Vaccine plan `political decision': expert

A top Montreal infectious-diseases expert and member of the National Advisory Committee on Immunization says Quebec took “a political decision” — and not a scientific one — in delaying the second shot of the COVID -19 vaccine by 90 days.

Dr. Caroline Quach, of Ste-justine Hospital, and her colleagues on the federal committee recommended on Jan. 13 that the second dose of the Pfizer-biontech vaccine be administered within 42 days.

However, Quebec is planning to start giving second doses in the week of March 15, 90 days after some residents of the Maimonides Geriatric Centre in Côte-stluc received their first shots. The government is basing its plan on the scientific advice of the Institut national de santé publique du Québec (INSPQ) that the booster shot could be delayed beyond the 21 days mandated by Pfizer's protocol.

However, the two INSPQ advisories reviewed by the Montreal Gazette — published on Dec. 30 and Jan. 15, respectively — do not mention a specific time frame for the delay, let alone giving second doses at 90 days.

“It's not the INSPQ that made that decision,” Quach said in an interview. “It was the government.

“I think it's more of a political decision than anything else. I guess they looked at how many doses they had.”

Quach added the federal committee set a delay of up to 42 days based on the data collected by Pfizer and Moderna, the maker of another vaccine, from their clinical trials.

“We went for 42 days because the two trials — Pfizer and Moderna — had their second dose given to participants up to 42 days,” she explained. “So we didn't have any more data.”

The day after the Gazette first reported that Quebec's vaccination plan ran contrary to the federal guidelines, Health Minister Christian Dubé held a news conference to defend the 90-day delay.

“With the recommendation made by public health to delay the second dose by up to 90 days, that will allow us to vaccinate more rapidly the residents of (private seniors' homes), because they will come after our health-care employees and the CHSLDS,” Dubé said at the time, alluding to longterm care centres.

Dubé was flanked by Dr. Richard Massé, a public health adviser to the government, who said the decision to extend the interval for the second dose from 21 days, as recommended by Pfizer, to 90 days was based on the “experience of working with many vaccines through time.”

Massé added that experience has shown vaccine immunity in general does not suddenly wane in a month or two. However, he pledged Quebec would monitor the effectiveness of the first shot during the 90-day period, and if there were evidence of subsiding immunity among the elderly, they would be administered the booster shot immediately.

The decision to postpone the second shot comes amid limited global supply of the vaccines. To date, Quebec has given first doses to 218,755 people, including the residents of CHSLDS and health workers. That represents 2.56 per cent of the Quebec population.

Marjaurie Côté-boileau, Dubé's press attaché, denied the decision to put off the second dose was political.

“We have listened to the recommendations of public health on the issue of the time between the first and the second dose,” Côté-boileau said in an email. “This is a public health decision. It is in no way political.

“Now, it is important to remember that we are going to give this second dose,” she added. “The 42to 90-day delay was recommended by public health because we needed to kick-start now and vaccinate as many vulnerable people as possible as quickly as possible. In the context where we have very few doses of vaccine, this is the best strategy to adopt.”

However, the families of those who live at Maimonides, where seven residents tested positive for COVID-19 after receiving the first dose in December, have been demanding the second shot be given immediately.

The issue of delaying the second dose has become more complicated amid reports of three more transmissible variants: B117 (circulating in the United Kingdom), B1351 (in South Africa) and P1 (in Brazil).

On Friday, British Prime Minister Boris Johnson suggested the B117 strain may be more deadly. That strain has been detected in a COVID-19 outbreak in a Barrie, Ont., long-term care centre, and five cases confirmed in Quebec.

South Africa's leading vaccine expert, Barry Schoub, has criticized England for being the first country to delay the second dose, warning this could put people at greater risk because of the emergence of the more transmissible variants.

Quebec appears to have been influenced by the British government in its decision to delay the second dose. On Jan. 6, the U.K.S Joint Committee on Vaccination and Immunization recommended a maximum interval of 12 weeks — or 84 days — between the first and second doses, based partly on the “evidence from the use of many other vaccines.”

When Premier François Legault announced on Jan. 6 the government would impose a curfew to counter a COVID-19 resurgence, Dubé unveiled the 90-day delay in a chart — a week before his public-health adviser, Massé, discussed it publicly.

(The delay) was recommended by public health because we needed to kick-start now and vaccinate as many vulnerable people as possible.