What’s Good, Not So Good and a Little Bit Confusing This Week

What’s good is that vaccines have been rolling out rapidly in City clinics this week, Health Canada has approved Pfizer for anybody 12 and up, and the federal science body dispensing immunization advice has provided greater clarity on the relative merits of the two types of vaccines.

What’s not so good is that those who don’t yet have appointments may have trouble getting one soon. And a lot of people don’t like it when scientists give nuanced answers to complex situations.

Vaccine Availability

When the Premier announced last week that increasingly lower age groups would, in rapid succession, be eligible to book vaccine appointments this month, he did so without matching that with the timing of vaccine availability. The City, whose clinics operate through the provincial booking website, heard that news through a press conference.

The plan for who can get vaccinated when is changing frequently, but you can find the latest details here. In short, those 40 and up are scheduled to start booking the week of May 10, 30 somethings are supposed to start the week of May 17, with anyone 18 and up eligible the week after. With Health Canada approving Pfizer for anyone 12 and up this week, there is some expectation that this age group could be added by summer.

The City’s nine clinics, meanwhile, are already mostly booked up until the middle of June, even with additional appointments opening up next week.

To recap who does what, the federal government buys vaccine and distributes it to the provinces; the Province distributes its vaccine supply to municipalities, hospital partners, pop ups, and pharmacies, decides who is eligible to book an appointment, and sets its website accordingly; the City takes the supply it is given and administers doses, mostly in its nine mass immunization clinics.

If the Province sets expectations that are not co-ordinated with supply, there is nothing the City can do about that except to ask for more vaccine – which it is doing. For the past two weeks, Ontario has been giving the Toronto and Peel hot spots 50% more than their per capita share. That is allowing both municipalities to make major strides in dousing the fire.

The Province’s advisory panel has asked for that extra allocation to continue for another two weeks. If the Province says yes, that will allow us to expand our clinic capacity to allow a lot more bookings; if the answer is no, we may be into a temporary booking logjam.

In any case, a larger vaccine supply is expected for June, which would open things up towards the end of that month. But, by then we also need to give priority to those needing their second shot within the proscribed 16 week maximum between doses.

Anyone looking to book an appointment should try to do so the earliest day they are eligible, at toronto.ca/COVID19. Your chances of an early appointment are better if you’re willing to travel a bit. Please note that it is possible to change an appointment if you later find one sooner or closer; the website will automatically make your cancelled appointment available to someone else.

Which Vaccine to Get

For months, we have been hearing that the best vaccine is the one you can get in your arm first. That’s what most health officials and political leaders continue to say because it is 1) Generally true 2) Nice and simple, and 3) Avoids the chaos that could ensue if people start shopping for vaccines.

But this week, the National Advisory Committee on Vaccination (NACI) changed the messaging with its declaration that some vaccines are slightly better than others.

Canada has approved two mRNA vaccines – Pfizer and Moderna – and two more using more traditional technology – AstraZeneca and Johnson & Johnson. Here’s what we know about both types.

  1. All four have been declared safe by both Health Canada and NACI – and there is a wealth of data from the hundreds of millions of doses worldwide which supports that conclusion.

  2. All four are effective at greatly reducing COVID transmission, and highly effective at preventing hospitalization and death.

  3. Extremely rare cases of a rare form of blood clot have been associated with both AstraZeneca and J&J. The incidence is thought to be about one case per 100,000 doses.

  4. While both AstraZeneca and J&J have high rates of efficacy, those for Pfizer and Moderna are even higher.

So, on a comparative basis, Pfizer and Moderna come out slightly ahead. This prompted NACI to make the controversial announcement that, depending on your personal situation, you might want to wait for an mRNA vaccine.

In other words – if you have equal access to both, go for Pfizer or Moderna; if one type of vaccine is more available than the other, consider how much sooner can you get it? Those with no exposure to risk either in or outside the home might want to wait a short time; those who live or work in a high-risk setting should take the first shot available.

This advice did not sit well with those who think giving people facts and letting them make their own calculations is a bad thing. And, to be fair, anything but simple messaging carries a risk that some people will think they heard that some vaccines aren’t safe.

As experts are quick to state, your chances of COVID-related death or medical complications, including blood clots, are many times higher than any risk associated with vaccination.

I think Canadians should feel reassured that our experts provide such careful scrutiny and thoughtful advice.