Should Canada revisit its booster strategy in the face of a new variant?
NORTH BAY -- As the world reacts to the emergence of a new COVID-19 variant first detected in southern Africa, questions are being asked about what this means for the vaccine's effectiveness — and whether access to boosters should be expanded.
Even before omicron arrived on the scene, Toronto physician and clinical researcher Dr. Iris Gorfinkel says vaccine boosters needed to be given out far more widely than they currently are.
Gorfinkel told CTVNews.ca in a phone interview that it remains difficult for people to access booster shots, in some cases because of existing age limits — for example, the current cut off for Ontario residents is 70 unless other conditions are met.
"Now we have omicron and suddenly the bar is raised. No, the bar was raised even prior to this," Gorfinkel said.
"We needed to be more aggressive right from the get go."
Governments, health officials and global markets responded swiftly on Friday to the news that omicron — named after a letter in the Greek alphabet and previously called "B.1.1.529" before it was renamed by the World Health Organization — had been classified as a variant of concern.
That same day, Canada suspended the entry of all foreign nationals who have travelled through southern Africa in the last 14 days.
As well, anyone in Canada who has travelled through the region in the past two weeks has been asked to get tested and remain in quarantine until a negative test result is received.
Canadians and other permanent residents returning from the region through another country must receive a negative test in the third country.
BOOSTERS AS A SOLUTION 'PREMATURE'
Dr. Fahad Razak, an epidemiologist at St. Michael's Hospital in Toronto, emphasized during an appearance on CTV News Channel on Saturday that there is still a lot that is unknown about the variant, including whether it is more transmissible, more severe, or if it can escape immune protection either from vaccination or a previous infection.
"There's really no evidence to link boosters specifically to protection against this variant and I think there's a lot of other steps we need to take first, and it would be premature, I think, to jump immediately to say, 'OK, boosters are our solution,'" Razak said.
He added that the importance of other public health measures remains, including proper air ventilation and filtration, mask-wearing and vaccinations.
"Rolling out boosters, I think, is not the initial step that needs to be taken," he said. "Now, it could very well be important very soon and it could be important for other reasons related to waning immunity, but it specifically is not the answer to the omicron variant."
Speaking on CTV's Power Play on Friday, Dr. Isaac Bogoch, an infectious disease specialist who sat on Ontario's COVID-19 vaccine distribution task force, said there isn't enough information on how omicron behaves.
Asked about the need for boosters, Bogoch said, while speculative, it would be "extremely unusual for the vaccines to be rendered useless just because a new variant emerged in one particular part of the world."
"So said another way, it's very likely that the vaccines still provided very reasonable protection," he said.
"Of course, this is speculation, of course we need to do the right tests to determine if that's true, and variant of concern or not there already is room in many parts of Canada to expand eligibility to third doses. We should have been doing this in some parts of Canada regardless of this news coming from southern Africa."
Cynthia Carr of Epi Research Inc. in Winnipeg also told CTV News Channel on Friday that the question of boosters will matter depending on whether a new version of the vaccine is needed, similar to influenza.
"So it's not about waning immunity, it's about changes," she said.
"So we'll need to understand does the immune system have enough information from the current vaccine to fight against this new variant, or is it just too weakened and that we would need to look at a new version of the vaccine, as I said as we do with influenza each year, and we will learn that as this proceeds."
WHAT WE DON'T KNOW 'MORE CONCERNING'
The concern, as expressed by the WHO, is that the variant has a large number of mutations, with preliminary evidence suggesting an increased risk of reinfection compared to other variants of concern.
The mutations appear to be in the spike protein, which the body's immune system uses to detect the virus, potentially raising the possibility that the variant could evade immune protection.
Many experts agree that more information is needed. Experts in South Africa have advised that some infected people have displayed no symptoms, similar to other variants.
As of Nov. 20, 86 per cent of Canadians aged 12 and older have received two doses of a COVID-19 vaccine, although vaccine eligibility was expanded this month to those aged five and older.
On Friday, Canada's chief public health officer, Dr. Theresa Tam, said there are no indications that the variant is present in the country.
While Canada's approved COVID-19 vaccines have demonstrated high levels of effectiveness, Gorfinkel says it's unclear how long immunity lasts and suggested full vaccination may in fact require three doses.
"It's what we don't know that is actually more concerning," she said, adding she believes chances are that the variant is already in Canada.
Gorfinkel also has appealed for a national vaccine registry and pointed to the number of unused, and wasted, vaccines in Canada.
An informal survey by The Canadian Press this month found that at least one million doses, or about 2.6 per cent of Canada's COVID-19 vaccine supply, have gone to waste since they first arrived last December.
With the onset of winter, people will be spending more times indoors together, especially over the holidays next month, and the added concern is the effect this will have on those whose immunity has waned since their second dose.
"What if you're starting at less immunity because you're older and have pre-existing conditions? Houston, we have a problem," Gorfinkel said.
COUNTRIES REPORT CASES
AstraZeneca, Moderna, Novavax and Pfizer have said they have plans in place to adapt their vaccines.
Meanwhile, several countries have already reported cases of omicron.
U.K. Prime Minister Boris Johnson on Saturday said the country, after finding two cases of the variant, would "boost" its booster campaign in response.
Health Canada has approved the Pfizer-BioNTech and Moderna mRNA vaccines as boosters for anyone 18 and older, six months after finishing a two-dose regimen.
Canada's National Advisory Committee on Immunization (NACI) has recommended provinces offer boosters to anyone aged 70 and up, along with those who received two doses of the AstraZeneca vaccine or one dose of the Janssen vaccine, as well as adults in First Nations, Inuit and Métis communities.
Provinces and territories, which are responsible for vaccine programs, have since adopted their own booster plans. Some have aligned with the NACI recommendations, while others such as Manitoba have allowed anyone 18 and older to get a shot.
No one from Health Canada or the Public Health Agency of Canada was available Saturday for an interview.
A spokesperson pointed to a news release Friday on the new border restrictions, as well as a previous statement from the Council of Chief Medical Officers of Health that reads in part: "Given there is currently no evidence of widespread waning of protection against severe disease in the general population who have been vaccinated against COVID-19 in Canada, boosters for this group are not required at this time but we will continue to monitor vaccine effectiveness and other data to inform the need in the future."