Sabrina Maddeaux: Scrambling Canadians should be furious booster shots were dismissed for months

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It’s OK to be furious right now. In fact, you should be. It becomes clearer by the day just how badly everyone from the National Advisory Committee on Immunization (NACI) to provincial premiers and public health officials bungled our pandemic response just when something resembling an end to this madness and tragedy was in sight. It didn’t have to be this way.

It seems little to nothing was learned from the pandemic’s first four waves. Chief among these failed lessons is the fact Canada isn’t exceptional. Science that’s true in other countries is also true here. We aren’t some Narnia-esque land of superior immunity, better health care, and Dudley Do-Rights. This is why it’s near inexplicable that Canada didn’t offer the majority of its population boosters when just about every other peer country was doing so.

The organizations and officials that refused to supply them and promoted so-called caution to the point of recklessness will now fall back on the old refrain “science evolves.” Sometimes, it does. But what we’re dealing with here hews much closer to public health malpractice.

Imagine if provinces had offered adults boosters at the 12-week mark back in September. Or even at the five or six-month mark in November or early December. This wouldn’t have been some radical jump ahead of science; the United States, United Kingdom, Israel, Germany, and France were all confidently well ahead of us.

The U.S. Federal Drug Administration (FDA) approved boosters for those 65 years and older in September, followed by all adults in mid-November. Britain’s National Health Service (NHS) started the process of vaccinating all adults over 50 in September, meanwhile Israel was aggressively pushing boosters to anyone over the age of 12. Germany recommended boosters for at-risk and elderly citizens way back in August, followed by all adults in November. Meanwhile, NACI didn’t get around to recommending boosters for adults over 80 years old until the very end of October, and finally got to individuals over 50 in December. Every step of the way, Canada was weeks, if not months, behind peers in fighting a virus where every day counts.

With Canada’s high vaccine acceptance rate, it’s very likely a large portion of the population would’ve received a third dose by now –– not by playing a medical version of the Hunger Games to track down scarce doses, but in an organized, calm fashion over a matter of months. With high enough uptake, those with truly poor immune responses to the initial doses may’ve been able to opt out. Instead, they’re faced with yet another Sophie’s choice.

Had this happened, Omicron would not be the threat to Canada it is today. We likely wouldn’t be talking about closures, lockdowns, and overwhelmed hospitals delaying surgeries yet again. May we still have needed some restrictions or protective measures to combat this new variant? Possibly, but they’d almost certainly be less draconian, with less impact on mental health and the economy. Even more importantly, fewer people would get sick, and likely fewer would die.

Worse than not providing boosters to those who wanted them, many Canadian health authorities and politicians actively undermined the messaging on third doses. Too often, public communication didn’t say “we don’t know yet,” but rather “you don’t need these.” Ontario “saluted” the supposed finished work of its vaccine taskforce before disbanding it. Its remaining campaign to reach individuals who hadn’t yet received a first or second dose was dubbed the “Last Mile Strategy.”

It’s entirely understandable why the average person thought they were done with vaccines and the pandemic was in the rearview mirror. What’s not clear is why politicians and public health officials who should’ve known better pushed this narrative. Perhaps it was wishful thinking; perhaps it was better for their polling numbers and donors. Either way, it was a colossal abdication of responsibility.

In their September report on boosters, NACI was decisive that the primary vaccine series for COVID-19 consisted of two doses of the Pfizer-BioNTech, Moderna or AstraZeneca/COVISHIELD vaccines (or any combination thereof), or one dose of the Janssen vaccine. They lectured on the importance of distinguishing between primary vaccine series doses and booster doses, and insisted that only immunocompromised individuals should receive a third dose –– and even then, they were iffy. “There are currently no data on the efficacy/effectiveness of an additional dose of a COVID-19 vaccine following a 1- or 2-dose primary series in individuals with immunocompromising conditions,” read the report.

By the end of October, their tune sounded less certain. In a newer report, NACI finally acknowledged “there is scientific debate about whether a third dose for COVID-19 truly constitutes a booster dose in the traditional sense… over time, what defines an optimal primary series could also evolve and be refined. Historically in other vaccine programs, it can take years of post-market use to determine the optimal intervals and dose number needed for a complete primary series to sustain long-term protection.”

To be clear, none of this –– not the scientific debate, and certainly not the historical track of vaccine programs –– was breaking news. They had the same information back in September when they pooh-poohed the notion of a three-dose series. Still, in October, they didn’t recommend third doses for anyone but the most immunocompromised.

Then, in early December, NACI released its most recent booster report. This one reads, “Cases of COVID-19 are increasing and variants, including the Delta variant, are circulating in Canada and in various parts of the world. A new variant of concern, Omicron, has also recently been detected.” Finally, they recommend boosters for people aged 50 and older. They also recommend a booster dose be “offered to adults 18 to 49 years of age at least six months after completion of a primary COVID-19 vaccine series.”

There’s plenty of blame to go around as to why boosters weren’t widely offered following this report, even though NACI’s language was less than urgent. It wasn’t a regulatory issue; Health Canada had approved boosters for all adults as of November 9. Premiers dragged their feet on bolstering booster capacity, reopening mass vaccine clinics, and communicating to the public that they would, in fact, need third doses and quick. This would’ve been unforgivable at any time, but was especially so as cold temperatures pushed people indoors and the highly social holiday season approached.

Mere weeks later, Canadians have been thrown into booster chaos. Ontario only approved boosters for all adults over the age of 18 last week, and that’s only in theory. In reality, many won’t see an actual needle until late January or February. They’re being shouted at for not understanding all along that it was a three-dose vaccine and being told their anger and frustration at authorities is counterproductive. There’s talk of changing the definition of “fully vaccinated,” which could impact vaccine passports. How could the average person not have a bad case of whiplash?

Not only was the decision to delay and downplay boosters bad for public health, it was bad for public trust. Canadians as a whole have been exceptionally understanding and forgiving of officials through the pandemic, but it seems their goodwill has reached its limit. Their fury isn’t misplaced; it’s been wholly earned. When this wave eventually passes, that anger should be channelled to force politicians and health officials to answer for Canada’s disastrous complacency on boosters.

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