Front Burner - Are all COVID-19 vaccines created equal?

Episode Date: March 8, 2021

How solid is the science behind delaying second COVID-19 vaccine doses? Are the shots from AstraZeneca-Oxford and Johnson & Johnson effective enough? Infectious disease specialist Dr. Isaac Bogoch answers our most pressing questions about the latest vaccine news.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hey, I'm Jamie Poisson and today Dr. Isaac Bogosh is here. He's an infectious diseases expert and member of Ontario's Vaccine Task Force. And we're going to talk about a few things. First, a lot of provinces are now saying that all adults will be able to get a shot by the end of June-ish.

Is that realistic? Changing guidelines that space out the time between the first and second vaccine play into this. Is delayed dosing based on good signs? Also, with the approval of Johnson & Johnson's vaccine, can you and should you go pick and choose which shot to get? Alright, let's get started. which shot to get. All right, let's get started. Hey Isaac, thanks so much for making the time today. Oh, my pleasure. So on Friday, there was an announcement from Justin Trudeau that some vaccine shipments are accelerating, and we're now expecting 36 million doses by Canada Day, plus more from Johnson & Johnson that just got approved. So bottom line, big influx of vaccines en route. With these accelerated Pfizer deliveries,

we'll now be getting 8 million doses by the end of March. In total, we can now expect 12.8 million doses from April to June from Pfizer alone. And then in addition to that, the National Advisory Committee on Immunization, NASI, is recommending that Canada stretch the doses on the two-dose shots to four months. Saying while studies have not yet collected four months of data on vaccine effectiveness after the first dose, the first two months of real-world effectiveness are showing sustained high levels of protection. So provinces are saying that they're going to do this. And I want to come back to the concerns about that in a minute. But all this news taken

together has provinces saying that they're now aiming to have all adults who want a vaccine given one by around the end of June. Ontario Ontario saying June 20th, BC, Canada Day, June 30th in Alberta. Isaac, do you think these new accelerated timelines are actually realistic? I think they are. I think they're totally reasonable and they're really reflective of a couple of things. One is getting greater access to vaccines. The second is having the provinces administer those vaccines. And of course, the third point, as you pointed out, was spacing the doses between those two vaccines, which basically gives us greater access. And I mean, obviously, we have to timestamp every one

of our conversations because this is the COVID era and things change quickly. But based on what we see coming in, based on the province's ability to administer vaccines and based on the dose spacing, I think those dates are reasonable. But like anything else, this may change with time and these might be conversations that we have that adjust over time. But currently, I think that's pretty reasonable. So let's say that nothing changes on the supply side and that nothing changes on this recommendation to stretch out the doses. How are the provinces going to ramp up here? You know, how are they going to do it? Pharmacies, doctor's offices, drive-thrus, operating considering that a lot of these governments have come under so

much criticism for sort of an inability to ramp up on so many things connected to this pandemic, right? Yeah, I think if you look at the provincial plans, you'll see that there's more similarities than differences. And you know, there's, it's there's not one right approach to vaccinating a significant proportion of your population. This is truly an all-hands-on-deck approach. So between mass vaccine sites, community centers, primary care, mobile pop-up sites, pharmacies, of course, we've seen mobile trucks as well that are going around to help vaccinate homeless and under-housed populations. I think we'll be able to vaccinate a significant number of people in a short period of time. In addition to that, if you go on the public health unit's websites, you can actually

see the estimates of how many people they might be able to vaccinate per day or per week. And it's rather inspiring. Like you look at Toronto, they're talking actively about vaccinating 24 hours a day, seven days a week if they have the supply. The chair of Toronto's Board of Health says round-the-clock clinics have always been part of the city's strategy. Toronto has developed an immunization model that can be scaled at any time based on supply. And so if we have enough supply to run 24 hours and get them out faster, that's exactly what we're ready to do. They say they can vaccinate anywhere from 300,000 to 400,000 people per week if they have supply. Peel, anywhere from 200,000 to 280,000

