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UPTAKE OF COVID-19 VACCINE BOOSTERS SLOWS IN CANADA DESPITE OMICRON’S RISKS,
GLOBE ANALYSIS FINDS

Health experts point to logistical delays, public uncertainty and other factors,
while continuing to stress that third doses are critical to stop severe illness
and save lives

Andrea Woo and Chen Wang
Published YesterdayUpdated 2 hours ago

Health-care workers at Toronto's Humber River Hospital tend to a ventilated
COVID-19 patient, who is also an unvaccinated nurse. With the contagious Omicron
variant on the loose, officials stress that having two regular doses and one
booster is a strong safeguard against severe illness.Nathan Denette/The Canadian
Press

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More below • Common questions answered about COVID-19 boosters

--------------------------------------------------------------------------------

Canada’s COVID-19 booster drive is slowing despite mounting evidence that an
additional vaccine dose is needed to maintain strong protection from severe
illness caused by SARS-CoV-2, according to a Globe and Mail analysis of uptake
across the country.

While the dominant Omicron variant has been shown to cause less severe disease
than the Delta variant before it, its hyper-transmissibility has walloped
Canada’s health care system, pushing the daily national patient count above
11,000 for the first time in January. Three large studies from the U.S. Centers
for Disease Control and Prevention (CDC) underscore the importance of boosters
in preventing severe illness from Omicron and future variants, but as of Monday,
only 41 per cent of Canadians had received an additional dose.

At its peak in the second week of January, nearly 350,000 shots were
administered daily across the country, on a seven-day rolling average. By the
end of the month, that had dipped to fewer than 200,000. The uptake of boosters
is also slower than that of the push for second doses, which peaked at about
487,000 shots administered daily, on a seven-day rolling average.

Daily COVID-19 vaccination booster dose administered in Canada
Seven-day rolling average
050,000100,000150,000200,000250,000300,000350,000Aug.2021Sept.Oct.Nov.Dec.Jan.2022440
THE GLOBE AND MAIL, SOURCE: The COVID-19 Canada Open Data Working Group, ontario
ministry of health
data
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dateroll_mean2021-08-014402021-08-024322021-08-034202021-08-044142021-08-054232021-08-064502021-08-074812021-08-083972021-08-094002021-08-104202021-08-114352021-08-124432021-08-134522021-08-144472021-08-154532021-08-164522021-08-174472021-08-184562021-08-194932021-08-204982021-08-215082021-08-225042021-08-235312021-08-245792021-08-256402021-08-267232021-08-278432021-08-288572021-08-298932021-08-3010202021-08-3111402021-09-0114382021-09-0218692021-09-0321072021-09-0422752021-09-0523802021-09-0623102021-09-0725912021-09-0830562021-09-0934212021-09-1036832021-09-1137402021-09-1238182021-09-1342462021-09-1447302021-09-1548772021-09-1650042021-09-17112392021-09-18113122021-09-19112822021-09-20120772021-09-21122472021-09-22124562021-09-23126992021-09-24133672021-09-25133212021-09-26132942021-09-27135452021-09-28136222021-09-29137582021-09-30136372021-10-0179692021-10-0279912021-10-0379752021-10-0477252021-10-05130822021-10-06128322021-10-07135282021-10-08141062021-10-09143032021-10-10144692021-10-11132342021-10-12111492021-10-13125462021-10-14133952021-10-15137382021-10-16139382021-10-17139792021-10-18177752021-10-19164602021-10-20165672021-10-21168912021-10-22173252021-10-23174842021-10-24175422021-10-25168332021-10-26173032021-10-27176302021-10-28177092021-10-29175492021-10-30177912021-10-31178212021-11-01180882021-11-02188322021-11-03200022021-11-04212502021-11-05226932021-11-06240792021-11-07247582021-11-08268182021-11-09299342021-11-10319772021-11-11310602021-11-12338992021-11-13339752021-11-14340982021-11-15363892021-11-16354652021-11-17357142021-11-18393842021-11-19397242021-11-20405002021-11-21407642021-11-22420112021-11-23433932021-11-24459632021-11-25478602021-11-26490432021-11-27491482021-11-28496742021-11-29509082021-11-30541112021-12-01562472021-12-02588372021-12-03624792021-12-04641162021-12-05654762021-12-06687812021-12-07748012021-12-08788412021-12-09828062021-12-10967382021-12-111009172021-12-121030202021-12-131146082021-12-141338702021-12-151465892021-12-161674892021-12-171811962021-12-181970432021-12-192108322021-12-202390962021-12-212612602021-12-222932512021-12-233131842021-12-243040442021-12-252837752021-12-262706532021-12-272405462021-12-282209952021-12-292307102021-12-302217672021-12-312221432022-01-012241912022-01-022292022022-01-032291962022-01-042587002022-01-052392622022-01-062455232022-01-072683992022-01-083032562022-01-093194932022-01-103476722022-01-113318402022-01-123358252022-01-133351312022-01-143364422022-01-153299022022-01-163274502022-01-173272222022-01-183126592022-01-193028642022-01-202916632022-01-212745652022-01-222647112022-01-232567672022-01-242467892022-01-252460492022-01-262317272022-01-272211022022-01-282115632022-01-292050382022-01-301996812022-01-31188569


