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Editorial Cartoon by Graeme MacKay, The Hamilton Spectator – Thursday May 6, 2021

NACI is right about AstraZeneca. It shouldn’t be ‘unsettling’ to trust the public with uncomfortable information

The National Advisory Committee on Immunization is being pilloried for asserting that, while taking the AstraZeneca and Johnson & Johnson vaccine is still generally a good idea, their higher risk for blood clots means that certain Canadians would be better served by waiting for a Pfizer or Moderna vaccine.

Despite high-level accusations that the message is “misleading” or even “dangerous,” NACI is right: Different vaccines obviously carry different risks, and it would be irresponsible not to weigh those risks against the risk of contracting COVID-19. The only reason NACI’s messaging sounds “mixed” or “unsettling” is because Canadian public health authorities have spent this pandemic strenuously avoiding nuance or even the basic notion that the public can be trusted with uncomfortable information.

The controversy began over NACI’s latest vaccine recommendations saying that they “preferentially recommend” mRNA vaccines such as the Pfizer and Moderna shots. NACI drew the distinction because of emerging data showing that, in rare instances, viral vector vaccines such as AstraZeneca and Johnson & Johnson can potentially pose a risk of blood clots. On Tuesday night, for instance, Alberta confirmed the death of a woman in her 50s due to complications from the AstraZeneca vaccine.

For most Canadians, the life-saving benefits of COVID immunity clearly outstrip any blood clotting risks posed by a viral vector shot. Nevertheless, while NACI said that Canada should continue to roll out as many vaccines as quickly as possible, there may be instances, particularly among young people, in which it’s preferable to sit out the immediate prospect of an AstraZeneca shot in favour of a Pfizer shot down the road.

“NACI cautions that in age groups younger than 30 years of age, the benefit of offering a viral vector COVID-19 vaccine instead of waiting for an mRNA vaccine is not a certainty, especially in areas of very low COVID-19 activity,” reads the new recommendations, which also say that “an mRNA COVID-19 vaccine should be preferentially offered to individuals” over 30 unless they prefer to get vaccinated earlier.

David Naylor, a co-chair of the COVID-19 Immunity Task Force, told CBC on Tuesday morning that it was an “unsettling” message because it “suggests that you got the second-best vaccine.” Infectious disease specialist Abdu Sharkawy tweeted that it was “dangerous” to imply “vaccine superiority.”

While many public health agencies have been free to take a single-minded focus on COVID-19 prevention to the exclusion of other health considerations, NACI’s mission has always been to maximize the benefits of immunization while weighing its potential harms. In NACI’s own words, their mission is to assess “how best to use authorized vaccines to achieve the greatest public health benefits.”

Over the last 13 months, Canada has gotten used to public health authorities prescribing blunt pandemic restrictions with little to no explanation as to why. Seldom has a chief medical officer ever gone on TV to explain the latest science on outdoor transmission and then asked their citizens to decide for themselves if a BBQ with friends is worth the risk.

NACI’s approach is different. Rather than follow Ottawa’s line to “take whatever vaccine is offered to you first”, they told the truth: Despite mass immunization being the single most effective way to save lives and end this pandemic, it doesn’t mean every AstraZeneca shot is a good idea.

In saying this, NACI didn’t issue an unequivocal “yay” or “nay” on the safety of AstraZeneca, they instead drafted a detailed risk-assessment to allow the public to figure out for themselves if AstraZeneca now is preferable to Pfizer later. You’re middle-aged and living in a hard-hit area with overwhelmed hospitals? Take the shot. You’re 21, living in Prince Edward Island and you barely leave the house? It might be worth waiting for Pfizer or Moderna.

NACI is certainly not an antivax organization. The group is composed of volunteer medical experts who have spent decades studying effective immunization. It was NACI who was instrumental in recommending the four-month gap between vaccine doses that has allowed Canada to maximize its limited supply and significantly push forward the national timeline towards herd immunity.

In a pandemic that has repeatedly seen politicians urge the public to “listen to the science,” NACI is the Platonic ideal of career scientists making recommendations without worrying about political narratives.

And yet, Prime Minister Justin Trudeau is now openly telling Canadians to ignore the NACI recommendation and take the first shot they are offered.

New Brunswick education minister Dominic Cardy took it a step farther, telling his constituents Tuesday to “ignore NACI, ignore anti-masker, ignore the people undermining the faith in science.” (National Post)