2021-03-01 Immunization Briefing

The Health Ministry of BC had a briefing to give an update on the province’s immunization status and plan. Here’s the slide deck and the press release.

The first plan‘s timeline was delayed a bit due to delays in supply, but things have generally gone according to plan.

Note that some news broke at the very end of the last workweek, and clearly the slides were made with old news.

THE END DATE MOVES UP!

The biggest news from today’s conference is that they are going to increase the interval between the first and second dose from 35 days to four months. This means that everybody* in the province will get vaccinated** by the end of July!

* Everybody meaning “all adults who choose to get vaccinated”.

** First dose. They say the second doses won’t be all finished until November.

From what I have seen in my reading, I believe that this delay will not compromise our health. In my opinion, this is a very good move. Canada’s Science Advisor disagrees, correctly pointing out that there has not been a clinical trial, but we do have data from the millions of people who have gotten vaccinated and we do have data from a study which looked at a three-month interval. The UK is using a 12-week interval now, so it’s not unprecedented.

In addition to getting more people good protection sooner, I speculate that it also means that the second dose for most people is likely to be a booster against variants of concern (e.g. B.1.351, the South African strain). Protect us now from what’s here now, and then in four months give us a booster for the stuff that is coming.

There had been 70K doses they were going to use in March as second doses that are now freed up to use as first doses. In addition to moving all age cohorts up, they are going to use 30K of that 70K to do more vaccination of remote indigenous communities.

Repeat, this is breaking news, and they haven’t had time to work out all the details of how this affects dates. (Cut them some slack, they have also been spending time organizing a huge mass vaccination plan!)

Parallel AZ track for in-person workers

The other piece of good news is that they are going to use the recently-approved AstroZeneca vaccine for people who are not able to work from home. They don’t yet know how much of the AZ vaccine they will get when — it only just got approved on Friday! — so they haven’t gotten the priority order finalized yet, but they said they would base it on risk. Occupations they mentioned specifically included first responders (police, fire, dispatchers), teachers, food processing workers, and grocery workers.

They also expect that the Johnson & Johnson vaccine will be approved someday, but they obviously have even less information about how much of that will arrive when.

Vaccine choice

There was a question about whether you would get to choose which vaccine you got. Dr. Henry said that would be limited: that if you were in an eligible occupation, you could choose to get the AZ vax early or wait for your age cohort to get Pfizer or Moderna.

I had the distinct impression that the age-based vaccination would continue to be the mRNA ones, and that they would reserve the AZ for mobile vaccination teams because it doesn’t need the low temperature storage that the mRNAs do. They did not say so, but I bet that’s because they want to have the flexibility to switch over to AZ if they have to.

Phase 1 Status

Phase 1 was for:

  • residents, staff, and essential visitors of long-term care homes
  • people waiting to get into long-term care homes
  • hospital staff who might care for COVID-19 patients
  • remote and isolated indigenous communities

They have done a good job of using the doses they have gotten:

They said they have vaccinated 90% of residents and staff in long-term care homes, which I think means first doses. They have seen a huge drop in cases among both residents and staff:

That they said they will continue to go back into care homes, and will pick up stragglers then. Obviously they have to go back to give second doses, but I had the impression that they were also going to semi-routinely go back to do more vaccinations.

They said that the immunizations of health care workers has also resulted in big drops in cases at acute care centres (which means basically “hospitals”), but did not have a chart for that.

They said that there are 205 indigenous communities, and they have vaccinated everybody (first dose, I assume) in 90 of those communities, except for communities close to metro areas, where they only did people 65+.

Phase 2

They are about to start Phase 2. Dr. Ballem said they expect to get about 415K doses between March and mid-April. (I think she’s sandbagging. I think we’re going to get 530K doses by the end of March, but it’s good to underpromise and over-deliver.) Addendum 2021-03-05: Pfizer committed to delivering 1.5M more doses to Canada by end of March, which means a little less than 190K more to BC, which means about 720K total by the end of March.

Those doses will be allocated as follows.

Priority populations from Phase 2 and any leftovers from Phase 1*190K
Remote and isolated Indigenous communities9K
People over 80175K
Indigenous people over 6535K
Vaccines reserved for outbreaks6K
Total415K

*The priority populations include hospital staff, community GPs, specialists, and medical specialists not yet immunized; people in congregate settings (like prisons and group homes); staff in community home support and nursing for seniors.

