Addendum 2024-08-24: Canada is not going to get any Novavax, per this private communication (not to me) (emphasis mine):
Thank you for contacting the Public Health Agency of Canada (PHAC) inquiring about the availability of Novavax’s JN. 1 COVID-19 vaccine in Canada.
PHAC is working with manufacturers and provinces and territories to ensure the most up to date COVID-19 vaccines are available to support Fall 2024 vaccinatior campaigns. The Government of Canada will be receiving up to 19M doses of mRNA vaccine to support provincial and territorial Fall 2024 COVID-19 vaccination campaigns pending regulatory authorization. There will be no federally procured supply of Novavax’s JN. 1 COVID-19 vaccine to support Fall 2024 vaccination campaigns.The decision on which COVID-19 vaccines to provide federally, is based on the overall assessment of the public health need. Given the Canada’s National Adviso Committee on Immunization (NACI) no longer preferentially recommends one vaccine type over another for COVID-19, that there is more data available for mRNA vaccines than the protein subunit vaccine for people who are immunocompromised, that either an mRNA vaccine (e.g. Moderna Spikevax or Pfizer-BioNTech Comirnaty) can be used for people who are immunocompromised, the vaccines that will be available in Canada meet the current public health needs.
In addition, demand for Novavax’s COVID-19 vaccine has been very low. In 2023 125,000 doses of the XBB vaccine were ordered and available in Canada of which only 5,529 doses were administered (data as of June 30, 2024). In total, less than 0.5% of total Novavax doses that have been delivered to Canada have been administered. This, along with limitations in availability of Canadian produced product, limit Canada’s ability to procure the product while operating within good stewardship of public resources and minimizing wastage.
In their most recent Guidance on the use of COVID-19 vaccines during the fall of 2024, the National Advisory Committee on Immunization (NACI) recommends COVID-19 vaccination starting fall 2024 for individuals at increased risk of SARS-CoV-2 infection or severe COVID-19 disease, including immunocompromised individuals, using the most recently updated COVID-19 vaccines.
If you are unsure whether to wait for an updated vaccine dose, consult with a healthcare provider about your risk of severe COVID-19 disease or speak to your local public health unit about vaccine access in your region. Individuals who prefer the Novavax Nuvaxovid vaccine or are unable to receive an mRNA vaccine should consider layering other personal preventive practices, such as practicing hand hygiene, wearing a well-fitting mask, and improving indoor ventilation, to reduce the risk of infection from COVID-19. Canadians are encouraged to visit the Government of Canada’s website: https://www.canada.ca/en/public-health/ services/diseases/coronavirus-disease-covid-19.htm! which is updated regularly to ensure that Canadians have the most up-to-date and credible information on COVID-19.
We hope this information is helpful and thank you for sharing your concern.
Public Health Agency of Canada / ‘Agence de la santé publique du Canada
People ask me relatively frequently which vaccine I think they should get based on the research I’ve seen. I tell them that I am not a doctor. I also have been telling them that I’m a Novavax stan, but that there just wasn’t enough research for me to unequivocably say that Novavax was better. I was not convinced: a lot of the Novavax comparison studies were small, or in rodents, or in test tubes, or not peer reviewed, or didn’t show a big difference from the mRNAs. There were very few head-to-head comparisons in people where Novavax had a clear advantage.
There was enough hard data to say that side effects were usually easier for Novavax than for the mRNAs. Still, it was clear that it mattered way more that you get a COVID-19 vax — some vax, any vax — than which vax you got.
I still feel like it’s more important to get a vax than which brand you get, but there is research (which I just found) which tips the scales for me to recommend Novavax (though remember, I am still not a doctor!): this paper from UK (2023-06-16) which I only just now found reports a really clear win for Novavax. Adolescents who got a Pfizer Classic first dose/Novavax Classic second dose combo had an 89% lower risk of a breakout infection in the 132 days after vaccination than those who got a Pfizer Classic first/Pfizer Classic second combo. In addition to the sick/not-sick results, they found that, compared to Pfizer1/Pfizer2, the Pfizer1/Novavax2 blood had:
- had 43% higher neutralizing antibody levels against BA.1 and BA.2 in their blood at 28 days after the booster;
- had 73% higher cellular immune (e.g. T-cells) responses in their blood at 14 days after the booster.
Yes, it’s in kids, not adults. Yes, the study was done in 2021, with the vaccines based on COVID Classic, in world where there were still enough uninfected people to act as controls, and with different variants. Yes, pretty much everybody has had multiple immunization events since then: the people who are still cautious have gotten lots of shots (eight for me now!) and the people who are not cautious have gotten multiple infections. BUT STILL! EIGHTY-FUCKING-NINE PERCENT! That’s a LOT!
Ahem.