people per week. Those are impressive numbers. And if we can give them the vaccines and they can administer them like that, we're going to be vaccinating a lot of people in a very short period of time. Okay. Well, I certainly hope that that happens. So I know there is so much that we could talk about today on the vaccine front, but I want to focus on two things with you. Concerns around extended doses and comparing vaccines. And let's do doses first. So as we mentioned, NACI is recommending Canada stretch out the doses from about three weeks to an unprecedented four months. And we are the first country in the world to recommend this. Ontario, BC, Alberta, Quebec, Newfoundland and Labrador

are already announcing that they're going to do this. When BC rolled out its first vaccines, the province made headlines for pushing back its second dose to 35 days. Now it's going much further. The important thing that we have learned is that these vaccines work, they give a very high level of protection, and that protection lasts for many months. Isaac, I read NACI's recommendation and I found it to be quite vague. And I guess, is this a good idea to stretch out the doses? And what evidence specifically is there to back this recommendation up? I love this question because it's been such a hot topic lately.

And I think it's important that we recognize what went into this decision and why this is a good decision. So personally, I am okay with stretching the doses. I am. I think it's a really smart decision from a public health standpoint. I think it's very, very wise to do. In addition to that, I think you can look at evidence from multiple areas. So you can look at immunologic evidence.

You can look at clinical trial evidence. You can look at some of the modeling that was based on the clinical trial evidence. You can look at some of the modeling that was based on the clinical trial evidence. And number four, you can look at real world evidence that's emerging from other parts of the world like Scotland and England. The study out of Israel makes an interesting conclusion. Dr. Monica Gandhi from UCSF says this study gives real world data that even a single dose can help prevent people from infecting others. One dose of the Pfizer vaccine, one dose, there was a reduction in after 28 days of 75% in infections, just having it in your nose, and 85% in disease. And all of that points to being able to safely space out the vaccines

to, I would say, two months or three months. I think we have the evidence to suggest that you can safely space out those vaccines between two months and three months. But like you, I also read the NACI guidance. And even though I agree with them, I would also like to see just like a grade 10 science test or a grade 10 math test. Show your work. You got to show your work. And I think it would be very helpful if they were more transparent in how they came to that four month conclusion. I don't disagree with it. But show us your work. Because if you show us your work, and you walk us through how you got to that point, I think you did still a little bit more confidence to the general population and to the medical and scientific community with that. Right. So I just want to pause on that for a moment. Like,

why are they recommending four months then? You know, even in their own recommendation, they admit that the available data is like two months. Yeah, I agree with you completely. It would just be nice to know what their thinking is. And I think that it would be great to have representatives of NACI stand up in front of the Canadian population and say, hey, this is how we got to four months. Again, I don't disagree with that statement. When you look at all multiple dose vaccines, of which there are many, you know, measles, hepatitis B and hepatitis A,

there's a lot of multiple dose vaccinations that are around. Spacing out those doses is usually not a big issue at all. And I think that the general public would be perhaps a little more accepting of this decision if we had open and transparent communication from the decision makers on NACI as to how they came to that conclusion. If we could talk a little bit about the efficacy of different vaccines and concerns around this, the AstraZeneca and the Johnson & Johnson vaccines have now both been approved in Canada. The Johnson & Johnson one is actually one dose. The AstraZeneca shot has an efficacy rate of 70%. The Johnson & Johnson has an efficacy rate of 66%. And so that compares to 95%

for the Moderna and Pfizer vaccines. I think that's top of mind for a lot of people right now. Like who wants to get a vaccine that's less effective? So I'm wondering if you could break down for me what those percentages actually mean. Like what does it mean that a vaccine is 66% effective? Well, I think it's important to recognize a couple of points here. When Pfizer and Moderna vaccine studies were going on, there were very few circulating variants of concern. There were very few of those in those trial sites. Whereas when AstraZeneca, Johnson & Johnson, even the Novavax vaccine studies were going on, there were way more variants of concern circulating at that time. So that delta, that difference in efficacy between mRNA vaccines and the other vaccines is probably

smaller. It's probably smaller than what those numbers suggest. Now, still, at the end of the day, it may very well be that some vaccines perform better than others. That might be true. But I think we also have to think about this from another point. In all of the vaccine studies, in all of them, it doesn't matter which vaccine, they all, not only did they all significantly reduce the chances of getting infected, but variant or not, they all significantly reduced the likelihood of people getting severe infections, hospitalizations, and death. They all did that. All of the vaccines do that. Now, it's time to sort of take a step back and look at where we're at right now. This is a public health crisis. Like, we are truly in a public health crisis where, you know, for example, in Canada, 90 something percent of the deaths, about 94 percent of the deaths are in people over the age of 60. get a vaccine. There is no reason to say, I want this one instead of that one right now.