DAILY COVID-19 VACCINATION BOOSTER DOSE ADMINISTERED IN CANADA

download csv
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https://s3.amazonaws.com/chartprod/KsqTtnp7MKoRinGJm/thumbnail.png

In B.C., about 721,000 adults who have been invited to book their boosters have
not yet done so, including about 46,000 aged 70 and up. (British Columbians must
register with a provincial system to receive invitations to book their COVID-19
vaccination appointments.) Alberta is trailing behind other provinces, with just
32.7 per cent of its population boosted as of Jan 31. And in Quebec, some health
experts have blamed January’s high death toll on the province’s slow campaign to
deliver boosters to seniors living in the community.

COVID-19 vaccination booster dose coverage of total population, by province
As of Jan. 31
NunavutAlta.PEISask.Man.NWTB.C.N.L.N.B.YukonQue.Ont.N.S.29.732.733.536.738.439.340.541.341.642.342.642.843.0%
THE GLOBE AND MAIL, SOURCE: THE COVID-19 CANADA OPEN DATA WORKING GROUP
data
share
×

provincerateN.S.43.0Ont.42.8Que.42.6Yukon42.3N.B.41.6N.L.41.3B.C.40.5NWT39.3Man.38.4Sask.36.7PEI33.5Alta.32.7Nunavut29.7


COVID-19 VACCINATION BOOSTER DOSE COVERAGE OF TOTAL POPULATION, BY PROVINCE

download csv
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https://s3.amazonaws.com/chartprod/ebq9hD2CKD6Xo7vL6/thumbnail.png

DAILY COVID-19 VACCINATION DOSES

ADMINISTERED, BY DOSE AND

BYPROVINCE

First doses

Second doses

Third doses (boosters)

British Columbia

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Alberta

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Ontario

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Quebec

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

THE GLOBE AND MAIL, SOURCE: PROVINCIAL

GOVERNMENTS

DAILY COVID-19 VACCINATION DOSES

ADMINISTERED, BY DOSE AND BY PROVINCE

First doses

Second doses

Third doses (boosters)

British Columbia

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Alberta

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Ontario

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Quebec

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

DAILY COVID-19 VACCINATION DOSES ADMINISTERED, BY DOSE AND BY PROVINCE

Third doses (boosters)

First doses

Second doses

British Columbia

Alberta

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Quebec

Ontario

220,000

200,000

180,000

160,000

140,000

120,000

100,000

80,000

60,000

40,000

20,000

0

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

Feb.

2021

Apr.

June

Aug.

Oct.

Dec.

Feb.

2022

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

The reasons for the delays are varied. Devon Greyson, an assistant professor in
the School of Population and Public Health at the University of British
Columbia, whose research has focused on vaccine confidence and uptake, said the
slower pace of booster administration may be partially attributed to logistical
issues. First and second doses are still being administered, as well as vaccines
to children age 5 to 11, which could potentially be creating capacity issues,
they cited as an example.

The uncertainty of the Omicron wave has also made personal decision-making more
difficult, Dr. Greyson said. “It takes a while for us to learn scientifically,
and that goes for every new variant: How is this variant going to work? How
protective are our current vaccines against this variant? How long is the
duration of immunity from a newer vaccine?” they said. “But also, this Omicron
wave has really shaken people, and they’re struggling in general. For some
people, the stress of this current wave feels as bad as the initial wave in the
spring of 2020, and that makes decision-making harder.”

