NACI chair responds to criticism, notes months left in her mandate

Omicron-targeted vaccines going into arms in Ont. The first Omicron-targeted booster is going into arms in Ontario and is now available for everyone 18 years of age and up.

OTTAWA — Chair of the National Advisory Committee on Immunization (NACI) Dr. Caroline Quach-Thanh says she has no regrets about the series of recommendations her panel of medical experts have offered in recent weeks, amid criticism from some that the moving of goalposts has led to confusion and unnecessary concern among Canadians.

In an interview on CTV’s Question Period, Quach stood by the work the panel—which advises the federal government on vaccination—has done throughout the pandemic, and opened up about the challenges it has posed as she prepares to wrap up her term at the helm of the committee.

“Looking in your rear-view mirror you always have a 20-20 vision, but moving forward you have to, you know, make educated guesses as to what's going to come, what data you're going to have, and we really make these recommendations keeping at heart the wellbeing of the Canadian population,” Quach said.

On Tuesday, citing new information and real-world evidence, NACI expanded its recommendation for the use of the AstraZeneca vaccine to include people 65 years of age and older. The agency changed course in stating the two-dose viral vector vaccine can and should be given to seniors, which is consistent with the terms of the regulatory approval issued by Health Canada when the agency first authorized the vaccine in February.

NACI’s change of guidance was a pivot from advice issued earlier in March against administering the AstraZeneca vaccine to Canadians 65 years of age and older, due to a lack of data about its efficacy in older populations. This prompted some concerns from people unsure whether this meant the vaccine was less safe, which health officials have since sought to clarify.

In separate guidance this month, NACI advised that the window between shots for all three of the two-dose vaccines—Pfizer-BioNTech, Moderna, and AstraZeneca—can be delayed by up to four months while still being effective, to allow Canada to maximize the number of people being immunized. As a result, second shot appointments are being pushed back or scheduled for much later than the window of time the pharmaceutical companies have suggested.

Reacting to Tuesday’s developments with the age groups being recommended to receive AstraZeneca Ontario Premier Doug Ford voiced his frustration with having to keep up with NACI’s continuously evolving advice.

“I can't begin to tell you the logistics behind it. It just messes everything up to be very frank with you. It's good news that they can you know, can go older than 65 but man, we have everything set up, get everyone lined up, and all of a sudden without notice today, now we can move the goalpost again,” Ford told reporters. “So now we have to change everything. It's not easy.”

Responding to this, Quach said that if they knew more data would come out in the days following NACI’s initial AstraZeneca guidance, they would have likely held off, but overall she has no regrets.

“I understand that some people may not be happy but… this is to me the best thing that could be done. I don't have any regrets on the recommendations we've made so far, and we're trying to you know, keep the highest standards in terms of rigor and transparency and accountability. There's nothing else that I can do, if I know that we've been doing our job well, then the outcome is fine,” Quach said.

Earlier this week Quach acknowledged that the way NACI’s advice had been communicated could have been improved with additional support from the Public Health Agency of Canada, which she said has since “recognized that the support was absolutely necessary."

Speaking to the reasoning why the guidance from NACI is not always consistent with what Health Canada has stated, Quach emphasized the independence of the panel, and as it has been designed, is meant to be at arms-length from the federal health agency.

“If you want that independence, then you need people who are on the ground doing other things. It also adds some insight into the decisions you're making because if you're only sitting in your ivory tower, it's harder then, to relate to what's actually happening,” she said.

The infectious diseases, immunology, pharmacy, epidemiology, and public health experts who make up this advisory body are considered arms-length to the government. The panel makes recommendations to the Government of Canada for the use of vaccines approved for use in Canada based on analysis of “the best current available scientific knowledge at the time.”

The body has been in existence since 1964 advising on various new vaccines, but since the onset of the pandemic, it has been predominately focused on COVID-19 vaccines and the prioritization of them. It reports to the Infectious Disease Prevention and Control Branch of the Public Health Agency of Canada.

Quach was candid in stating that NACI members, who all have full-time jobs outside of the work done for the advisory committee, are “exhausted.”

“Between the number of emails that come in to tell us that people don't agree with what we've been doing. The, you know, various media interviews, all the explanation we have to give, the communication, and also of course you know looking at the data and making recommendations on top of research, family life, and clinical practice or public health, it's actually quite consuming,” she said, noting that her time as chair will be coming to an end in June.

“I have 85 days left in my mandate as chair of NACI and then it will be someone else, but it has been a tough year,” she said in the interview taped on Friday.