Sunday House Call, #773, January 17, 2021: “Please sir, can I have some more?”

With the shortage of vaccines or at least the reduction in vaccine delivery to Canada, we are faced with several issues. I want to preface this by saying that on all levels of government, health professionals, health bodies, etc., there is a genuine goal to help all Canadians to safeguard their health. What I want to talk about is the decision-making process and thinking that should be subject to a certain level of scrutiny.

The first is do we give the first dose of a vaccine to his many people as possible hoping that we receive enough to provide them with the second dose? The assumption is that, as I talked about last week, certain models indicate that more people will be protected by giving the first dose. However, there were caveats to this and it was a thought exercise and mathematical model and did not reflect what is going on in the world on the ground right now.

Secondly, if we decide to do this, we are engaging in a mass clinical trial without the consent of the participants. There is no control group to know whether this will be helpful or determine the outcome.

Thirdly, as I discussed, we do not know the impact of delaying the second dose with respect to clinical outcomes, saving lives, reducing morbidity, etc.  because the evidence is scant. Indeed, Pfizer has remained firm recommending that the dosing should be three weeks apart.

They are probably doing this for two reasons; They want to stick to the evidence, and secondly if they agree with the delayed second dose and it does not work, their reputation with be in tatters. People could have been harmed and suspicion about the whole vaccination study and clinical trial process will be put into disrepute and discredited in the eyes of the public.

Fourthly, it is somewhat ironic that governments that profess to follow the evidence now seem to be basing their decisions on assumptions.

So, what I ask you since we are going to be the ones receiving the vaccines, how do we want the vaccination rollout to proceed?

With the stakes so high, do we take the risk of a single vaccine dose with an extended interval for the second that seems to vary between a maximum of 42 days to 90 days to incompletely protect more people, or do we take the safer route following the recommendations of the vaccine manufacturers and stick to the dosing intervals thereby ensuring people are maximally protected?

My view is that I prefer to take the route that has the best evidence for it. It seems ethically questionable to subject people to what amounts to an uncontrolled clinical trial during the pandemic based on an assumption that the increased dosing interval will not cause harm but without hard evidence to show support it. Public confidence in their health professionals and governments will be severely compromised if there is a bad outcome to this decision. Do we want to take a chance with the law of unintended consequences?

This is not an academic exercise under controlled conditions. If you are wrong, there are very real-world human consequences.

Show Resources:

How effective is a single vaccine dose against Covid-19?

Alternative Dose Allocation Strategies to Increase Benefits From Constrained COVID-19 Vaccine Supply

Pregnant, breastfeeding and immunocompromised people no longer excluded from getting COVID-19 vaccine in Ontario

Your Calls:

  • Can I get the coronavirus vaccine if I am taking immunosuppressant medication?
  • A 70 year-old man with diabetes asks if he should get the pneumococcal vaccine Prevnar-13 (yes)
  • What is the difference between phlegm and mucous?
  • A caller asks if her husband should get the coronavirus vaccine if he has had a splenectomy.
  • Can an immunocompromised person receive live attenuated vaccines?(No)
  • Can a person taking Plaquenil have the coronavirus vaccine (yes)
  • If a person is acutely ill, should their coronavirus vaccine dose be deferred until they have recovered?