Vancouver resident David Laing was seven days into fighting COVID-19 when he
awoke one morning in early January to an invitation to book his booster. The
digital marketing specialist was still experiencing nagging symptoms, including
severe headaches, lower back pain and a cough, so when he saw the automated text
message, a flitter of excitement quickly became frustration.

He rolled over and typed out an expletive, along with the message: “I already
got COVID.”

“I was just so frustrated that I texted them back hoping that some IT guy on the
other end would be like, ‘Dang. That sucks, buddy,’” said Mr. Laing, 38.

But as his symptoms, and annoyance, subsided, he was left wondering when he
should book his appointment for. Did his infection induce some immunity? Should
he wait? He held off as he started looking for answers.



Lucie Fletcher, 5, looks toward her mother, Dr. Daniele Behn Smith, as
registered nurse Erin Thorpe administers a Pfizer vaccine in Victoria last
November.Chad Hipolito/The Canadian Press

When Vancouver resident Catherine Fenn was invited to get her first two doses of
COVID-19 vaccine, she accepted acquiescently. She didn’t love the idea of
vaccinations in general, but understood that they were one of the best tools to
change the course of the pandemic.

After both shots, Ms. Fenn, 61, experienced a headache, fever and persisting
joint pain in her knees, hips and elbows, which her doctor later explained could
be a side effect of her vaccination. When she got her invitation to book her
booster last month, she decided to wait.

“I think if Omicron was a horrible variant and people were dropping dead on the
sidewalk, I’d say, ‘Okay, who cares about joint pain? I’m going to do it,’” Ms.
Fenn said. “But I don’t feel the same urgency with Omicron that I did when I got
those two shots earlier. So I’m just kind of waiting and seeing.”

Governments and public-health officials have urged Canadians to get their
boosters but have so far stopped short of adding a third-dose requirement to
existing vaccine certificates. It’s a move that some feel should be
reconsidered.

“There’s a window of opportunity, which is [closing] relatively soon, to slow
down a bit the spread of Omicron, increase consumer confidence and be able to
further open the economy,” said Peter Juni, scientific director of Ontario’s
COVID-19 Science Table.

With the province having reopened restaurants, gyms, concert halls and other
venues with capacity limits this week, he said now would be an ideal time to
begin education campaigns for a mid-February deadline to require boosters to
enter these discretionary settings. “We have to do it relatively swiftly, or we
don’t do it at all,” he said.



At the Humber River Hospital, a health-care worker walks past a thank you sign
in the ICU.Nathan Denette/The Canadian Press

The U.S. CDC released three large studies in January that highlight the
importance of boosters during the Omicron-driven surge. One study that looked at
nearly 88,000 hospitalizations in 10 states during the Omicron wave found that a
booster dose was 90-per-cent effective at preventing hospitalization, compared
to 57 per cent for two doses, six months after the second dose.

The study also looked at nearly 223,000 emergency-department and urgent-care
visits, finding that a booster was 82-per-cent effective at preventing these
visits, compared to 38 per cent for two doses, six months out.

“These findings underscore the importance of receiving a third dose of mRNA
COVID-19 vaccine to prevent both moderately severe and severe COVID-19,
especially while the Omicron variant is the predominant circulating variant and
when the effectiveness of two doses of mRNA vaccines is significantly reduced
against this variant,” wrote lead author Mark G. Thompson. “All unvaccinated
persons should get vaccinated as soon as possible.”

Emerging Canadian data also underscore the importance of boosters. From
mid-December to mid-January, unvaccinated Ontarians aged 60 and older were 22.4
times more likely to be hospitalized than those who had received three doses,
and 11.8 times more likely than those who had received two.

In Alberta, data from the past 120 days show that unvaccinated people aged 60
and older were 35 times more likely to be hospitalized than those who had three
doses, and five times more likely than those who had received two.

In the U.S., some states, postsecondary institutions and employers have added
boosters to existing vaccination certificates, and Hawaii is expected to
announce this month that all visitors to the Aloha State must have a third dose
to bypass a five-day quarantine requirement.



