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Saving Lives, or Saving Vials?

BC has been and continues to be an outlier when it comes to COVID-19 pandemic management. Why? BC’s public health approach to the pandemic has differed from other provinces in many ways: from limited to poor data to no data at all, the worst excess mortality rate of all provinces, late first booster shots, and belated adoption and rollout of rapid antigen tests.

Now access to the 4th dose of the COVID vaccine in BC is the most limited in the country. 

In BC, the recommended minimum age for the second booster (or fourth dose) is 70 years or 55 years for Indigenous peoples. It is also restricted to those who are at least 6 months past their previous dose. There is a disincentive for individuals choosing to receive their second booster now, as they are told by public health that they will then not be eligible for the new bivalent vaccine potentially available this fall. Why are vaccine boosters being rationed while 225,000 are set to expire at the end of July?

Compare BC’s second booster eligibility to the rest of Canada:

 PEI: 12+ years old, 3-6 months after last booster

Quebec: 18+ years, 3 months or more after last booster 

Ontario: has just expanded availability to 18+ years from 60+, with a 3 months post booster interval for the immunocompromised and seniors or older adults living in congregate settings, for all others the recommended interval is 5 months 

Nunavut: 18+ years, from 4.5 months after last booster

Manitoba: 50 years and over,+ years, from 4 months after last booster

Nova Scotia, New Brunswick and Saskatchewan: 50+ years, 5 months after last dose

Yukon: 50+ years, 6 months after last booster 

NWT: 60+ years, 6 months after last booster

Alberta & Newfoundland: 70+ years, 5 months after last dose

Why the difference, we ask? 

Covid is the same disease with the same predictors of severe outcomes no matter which province you live in. 

Dr. Henry, BC’s Provincial Health Officer has repeatedly stated that ‘BC has its own pandemic.’ That is mostly true in terms of the consequences of bad, BC-specific public health policies, such as 

  • allowing Whistler to remain open in 2021, leading to the Canada-wide spread of the Gamma variant; 
  • early removal of mask protection during BC’s own version of the “best summer ever” resulting in a large Delta wave; 
  • slow introduction of masks in schools;
  •  a delayed rollout of the 3rd dose in LTC homes ahead of the fall Delta wave; 
  • and closing vaccine clinics for the winter holidays just as Omicron was taking off. 

Omicron has changed everything. 

Omicron is more contagious than prior variants, leading to rapidly evolving mutations giving rise to sub-variants that are each better at evading the antibody neutralization from both our current vaccines AND prior infections. Not only are reinfections more common now, they are occurring sooner than ever before. And we have recently learned that Covid reinfections are not necessarily benign. With each reinfection, there is the potential risk of Long Covid as well as an increasing risk of hospitalization, death and developing adverse health outcomes including heart and lung disease, and more.

Herd immunity is not possible with our current vaccines. 

Not everything is lost though, as vaccines have continued to protect against severe outcomes: hospitalizations, critical care admission and death. Vaccine protection does wane over time, dropping most rapidly against infection but also against serious outcomes. This was the reason behind BC’s 2022 spring booster rollout for seniors and clinically extremely vulnerable individuals. BC is now headed into our third Omicron wave of 2022 which is expected to peak in August. Our healthcare system is already in serious trouble. It cannot sustain repeated surges of hospitalizations from COVID. We must limit the added strain on our already stressed and burnt out health professionals and protect them against developing repeated Covid infections. If we don’t, who will be left to care for you at your next Emergency visit?

If vaccines are the only protection BC is willing to offer, why can't we get them?

Many healthcare workers are now seven months out from their third dose and must be protected immediately. The same holds true for many British Columbians who are now approaching the six month mark. It makes no sense to waste vaccines when British Columbians are putting their hands up for a fourth dose, and while many who can afford to are heading to the US to obtain one. The government should not be amplifying inequities.  

BC cannot wait until late fall for the updated Omicron booster. 

As we have learned, Covid is not a seasonal virus that peaks in fall and winter only, it is an every season virus: fall, winter, spring and summer. With the arrival of Omicron and the removal of all protections against viral transmission, sub-variants are now appearing in rapid succession.

Reference: Diego Bassani, PhD 

The BA.5 wave is here now and as evidenced by other European countries, United Kingdom and  Australia’s own experience, we should not underestimate its impact on society and healthcare. Waiting to vaccinate British Columbian in the fall is risky as new mutations will have appeared by then. Who knows how effective this new booster will be, let alone how many doses BC would be receiving and when? Governments and big pharma must immediately invest heavily in the development of COVID vaccines that are agnostic to specific variants and can provide lasting protection against both infection and severe outcomes. 

In the meantime, to follow Minister Dix’s suggestion to “adapt to the circumstances in front of us,” BC Public Health must immediately open access to second boosters for anyone 12 years and older and shorten the interval between doses to respond to the heightened epidemiologic risk we are now in. The punitive threat of withholding a fall bivalent booster from people who act now to refresh their waning immunity must be dropped; BC should follow Ontario’s lead and reassure its citizens that protecting themselves now doesn’t mean they’ll be left unprotected in the fall. 

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