Residents and staff of First Nations personal care homes in Manitoba to get third COVID-19 vaccine dose

Residents and staff of First Nation personal care homes in Manitoba are now eligible for a third dose of a COVID-19 vaccine.

The province announced the news Monday morning, adding that the eligibility will expand in October to residents of all personal care homes throughout Manitoba.

"We will be working with these facilities and our regional health authorities in the coming weeks to put the necessary plans in place," said Dr. Joss Reimer, medical lead of the Vaccine Implementation Task Force, at a virtual news conference.

Dr. Marcia Anderson, public health lead for the Manitoba First Nation Pandemic Response Coordination Team, said this earlier expansion is needed for residents and staff of First Nation personal care homes due to barriers and systemic barriers experienced by First Nations communities.

Anderson noted there was a recent outbreak at a care centre in Sagkeeng First Nation, which resulted in 37 COVID-19 cases among people who, for the most part, were vaccinated. Three people were hospitalized and two died as a result of this outbreak.

"We have to consider our local data that highlights the unique context of First Nations communities, as well as the rapidly evolving evidence," she said.

"This will help to protect our most vulnerable people and contribute to the maintenance of safe staffing levels as we enter the fourth wave."

Anderson noted that Monday's third dose expansion includes about 200 residents and 400 staff at 10 First Nation personal care homes in Manitoba.

THE THIRD DOSE SITUATIONS

Last week, third dose eligibility was announced for immunocompromised Manitobans, those who require a third dose for travel, or those who previously received doses of vaccines not approved by Health Canada.

According to Reimer, there have been studies showing lower levels of antibodies in those who are immunocompromised even after two doses of the vaccine. She added that immunocompromised people are also overrepresented in breakthrough cases, and in particular, breakthrough hospitalizations.

"The good news is that the studies also show that many of these same groups had a much better immune response after three doses," Reimer said.

For residents of personal care homes, the situation is different.

Reimer said the initial data shows excellent protection from the vaccine for this group of people. She added that the immune response in the elderly may be somewhat weaker than in younger populations but is still high enough to be "very protective."

"In a normal immune system, after infection or vaccination, the first major marker of immune response is the development of antibodies," Reimer explained, saying antibodies prevent infection from occurring in the first place but are only part of the overall immune system response.

Reimer went on to say two other parts of the immune response are memory B-cells, which are responsible for making future antibodies, and T-cells, which find and get rid of infected cells after a virus enters the body. These take longer to develop but last longer than antibodies.

"For most people, this means that antibodies will decrease over time, but protection against infection, and even more so, protection against severe disease is handled by B-cells and T-cells going forward," she said.

Since it has been eight months since the province began administering vaccines in personal care homes, it is expected that residents may have lower levels of antibodies. However, the B-cells and T-cells are still providing protection and preventing severe disease.

"If we were not still in the midst of a global pandemic, perhaps we would be comfortable to depend on this cellular immunity," Reimer said.

"Unfortunately, there is still a lot of the virus circulating in Canada and around the world. So even a normal decrease in antibodies in a group that already had a somewhat weaker immune response could translate into more infections and more severe outcomes.

The province is not currently seeing increased rates of infection or severe disease in the general personal care home population. However, data shows that this is a possible risk.

Reimer added there is no clear evidence of waning immunity for the general population.

"Most of the data has been showing that for young, healthy people, there is actually zero benefit of getting a third dose at this time," she said, noting that this could change over time.

More information on third doses can be found online.