Phase 2 Timeline

For the first two weeks of Phase 2, they will be doing

  • congregate settings (e.g. group homes and prisons)
  • hospital and community health care workers
  • residents and staff in independent living homes (NB: all residents, not just >80 residents)
  • high risk seniors in supportive housing
  • long-term home support clients and staff

Then the first age-based cohorts will start, the over 80 year-olds (65 for indigenous). For them, there will be a phone-in system, and they can have a helper do the call-in for them. (The caller will need full name, date of birth, postal code, care card number, and contact information for the person getting the shot. They will get confirmation via text or email; if they don’t have text or email, they can have it sent to a friend or family member.)

Each cohort will have a date when they can start calling in. If someone misses the date, no big deal, they can always call later. (Nobody is going to say, “well, you missed your date, you can’t have one!”)

The dates for the over-80/over-65 indigenous people are as follows:

Birth yearCall start dateVax start date
1931 (90+)8 March15 March
1956 (for indigenous people)8 March15 March
1936 (85+)15 March22 March
1941 (80+)29 March29 March

They clearly were aware of the problems which Alberta had with their phone-in system, and there are several things they’ll do to try to make sure the call centre doesn’t crash:

  • Each Health Authority has a different number.
  • The call centre will be open seven days a week, 7 am to 7 pm (PST/PDT).
  • It sounded like one of the very first questions in the call centre script is “what’s your birthday”, and the caller will get kicked off pretty quickly if they are too young.
  • They will shunt general questions to the COVID info line.
  • They want to message the hell out of the phone registration, with ads everywhere, in part to make sure everybody knows to get vaccinated, but also to spread the message that calling before your date makes you an inconsiderate jerk. (They will be much more polite about it than me, of course.)

Phase 3&4: Mass vax!

Phase 3 will see age-based mass vaccination clinics. They said that there would be some big centres, “Bigger than we’ve ever done before”. (I immediately thought, “Convention Centre, here we come!”)

Mobile clinics will visit rural communities and people who are homebound due to mobility issues.

Registration will be done online and via one, province-wide phone number. (They really want you to use the website, it seems, and they think the under-80s will be okay with website registration.)

Addendum: on 2021-03-02, Dr. Henry said “end of June” today for when we would all be vaccinated, which she explained away as basically a mistake, but I bet that end of June is her actual target and that she’s sandbagging when she says end of July.

Note that if we get everybody vaxxed by 5 July, then we can start doing second shots, which would mean a delay of three months and not four. (I suspect we’ll have more variants circulating by then, and public health will want us to get booster shots designed to counter those strains, so be willing to give the second shots sooner.)

Q & A

Heavily paraphrased Q&A that I didn’t cover elsewhere.

Q: Will people need the provincial services app?

A: No.

Q: Are you concerned about staffing?

A: We’ve expanded who can vaccinate significantly. (NB: they did not talk about the non-vaccinators at all, which I took to mean that they did not think the unskilled labor would be a problem at all.)

Q: Are you sure we are going to get supply?

A: Well, we are dependent upon foreign suppliers, so anything could happen, but the supply at this point looks really good. Also remember that we ordered a LOT of vax from a bunch of suppliers, so we should be okay. (NB: Based on this article, we should have enough doses for all the adults in Canada by the end of June.)

Q: So can we all stop worrying and Doing The Things?

A: NO! We’ve still got a few months to go! Keep Doing The Things!

Q: Are we seeing vax hesitancy?

A: Not much. Some communities are more hesitant due to misinformation, we are working with leaders in those communities.

Q: What about adverse reactions?

A: They are very rare, almost all allergic reactions, and our people have training on how to deal. We’ve had a few dozen, I don’t remember the number — that we dealth with on cases on-site. I think there have been zero deaths globally.

Q: AZ isn’t so good against variants, eh?

A: Well, ya gotta be careful because the clinical trials were all different, including at different times, so you can’t do a direct comparison between them. AZ is fine against B.1.1.7 and we don’t have much B.1.351 here yet.

Closing

Premier Horgan closed by pointing out that next week will be the one-year anniversary of rolling out the pandemic plan, and at that time, they figured that it would be 12-18 months until a vaccine. Here we are at less than a year and we’ve vaxxed about 200K people! Yay BC!

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