A sign in Montreal advertises Quebec's COVID-19 vaccine passport.Graham
Hughes/The Canadian Press

Ontario’s Dr. Juni said it would be a logical next step to add a booster
requirement given that two doses no longer protect against infection from
Omicron. “The logic of the vaccine certificates is to protect people from
serious outcomes; we don’t let them expose themselves in high-risk settings if
they’re not vaccinated. That’s okay,” he said. “But the other part is to keep
infections under control, and this part is not addressed any more with a vaccine
certificate that is based on two doses.”

Nazeem Muhajarine, a professor in community health and epidemiology at the
University of Saskatchewan, agreed with the rationale of adding a booster
requirement to vaccine certificates.

“I think we have to do this sooner than later, and particularly with the
incentivizing idea in mind,” said Dr. Muhajarine, who is also a member of the
Coronavirus Variants Rapid Response Network, a national research group that
responds to the potential threat of emerging SARS-CoV-2 variants.

“The sooner we have more people whose vaccines are up to date, the better we
will be, in terms of serious outcomes of Omicron COVID and any other variants in
the future. All of our health care workers have been stretched to the limit and
we don’t have capacity to keep doing everything that we need to do.”

Isaac Bogoch, an infectious-diseases physician at Toronto’s University Health
Network, said governments must determine what their goals are and build policy
around them. Including boosters in vaccine certificates would create safer
indoor spaces, but these requirements should not be considered
“pandemic-altering policies” as much transmission still occurs outside of
restaurants, gyms and other businesses, he said.

Further, such a requirement cannot be fairly rolled out until there have been
meaningful efforts to boost people equitably, he said. Data up to Jan. 9 showed
that less than 20 per cent of people in some of Toronto’s northwest
neighbourhoods had received a third dose, for example, compared to 50 per cent
for some more central neighbourhoods.

“When you look at who’s got a third dose, it’s high-income neighbourhoods, and
there’s actually a huge disparity with the communities that are
disproportionately impacted by the virus and by policies to curb the virus,” Dr.
Bogoch said.

“So if you make that policy now, suddenly, you’ve excluded significant segments
of your society from going to a restaurant, grabbing a drink at a bar, going to
the movies. … It would be really unfair.”

Mr. Laing, the Vancouver resident who recently recovered from COVID-19, said he
is certain he will get his booster. He is still deciding on exactly when,
figuring he has some time on his side.

Ms. Fenn continues to mull getting hers. If it were required in order to see her
elderly mother in long-term care, or to enter restaurants and other
discretionary settings, she would concede and book her shot, she said. She also
often imagines the consequences if she were to get COVID-19 and infect others.

“What if I gave it to somebody unknowingly, in that incubation period, who is a
vulnerable person? Or gave it to anybody, and somewhere down the line a
vulnerable person gets it?” Ms. Fenn said. “So that bothers me. I have thought
about that, for sure.”

With a report from The Canadian Press







DON’T HAVE A BOOSTER SHOT YET? EXPERTS RESPOND TO CANADIANS’ COMMON QUESTIONS

Patients wait for vaccines at the University of Toronto's Mississauga
campus.Tijana Martin/The Canadian Press

I’VE HAD MY PRIMARY SERIES OF TWO COVID-19 VACCINE DOSES AND RECENTLY GOT COVID.
WHEN IS THE BEST TIME TO GET MY BOOSTER?

The National Advisory Committee on Immunization (NACI) recommends that a person
with a COVID-19 infection get a booster, at the earliest, when one has completed
his or her self-isolation period and is no longer symptomatic. However, some
physicians may recommend a longer interval to produce a more robust immune
response.

Janine McCready, an infectious-diseases physician at Michael Garron Hospital in
Toronto, recommends waiting one to two months after a natural infection to allow
one’s immune system “to mount a response to the infection and then boost on top
of that for additional protection.”

Earl Brown, emeritus professor of virology at the University of Ottawa,
recommends an interval of two to four months after an active infection. “This is
because responses mature with time, but also weaken with time, so there is
always a tension between renewing your levels of partial immunity and waiting
for a more responsive immune system, which increases with time after
vaccination,” he said.

NACI cautioned that the risk of reinfection over time, as well as the protection
offered by previous infection against new variants, is difficult to determine.

“Therefore, if a delay in administering vaccination following infection is being
considered, risk factors for exposure (including local epidemiology and
circulation of variants of concern) and risk of severe disease should also be
taken into account,” a NACI statement read.

