British Columbia's Sixteen Week Decision.

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Update, Fri March 5th: The single shot J&J vaccine has been approved in Canada

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When we first heard about British Columbia's decision on Monday to maximize the first jab coverage of the COVID vaccines by extending the time to boost to four months on Monday we also heard that, despite Bonnie Henry's foreshadowing, the National Advisory Committee on Immunization (NACI) did not yet support the change:

...Henry said the B.C. CDC has been exchanging data with colleagues across the country and similar results are coming from Quebec, as well as from the U.K., Israel and other countries.

She also said the National Advisory Committee on Immunization (NACI) has been looking at the issue and will be issuing a statement on the matter in the near future.

As of (Monday) March 1, however, the advice NACI is providing on its website says that the interval between the first and second shots of the Moderna vaccine should be four weeks, the interval for Pfizer should be three weeks and the interval for the Oxford-AstraZeneca vaccine should be 12 weeks...


Well, that all changed yesterday, Wednesday, March 3rd.

First, in the morning, Justine Hunter and Ivan Semeniuk of the Globe and Mail published a piece saying, on the basis of statements from un-named sources, that NACI was going to change its recommendations:

An expert panel that advises the federal government on vaccination has determined that second doses of COVID-19 vaccinescan be given up to four months after the first, two sources say.

The shift from the National Advisory Committee on Immunization (NACI), which previously supported extending the interval between doses to no more than six weeks, would open the door for more people to receive their first vaccination while supplies are still limited. It would also lend support to other provinces to follow the new vaccine schedule B.C. adopted on Monday...

Then, later in the day on Wednesday, NACI made it official on their website:

• NACI recommends that in the context of limited COVID-19 vaccine supply, jurisdictions should maximize the number of individuals benefiting from the first dose of vaccine by extending the interval for the second dose of vaccine to four months.
  
  
• Extending the dose interval to four months allows NACI to create opportunities for protection of the entire adult population within a short timeframe. This will not only achieve protection of the adult population, but will also contribute to health equity

So.

What is the actual evidence that this will work?

Well, while NACI notes that there is real world evidence of efficacy of the first shot working for periods that extend past what was originally done in the phase III trials, they also explicitly state that the data for 16 week evidence of efficacy is not yet there:

• While studies have not yet collected four months of data on vaccine effectiveness after the first dose, the first two months of real world effectiveness are showing sustained high levels of protection

Here in B.C. our public health folks at the CDC have generated some of that first shot efficacy data in local long term care facilities as we noted earlier.

In addition, there is more of that real world evidence being generated in other jurisdictions such as the U.K., as reported by the British Medical Journal on Tuesday.

Having said that, there really are no four month data yet which means that monitoring will really matter (see below).

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Now, some will note that Anthony Fauci down south is still recommending that his country people to stick to the original specifications of the vaccine manufacturers for the timing of the second dose. However, it is important to further note that the U.S. has a whole lot more vaccine than we do which is precisely the matter at hand as Bonnie Henry reinforced on Tuesday.

The key here in Canada can likely be found in another bullet point from the NACI update:

• NACI will continue to monitor the evidence on effectiveness of extended dose intervals and will adjust recommendations as needed.

Personally, I hope that we hear more detailed specifics about how that monitoring will be done, both nationally and provincially, to ensure the best outcomes possible.

I also hope we have a Canadian decision on the single shot J&J vaccine, which has been approved in the U.S., as soon as possible (see update at top of post) given that increases in supply will make it easier to 'adjust' those 'recommendations' noted by NACI above to the best effect for everyone.

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Tip 'O the Toque to longtime reader Booey for reminding me of A. Fauci's position.

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