Other Research
Please understand that it’s not that one the 89%-better-in-kids study convinced me that Novavax is better. This one study kicked me over the top. (Remember, I was already a Novavax stan.) I think it’s worth compiling, in one place (i.e. here), all the different other pieces of evidence.
- I can’t find it now, but I swear I heard someone from Novavax say, during a (Zoom) presentation to an FDA committee, that they even saw some neutralization against SARS-CoV-1. Not SARS-CoV-2, SARS-CoV-ONE, the original. (NB: Obviously this wasn’t peer reviewed, and hell, the guy might have been lying, and it’s possible that I’m making it all up… but I remembered because it was such a surprising revelation.)
- 185th Meeting of Vaccines and Related Biological Products Advisory Committee (2024-06-05) shows two different cases of broad responses:
- At about 3h29m in the video, they show that blood from patients with XBB.1-based booster (after 3 previous mRNA doses) doesn’t show much difference in the levels of neutralizing pseudovirus titres between JN.1 and its descendants (e.g. KP.2).
- A minute later, at 3h30m, they show that blood from patients who got a JN.1 booster had good neutralizing levels against a wide range of JN.1 descendants. Yes, neutralization against the JN.1 descendants was worse than against JN.1, but was still pretty good.
- This paper (2024-05-16) reports that Novavax Classic and Novavax B.1 as third shot (after two Moderna Classic doses) had significantly lower viral loads in the upper airway than either unvaccinated monkeys or monkeys that got a Moderna Classic third shot. The upper respiratory load dropped two days after the booster and stayed down.
- This presentation by Novavax to the US CDC (2023-01-26) found that a booster vax (after three earlier mRNA Classics) based on their COVID Classic did very slightly better in test tubes against BA.1 and BA.5 than their monovalant BA.1-based booster or their bivalent BA.1/Classic booster did. Broader protection.
- This paper from USA (2022-07-19) reported that Novavax did quite well. They looked at several combinations of vaccines (three mRNAs, three Novavax, and some combos other vaccines which aren’t really applicable to Canada) against COVID Classic, BA.1, BA.2, BA.2.12, and BA.4/5. Novavax did MUCH better against COVID Classic, BA.2, and BA.2.12 than any of the other vaccine combos that they looked at. They were slightly better than any others against BA.1, and slightly worse than three mRNAs against BA.4/5 (but still significantly better than any others overall).
- This Twitter thread (2022-03-14) gives an argument for why Novavax would have broader protection than the mRNAs. It says that because of how the Novavax vaccine stabilizes the furin cleavage, that lets it present the S2 piece of the spike protein better, and that S2 changes much less frequently than the other piece of the spike.
Contrary Research
There has been some research which seems to say that Novavax is not as good. I would be remiss to not mention it:
- This paper from Australia (2023-08-31) reports that three doses of Novavax Classic did not prevent infection in humans as well as three doses of either Pfizer Classic or Moderna Classic against BA.1; Novavax Classic as a booster also did not do as well as the mRNA Classics.
- This paper (2024-05-16) reports that Moderna Classic, Novavax Classic, and Novavax B.1 all did pretty much the same (not better) as a third shot (in blood of monkeys, after two Moderna Classic shots) against COVID Classic, BA.1, BA.2.75, BA.5, BA.2.75.2, and BQ.1.1 across a bunch of different metrics. (NB: This is the same paper which found that Novavax Classic and Novavax BA.1 resulted in significantly lower viral loads in the upper airway.)
- This paper from South Africa (2023-01-21) reports that three doses of Novavax Classic gave results in test tubes which were slightly better than three doses of mRNA Classic against BA.1 but slightly worse against BA.4/5).
KP.2 vs JN.1?
So what about the fall boosters? Novavax is putting out a JN.1 vax while the mRNA tag team has decided to do KP.2 formulations. KP.3 vaccines is what the CDC finally asked for, a week after they said they wanted JN.1. Novavax said, effectively, “nah, we think JN.1 is good enough”, and it probably is. (See again the 2023-01-26 presentation to the US, at about 3h30m.)
Not only that, but LB.1 (JN.1.9.2.1) has a little under 20% of the variant “market” right now, and LB.1 is NOT a descendent of KP.2 (JN.1.11.1.2). It’s not even a sibling, it’s more like a cousin. This means that a JN.1 booster is likely to be a closer match than KP.2 against LB.1.
(FYI also that JN.1 is not a child of XBB.1, but a child of BA.2.86, so having had an XBB.1 booster isn’t going to help much against JN.1 and its descendants.)
Addendum: Recommended Reading
I found this long and very detailed/technical blog post (2024-09-03) after I wrote this post. The author says it’s a perfectly adequate vax, but slightly less effective than the mRNAs. He agrees that it has fewer side effects. He seems to really know his stuff… so you should probably pay more attention to him than to me. I might still try to get a Novavax shot, but I freely admit that part of my attraction is emotional and not logical.
1 comment
Comments are closed.