A Montreal boy shows his 'brave child diploma' after being vaccinated.Paul
Chiasson/The Canadian Press

IF I’VE HAD TWO DOSES AND AN INFECTION, DO I HAVE ENOUGH NATURAL IMMUNITY TO
SKIP A BOOSTER?

It is too early to know the exact impact of the Omicron variant on immune status
and disease resistance. Pre-Omicron studies have shown that some protection from
COVID-19 persists for several months after infection, however this can vary
greatly depending on a number of factors including which variant it is as well
as a person’s age and the overall strength of their immune system. A U.S. CDC
study published last September of 76 people with lab-confirmed COVID-19 cases
found that 36 per cent did not develop antibodies.

In population studies, postinfection immunity was much less protective against
reinfection than vaccine-induced immunity, Dr. Brown said. Studies of people who
were both infected and vaccinated showed they had much higher levels of
immunity, but that immunity was not long-lasting and reinfections occurred.

“Omicron infection will boost the immunity of a double-vaccinated person to
levels that are as high or higher than a third dose of mRNA vaccine,” Dr. Brown
said. “This level of immunity is expected to be good against reinfection with
Omicron and other variants, but this has not yet been seen. If you want to
maximize your benefits of vaccination, you will obtain a third mRNA vaccine dose
any time after eight weeks of your natural infection to maximize the
vaccine-induced immune response.”

A health-care worker holds a vial of the Pfizer vaccine.Maya Alleruzzo/The
Associated Press

WHICH BRAND OF VACCINE SHOULD I GET? IS ONE BETTER THAN THE OTHER?

Pfizer’s booster dose contains the same 30 micrograms (mcg) of mRNA as its first
two doses, while Moderna’s primary series contains 100 mcg each and its booster,
50 mcg. The Pfizer and Moderna boosters are considered interchangeable for most
people.

For young adults aged 18 to 29, NACI recommends Pfizer over Moderna because of
lower reported rates of myocarditis and pericarditis, rare heart inflammation
conditions, than compared to Moderna’s full-dose 100-mcg vaccine. Data specific
to Moderna’s 50-mcg booster dose are limited.

As of Jan. 14, there was a total of 1,643 reports of myocarditis or pericarditis
– made since the start of the pandemic – to the Public Health Agency of Canada.
Of these, 1,045 followed a Pfizer vaccine, for a reporting rate of 2.1 per
100,000 administered doses. There were 563 following Moderna vaccination, for a
reporting rate of 2.8 per 100,000 administered doses.

For people who are aged 70 and older, or for those who have weaker immune
systems, a full 100-mcg Moderna dose may be preferred for a booster.



I’VE HAD TWO DOSES AND DON’T FEEL ANY URGENCY TO GET A THIRD. WHY SHOULD I?

While a primary series of two doses offers almost no protection from Omicron
infection, it still roughly halves the likelihood of hospitalization and death,
Dr. Brown said. Young, healthy people are generally at lower risk for serious
disease; however, they can still contribute to increased disease and hospital
burden by transmitting COVID-19 to others.

“As hospitals are now the weak link in our health care system, it is currently
important that we decrease the level of infection to keep high-risk individuals
from needing hospital care,” he said.

Jamie Scott, professor emerita at Simon Fraser University and a former Canada
research chair in molecular immunity, said while men, people aged 60 and up, and
those with pre-existing conditions, such as diabetes or high blood pressure, are
at higher risk of severe illness from COVID-19, young people are not risk-free.

“I can tell you young people are getting sick and dying,” she said. “So you’re
taking some dice and you’re rolling them. And so the question is, do you really
want to get infected? Not only that, but you might give it to somebody else.”

(Return to top)





COVID-19: MORE FROM THE GLOBE AND MAIL

THE DECIBEL

Pfizer’s recently approved antiviral pill, Paxlovid, offers some hope for
stopping severe illness or death from COVID-19 – but there are a lot of caveats,
and supply and eligibility is limited. Health reporter Carly Weeks explains.
Subscribe for more episodes.

EXPLAINERS

How many doses have been administered in Canada so far? Latest data

Where do I book a COVID-19 booster or a vaccine appointment for my kids? Latest
rules by province

Omicron symptoms mirror the flu and cold. What should I do if I feel sick?


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