The first part of a public health crisis is stop the death, right? Stop people from getting seriously ill and stop dying. And all of those vaccines, any one of those vaccines will accomplish that goal. Currently, the best approach now from a public health standpoint, do whatever you can to stop people from dying. And any of these vaccines will do that. Okay. Although there are concerns about the AstraZeneca one being used on people over 65 right now, right?

Canada's Senior Advisory Committee on Immunization said the AstraZeneca shot should not be given to seniors. That puts them at odds with Health Canada, which has already approved the vaccine for all adults. Well, there are concerns among some people, but not all people. Are you one of those people? I mean, I just mentioned,

like I would use anything at my disposal to stop the deaths. AstraZeneca looks like a great vaccine to stop the deaths. I think where that concern arose from is this was just in the clinic, this was just in the clinical trials. Well, there just wasn't a lot of people enrolled that were over the age of 65. Nassi says it's due to limited information on the efficacy of this vaccine in this age group at this time. Just over 90% of the participants in Oxford AstraZeneca's clinical trials were under 55 years old. So some places said, OK, they didn't enroll enough people over the age of 65.

We can't confidently say this vaccine is effective in that age group. We're not going to recommend it for people over the age of 65. We should point out that a lot of places don't care and said, look, this vaccine performed fantastic. 18 and up, you can get it. But some places like France and Germany said, no, we're not going to give it over the age of 65. But here's what happened. Fast forward, now there's some real world data that emerged from Scotland and then a few days later from England demonstrating that, oh, a lot of people got this vaccine and it really looks like it's very protective, especially in older populations over the age of 80 and subgroup analysis in people over the age of

70. Researchers in Scotland vaccinated nearly half a million people with the Oxford AstraZeneca shot, many of them elderly. Non-peer reviewed results show that four weeks after the first dose, the risk of hospitalization fell by up to 85%. If you look at the real world data from Scotland, single dose Pfizer versus single dose AstraZeneca, it actually showed, if you really want to get into the details, it actually showed that the AstraZeneca vaccine maybe slightly non-significantly, but slightly outperformed the Pfizer vaccine in real world data. So with that emerging data, France and more recently Germany said, you know what, there is enough data to support this use in populations over the age of 65. And they just

changed their policy and they are vaccinating people over the age of 65 with AstraZeneca. Canada obviously didn't do that. And again, I'm not saying that's wrong. I'm just saying it's yet another example of multiple people looking at the same data and coming to different conclusions. Right. And you know, you're saying basically that NACI, which is now recommending that the AstraZeneca vaccine not go to people over 65, I mean, they could change their mind at any day as well. But I just want to be really clear, Isaac. So like, if you were 64 years old right now, and you could get the AstraZeneca vaccine next week, which is being offered to people under 65 in provinces like Ontario right now, or wait a few months to get the Pfizer vaccine, like what would you choose?

I'd get the vaccine, whatever vaccine was available to me. This is my personal decision. Obviously, I'm not here to impose this on everybody else, but I would just take whatever vaccine was available to me first. Because the vaccines that we have in Canada all do what we want them to do, no matter what vaccine. They all prevent serious hospitalization and death. I don't want to get sick and I don't want to die. I would take whatever came to me as soon as possible. And then, of course, with the caveat that, yes, that is the decision right now. But two months, three months, four months, six months, who knows down the line, we're all going to get a booster. We're all going to get some updated vaccine that accounts for the variants of concern. It's going to happen. This is not the last vaccine you're ever going to get for COVID-19. happen. This is not the last vaccine you're ever going to get for COVID-19. And later on, there might be some better data to say, hey, you know what? You got AstraZeneca. We want you to get the Johnson & Johnson. Or you got the Johnson & Johnson. We want you to get the Moderna or Pfizer. Of

course, things are going to change with time. Data evolves with time. But right now, public health crisis, public health emergency, and you've got four different products that stop you from dying. Take whatever one becomes available first. It would be a tragedy to wait two or three months until you got another different vaccine that you wanted. And in that timeframe, got sick and went to hospital or died. This is totally preventable. Right. And I do want to be clear about one other thing too. We're talking about choosing vaccines here. Is that even on the table? Like, is it even going to be possible for us to go vaccine shopping?

