B.C. will roll out fourth COVID-19 boosters to those age 12 and older in the fall, with some exceptions for those close to the current age and medical eligibility criteria who want one now.
The province has so far made fourth doses available to people age 70 and older in long-term care and assisted living and in the community, Indigenous people age 55 and older and those who are clinically extremely vulnerable.
B.C. Health Minister Adrian Dix made the announcement about the fall booster rollout for those not currently eligible on Friday.
The fall “bi-valent” Moderna and Pfizer booster will target the Omicron variant, unlike the current vaccine, which targeted past variants. B.C. is waiting for the vaccines to be approved by Health Canada to roll out its fall boosters.
The province’s fall booster program is based on recommendations by the National Advisory Committee on Immunizations and chief public health officer Dr. Theresa Tam.
Penny Ballem, executive lead of B.C.’s immunization program, said it’s best to wait until fall for the next booster. “But if you really feel that you’ve got special circumstances, you can give a call centre a call and we will arrange for you to have a booster.”
As with previous vaccine rollouts, advisories about the fall program and then invitations to book a shot will go out by age group, starting with older British Columbians not yet eligible for a fourth dose.
The province’s invitation system can send out 40,000 invitations a day and will start to do so on Monday.
Dix said the province’s number-one priority is protecting people, especially those at highest risk of severe illness or death. “B.C. has followed advice from public health since day one and implemented measures to protect those living in long term care, elderly populations, and those who are clinically extremely vulnerable.”
Dr. Martin Lavoie, deputy provincial health officer, warned hospitalizations with COVID-19 have been rising, driven by Omicron subvariants, with the most vulnerable being those age 80 and older.
The Omicron subvariant BA.5 is on the rise and likely to become the dominant subvariant, he said.
Sixty-six per cent of British Columbians have had two shots and a first booster, but about 1.3 million have not yet received their recommended third shot.
“Right now it’s very important to have received all the doses that are recommended,” said Lavoie.
Prior to Friday’s announcement, infectious-disease specialists who back B.C.’s focus on promoting third COVID-19 shots and delaying fourth boosters until the fall blamed poor messaging for public confusion and anxiety and said it will only breed mistrust in the immunization program.
Nanaimo infectious disease specialist Dr. David Forrest said he agrees with B.C.’s plan to encourage people to get their overdue third-shot boosters — for the greatest protection against severe illness and death — and to delay fourth boosters until the fall, when it’s expected there will be a larger wave of infections and an Omicron-targeted vaccine.
While the current vaccine won’t prevent against infection from Omicron, a third dose has preserved its ability to prevent severe illness, said Forrest. “Even though there’s a new variant circulating, it seems you’re still well protected from serious illness, which is what the vaccines are designed to do — not prevent infection.”
Forrest said since the fourth dose is targeted to an earlier variant, the immune system’s “memory” will be tuned to that original version of the virus and possibly unable to mount a more effective response to subsequent infections.
“So the other value in delaying giving everybody the fourth booster dose may be if there’s an Omicron-specific vaccine coming out, that by delaying things you may stimulate an immune response to the new antigens.”
Infectious-disease expert Dr. Isaac Bogoch says many communities and individuals are under-vaccinated “and that’s the elephant in the room.”
“Let’s get third doses into the eligible population,” said Bogoch, a professor at the University of Toronto.
It’s clear the fourth dose is most needed by those who are at risk of significant illness, those on the older end of the spectrum, and for people with underlying medical conditions that would put them at greater risk for severe infection, he said.
“These are the people who would benefit from a fourth dose,” said Bogoch.
Infectious-disease specialists worry public-health policy around immunizations will be driven by polarizing social-media campaigns, not science. Doctors have told the Times Colonist that patients here are flying to the United States to get their fourth boosters.
As the subvariants BA.4 and BA.5 drive a third wave of the Omicron variant, public concern about whether a fourth dose is needed is mounting.
On June 29, NACI recommended provinces should offer fall boosters to people age 65 and older and all people at high risk of severe disease from COVID-19 infection — regardless of how many boosters they’ve had previously and six months after their last dose. It also said provinces “may” offer it to those 12 to 64.
On June 30, Tam issued a statement urging Canadians to catch up on their booster shots — 40 per cent of Canadians still have not received a booster following their primary two shots.
Because the Omicron subvariants BA.4 and BA.5 driving the current wave expected to peak in August are more immune-evasive and highly transmissible than their predecessors, “two doses of COVID-19 vaccines offer less protection than against previous variants,” making keeping up with boosters very important for reducing the risk of hospitalisation and death due to COVID-19, said Tam.
Bogoch said some provinces may open up fourth shots to everyone, but “the question you have to ask yourself is exactly who would benefit from a fourth dose?” The answer is older people with underlying medical conditions, he said.
Some infectious disease specialists argue a 25 to 35 year old man who has had three COVID-19 doses — making the chance of hospitalization close to zero — wouldn’t gain much protection from a fourth dose today, runs the very rare risk of an adverse event such as myocarditis that outweighs the benefit, and would be only four months from his last vaccination when a possible Omicron-based vaccine is made available in the fall.
The recommended interval between vaccines is six months.
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