'Get the first vaccine that you can get': NACI recommendations could lead to vaccine hesitancy, UW expert says

The recommendations from the National Advisory Committee on Immunization (NACI) issued on Monday are broad and may contribute to vaccine hesitancy in Waterloo Region according to a vaccine specialist at the University of Waterloo.

In an interview with CTV News on Tuesday, Dr. Kelly Grindrod, an Associate Professor with the School of Pharmacy at the University of Waterloo, suggested communication from the NACI may cause confusion and lead some people to avoid or delay getting a COVID-19 vaccine.

“We absolutely have a lot of virus in Waterloo Region. It seems to be trending in the right way but, we’re by no means out of the woods,” said Grindrod. “I think in regions that have hotspot neighbourhoods, the message continues to be – if you can get a vaccine, get the first vaccine you can get.”

On Monday, speaking on CTV’s Power Play with Evan Soloman, the Chair of NACI, Dr. Caroline Quach-Than, suggested in cases of low risk to COVID-19 exposure, waiting for a ‘preferred’ mRNA vaccine should be considered.

“We want this to protect people who are not able to think, necessarily, through the pros and cons of every vaccine,” said Quach-Than. “The question is really to say, ‘This needs to be an informed consent.’ If, for instance, my sister was to get the AstraZeneca vaccine and die of a thrombosis when I know that it could’ve been prevented and she’s not in a high-risk area, I’m not sure I could live with it.”

Quach noted NACI now recognizes a ‘safety signal’ associated with the vector-based vaccines and has adjusted its recommendations accordingly.

The messaging from NACI saw a number of Intensive Care physicians speak out against the recommendation to “vaccine shop” arguing the communication could lead to delayed vaccination and more serious outcomes from COVID-19.

“The idea that we are giving this confusing message to say, ‘If the statistics in your area are friendly to waiting, then go ahead and wait.’ The numbers don’t matchup to reality,” said Dr. Hassan Masri, an intensive care specialist in Saskatoon, in an interview with CTV News Channel. “The numbers in Alberta, Calgary specifically, are more per capita than India. The numbers in Ontario are by no means good numbers.”

Dr. Isaac Bogoch, an infectious diseases physician and member of the Ontario Vaccine Task Force, says there is a need to enable people to make an informed decision but notes, the country is in the midst of a public health emergency.

“Based on the context, based on the risks, based on the benefits, based on the alternatives – this is why many healthcare professionals have been saying, ‘Take the first shot that’s available,’” said Bogoch.

According to Grindrod, only a privileged few make up those who would qualify to wait for a preferred vaccine.

“If you’re someone who works from home, who lives alone, you don’t have to take care of anybody else, you’re very low risk, you’re not an essential worker-type job, you’re not the main caregiver to other people in your house – maybe you have the luxury of waiting,” said Grindrod. “That’s the challenge of NACI’s statement, is it really focuses on people who have the privilege of having extremely low risk of exposure.”

A transcript of the interview can be read below:

Q: What did you make of the recommendations that we saw from NACI come out on Monday?

Dr. Grindrod: In some ways the recommendations weren’t entirely different than what we were already thinking before; the challenge was more in how they were shared. It was the idea that, ideally you have access to an mRNA vaccine like Pfizer or Moderna but, in situations where it’s going to be quite some time before you could access it, the big question that everybody has is, ‘Should I get the AstraZeneca vaccine if I could get it tomorrow versus waiting?’” The recommendation was kind of in those lines which was, ‘If you feel like you need it, you could get it earlier.’” The way it was communicated I think for a lot of people who did in fact get it, it was quite hard for them; there were a lot of questions around whether people had made the wrong decision.

Q: The preferred status isn’t new but, what was new at least in terms of what was shared with us on Monday is this safety signal associated with AstraZeneca, and now the Johnson and Johnson vaccine. Can you explain to us what exactly this means?

