZeneca’s total supply of doses to Ontario pharmacies have been administered, according to Justin Bates, chief executive officer of the Ontario Pharmacists Association.
Another 655,000 doses of AstraZeneca are set to arrive in Canada before the end of May. Earlier Tuesday, Prime Minister Justin Trudeau announced that Ottawa will continue to push suppliers to deliver the AstraZeneca doses that Canada is expecting and said Canadians should take the first vaccine offered to them.
But the question remains: who will choose AstraZeneca in the country now that the supply tap, particularly for Pfizer — now authorized for use as young as 12 — has been fully opened and now that two provinces have paused first doses?
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Infectious disease specialist Dr. Sumon Chakrabarti says it’s important to note that mRNA vaccines and vaccines like AstraZeneca are both highly effective against COVID-19.
While the rare blood clots are more common than previously thought, they still remain rare. Last month Ontario was having an exponential rise in cases and supply was limited — that meant AstraZeneca was crucial to getting the virus under control, he said.
“But now we’re getting a massive glut of Pfizer coming in. The risk of transmission is lowering right now. So now the context changes a little bit,” he said, adding that we have the luxury of pausing AstraZeneca.
But the problem in the lead-up to this messaging, Ontarians were hearing different information from different sources, which clouded the public’s understanding of the benefits and risks of the vaccine, he said.
AstraZeneca significantly reduces the chances of being hospitalized with COVID-19 and reduces the chances of disease transmission, and is about 76 per cent effective in protecting individuals from COVID-19 after one dose, within 22 to 90 days, according to the vaccine’s makers. In Canada it was originally recommended for 18 and older, but has faced various changing age restrictions in different provinces and was available for those 40 and older in Ontario, until Tuesday.
Bates said pharmacists have been inundated with calls about AstraZeneca in the last few days.
“The NACI press conference put a lot of onus on the health-care providers to deal with some of those mixed messages,” he said. “That’s a challenge because all along everyone’s been saying: take the first one that’s offered you.”
Allowing mixing of vaccines may ward off general hesitancy, he said. But the messaging so far has put “patients in a vulnerable spot, it puts health-care provides in an awkward spot as well, and it’s less than ideal.”
The Star called multiple pharmacies, before the announcement that AstraZeneca could be paused, across the GTA and Toronto, who all relayed that they’ve seen an increase in calls about concerns around AstraZeneca since NACI’s announcements.
The Keele-Ingram pharmacy in North York was picked as one of 60 locations in Toronto and Peel Region to administer the Pfizer vaccine last week. Its wait list currently has 18,000 people on it, while the pharmacy is only going to receive about 150 doses a week.
But amid the mad rush to grab a Pfizer dose, it was clear what many callers didn’t want: AstraZeneca.
“A lot of people are specifically asking for Pfizer. They say ‘oh, we don’t want AstraZeneca, we only want Pfizer,’ ” said Nancy Ng, the pharmacist at Keele-Ingram.
The pharmacy is in the Brookhaven-Amesbury neighbourhood, which had a rate of 1,014 COVID-19 cases per 100,000, about 27 times higher than the city’s rate.
Currently, 46 per cent of the people in neighbourhood have been vaccinated. Ng said she’s concerned that the new reluctance around AstraZeneca has made people more likely to want to pick and choose their vaccine.
She said some who have already had the shot feel “cheated,” though the efficacy of AstraZeneca has not changed.
In a neighbourhood hit hard by COVID, that’s concerning, she said.
“I think it deterred people from being as excited over AstraZeneca, especially now that Pfizer is available. It’s almost as a status thing, you know ‘I got Pfizer over AstraZeneca.’ It’s really tarnished the whole AstraZeneca movement.”
With files from Tonda MacCharles
Olivia Bowden is a Toronto-based staff reporter for the Star. Reach her via email: [email protected]
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