Who knows? Who knows? I mean, currently, there's such a dearth of vaccines that it doesn't look likely. But later on, we can sort it out when we've sort of protected everyone from getting really sick and dying. When it comes to our boosters and whatnot, we certainly might have policy updates. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem.

Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to,

50% of them do not know their own household income? That's not a typo, 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. Isaac, I know we've been talking a lot about efficacies, but if I end up getting like the Johnson & Johnson vaccine

with a 66% efficacy rate, should my behavior after I get it be any different than if I got the Pfizer vaccine with a 95% efficacy rate? I guess what I'm trying to ask is, do I have a higher chance of still getting COVID and then spreading it around, which would be bad, even if I don't get a sick. Yeah, I don't think we're in a position where we're going to start to have different behaviors and different recommendations for different vaccinations. We all know that the efficacy between all the vaccines is a bit artificial. Some might be a little bit better than others, but because the playing field is probably a little closer than what the published peer review studies

demonstrate, I really think that at the end of the day, we will not have different recommendations for individual behavior based on what vaccine you had. Okay. And before we go, I just, I do want to ask you about these variants of concern and how well these vaccines stack up against each other in terms of protecting against the new, more contagious coronavirus variants like the South African strain. You know, I note that South Africa pulled the AstraZeneca vaccine. The government may sell or swap its doses after a clinical trial showed it only offered minimal protection against mild to moderate infection by the fast spreading 501Y.V2 variant.

So how are they doing compared to each other in protecting against these strains? mild to moderate infection by the fast-spreading 501Y.V2 variant. So how are they doing compared to each other in protecting against these strains? Okay, tough conversation to have because there's multiple vaccines and there's multiple variants of concern and the different vaccines stack up to the variants in slightly different manners and the degree of certainty with the data varies from pretty certain to less certain. So in general terms, the UK variant does not appear to reduce the efficacy of the vaccines to a significant extent. Said another way, if we're talking about the B.1.1.7 variant, that's the variant that1.1.7 variant, that's the variant that was initially discovered in the UK, any one of these vaccines is likely to

be okay. The variants discovered in South Africa and Brazil are a bit of a different story. Some of the vaccines may be more protective against those variants than others. But again, protective against those variants than others. But again, the devil's in the details. You know, the ones like AstraZeneca. Well, you know, they said that the AstraZeneca vaccine wasn't that effective against that variant of concern. When we look at the data, it's kind of hard to make a huge conclusion because it didn't enroll a ton of people and there wasn't, you know, most of them were healthy young people. It's hard to know. So I think it's fair to say that there's emerging data from multiple sources, clinical trials, lab-based immunology data, and then real world experience. And based on all of those emerging

data sets, it's likely, I got to be careful with my words, it's likely that these vaccines will still reduce your risk of hospitalization and death with the variants of concern, even if they're less effective. If we think about where we're at in Canada, by far the most common variant of concern by far is the B.1.1.7, which is the one that was initially discovered in the UK, and all of the vaccines, all of these vaccines are reasonable and will provide significant protection against that one. And it's also very likely that we'll all be getting boosters and updated vaccines that accommodate for the other variants of concerns that are starting to circulate at a later date. Okay. Isaac Bogosh, thank you so much, as always.

My pleasure. Have a great day. All right. So in other vaccine news, Canada's health minister, Patty Hajdu, has suggested that Canada may be considering the possibility of requiring vaccine passports for people entering the country. Here's what Hajdu told my colleague Rosemary Barton yesterday. The issue of vaccination certification is a very live one right now. It's being discussed around the world. I'm a member of the G7 health ministers. We meet every couple of weeks. This has been on our agenda. We'll be following this story closely, but that is all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner.

We'll talk to you tomorrow.