Dr. Grindrod: What we’re talking about is something called Vaccine Induced Thrombotic Thrombocytopenia, or they call it VITT for short. It appears to be this immune reaction that triggers a very rare but, potentially serious clotting problem. A safety signal – so when people were asking early on, they’d say, ‘Okay, I want long-term research, I’m not going to take it until there’s long-term research.’” That’s actually not what we were waiting for, what we want to see is when something like a drug or a vaccine is given to millions of people sometimes side effects show up that don’t show up in trials of 40,000 to 50,000 people; sometimes you get a ‘safety signal’ – something that’s rare and serious. That’s exactly what happened here. We had excellent data out of Europe suggesting that this rare but, serious reaction can happen across ages, maybe a little bit more in young people. We had to weigh the risk and the benefits.

Q: We’ve seen millions of doses of AstraZeneca used across the United Kingdom and Europe. What have you made of its use there?

Dr. Grindrod: That’s the thing about these vaccines, they are extremely effective. The most important outcome for all the vaccines for COVID is if they prevent severe illness, hospitalization and death – and all four vaccines that are in the market in Canada protect against almost all cases of severe illness, hospitalization and death. Now what you have to weigh that against is this very rare, but serious potential reaction called VIT. We know with AstraZeneca it seems to happen with one in every 100,000 vaccinations; with Johnson and Johnson it might be closer to one in every 500,000. To put that in context, what we’ve seen from some of the Ontario data, is that in most regions for every 60 vaccines that you give you prevent one case of COVID, and in a hotspot it’s closer to about 30 vaccines that you prevent one case of COVID so, these vaccines are really effective in the context of a third wave where there’s a lot of virus, the hospitals are full and the health system is under a lot of strain.

Q: What would your recommendation to someone in Waterloo Region be when it comes to getting the AstraZeneca shot or the Johnson and Johnson shot?

Dr. Grindrod: The message is going to continue for some time to be – get the first vaccine that you can get. If you’re in a region that doesn’t have a lot of virus, if you’re in a lucky region, some of the east coast for example, that isn’t dealing with a lot of spread, if you were in another country for example in New Zealand or Australia where you don’t see a lot of spread, you may really start to question the value of the vector vaccines. When you’re in a place like Ontario, Alberta, British Columbia, places that are dealing with a lot more virus right now and the hospitals are really strained – the benefits of the vector vaccines, AstraZeneca and Johnson and Johnson, vastly outweigh the risks. That’s the challenge of the NACI statement, it was one broad statement that people have to try to apply to their own lives.

We absolutely have a lot of virus in Waterloo Region. It seems to be trending the right way but, we are by no means out of the woods right now. As many would know, in a lot of our hospital systems across Ontario [patients are being transferred] from the Greater Toronto Area and Peel Region because their hospitals are at capacity. Our hospitals are also feeling some strain from those areas as well. We have hotspot neighbourhoods in Waterloo Region as well; the message continues to be if you can get a vaccine, get the first vaccine that you can get.

Q: Is hesitancy a real possibility now after the messaging we got this week from NACI?

Dr. Grindrod: I think for a lot of people there are two concerns: one is that people who got the [AstraZeneca] vaccine are now feeling regret or feeling like they made a mistake; and for folks like that, good for them for going out and getting a vaccine and protecting themselves and protecting people around them. It was the right decision for them at the time and I think it continues, probably for quite some time, to be the right decision. The other one we’re really worried about though, is that the statement, because it was a bit confusing and maybe a little bit difficult for people to understand the nuance of the statement, might lead them to have lower confidence in vaccines and maybe avoid getting the vaccine or delay getting the vaccine. As we hear from many physicians who work in hospitals and ICU’s, they continue to see patients who had an opportunity to get the AstraZeneca vaccine who turned it down and then get COVID and they end up in the ICU. Like it or not, that’s the situation that we’re in in Ontario.

If you’re someone who works from home, who lives alone, you don’t have to take care of anybody else, you’re very low risk, you’re not an essential worker-type job, you’re not the main caregiver to other people in your house – maybe you have the luxury of waiting. That’s the challenge of NACI’s statement, is it really focuses on people who have the privilege of having extremely low risk of exposure always had that privilege of choosing a vaccine but, there’s a whole lot of people in Waterloo Region and in our society that don’t have the luxury of having almost no risk.

(Video and transcribed interview edited for time and clarity)