Quebec will allow 90 days before the second dose of vaccine, more than double what the national committee advises



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QUEBEC – Quebec public health officials said on Thursday that provincial advisers had recommended an extended COVID-19 vaccination schedule for up to 90 days between the first and second dose – more than double what a National advisory committee had recommended a day earlier.

“In our context, this is the best strategy,” said Minister of Health Christian Dubé during a press conference Thursday on the progress of vaccination in Quebec.

Quebec announced at the end of December that it would delay second doses or “boosters” of the vaccine, but the province did not say until Thursday what kind of delay it had in mind.

Provincial authorities now say the second dose should be between 42 and 90 days after the first.

Such a schedule would allow the province to give the vaccine to more people who would otherwise have to wait for their first dose, health officials said.

A 90-day time frame is much longer than what was recommended by Pfizer (21 days, for its vaccine), Moderna (28 days, for its vaccine) and federal public health advisers in their recommendation on Wednesday (until to 42 days for both). vaccines).

However, that national advisory committee, called NACI, said on Thursday that the provinces have some leeway to make their own decisions and that they are not opposed to Quebec’s 90-day schedule.

Canada’s deputy chief public health officer Dr Howard Njoo said “exceptional circumstances” in some provinces may mean they must deviate from federal recommendations.

“It’s kind of the interplay between the actual epidemiology, on the ground, the fact that there is a clearly increased rate of cases, of hospitalizations,” Njoo said, and the vaccine guidelines.

EXTENSION BASED ON “ EXPERIENCE ”, NOT DATA, SAYS QUEBEC

So why is the province talking about 90 days?

Health Ministry adviser Dr Richard Massé said experts in Quebec believe immunity is likely to last longer than 42 days, as recommended by the NACI committee, but clinical trials are failing. are not extended beyond.

What they rely on instead is past experience with other vaccines.

“What we have is the experience of working with many vaccines,” said Massé. “Immunity is not something that is ‘on’ or ‘off’.”

While the Quebec health ministry said a single dose can provide up to about 90% effectiveness against the virus, Pfizer says a single dose is only 52.4% effective.

Massé told reporters that the discrepancy came from a different and more specific analysis of Pfizer’s test data.

He said Pfizer, when investigating the matter, had included people who had received their first dose but had not had time to develop immunity.

“It takes 12 to 14 days to have immunity,” Massé said. “If you count the people who contract the disease two, three, five days after receiving the vaccine, it is not really a failure of the vaccination because the immunity [hasn’t been built up]. “

An expert told CTV News this week that there were large variations in efficacy estimates due to the small sample size of people who only received the first injection in the Pfizer trial. This expert, Dr Donald Vinh, said that in his opinion the effectiveness is probably between 60 and 69 percent.

In a statement to CTV News, Pfizer Canada spokesperson Christina Antoniou reiterated previous statements that Pfizer had not evaluated the effectiveness of its vaccine over other dosing regimens.

“There is no data to show that protection after the first dose is maintained after 21 days,” she said.

“We recognize that recommendations on alternative dosing intervals belong to health authorities and may include adapting public health recommendations in response to changing circumstances during a pandemic,” she wrote.

But for Pfizer, “as a biopharmaceutical company operating in a highly regulated industry, our position is supported by the label and indication agreed with Health Canada and informed by data from our Phase 3 study.”

Minister Dubé said the province had spoken to Pfizer. On January 5, Pfizer told CTV News that Quebec did not notify the company before deciding to delay the second dose.

“We have had conversations with Pfizer,” said Dube, “to inform them of the reasons why we are making these decisions.”

Earlier this week, Premier François Legault said that in discussions with the federal government, the province learned there could be a risk of losing Quebec’s vaccine supply if Pfizer is not satisfied with its dosage regimen.

On Thursday, Pfizer’s statement said the company “remained[s] We are committed to continuing our dialogue with regulators, health authorities and governments, and to our ongoing data sharing efforts to help inform any public health decisions aimed at defeating this devastating pandemic. “

Massé and Dubé have said they hope for an increased supply as they would favor a shorter delay before the second dose if the province’s vaccine shipments increase.

“Saving lives is a moral imperative,” Dubé said.

“The more doses we have, the more we can reduce the time between the first and the second dose.”

NEXT STEPS IN VACCINATION IN QUEBEC

With around 65% of CHSLD residents having already received a first dose, Dubé said Quebec will begin vaccinating residents of private seniors’ residences (RPA) on January 25.

He said that with an extended schedule between the first and second dose, the province may also consider vaccinating the general elderly population earlier.

With new vaccine shipments arriving in the province this week, Dubé said 115,000 people have now been vaccinated.

In total, the province has received 162,000 doses to date. Dubé says Quebec is on track to increase that total to 250,000 in February.

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Will delaying the second dose of the vaccine for 90 days work? Dr. Caroline Quach is an epidemiologist and head of the infection prevention and control unit at Saint-Justine Hospital, member of the National Advisory Committee on Immunization.

–With files from CTV’s Kelly Greig

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