In a reversal of its own guidance issued earlier this month, Canada’s National Advisory Committee on Immunization (NACI) is now recommending that AstraZeneca’s COVID-19 vaccine be used on people aged 65 or older.
The committee now says “real-world evidence” has demonstrated that the vaccine is safe and effective in older adults, particularly against severe illness from COVID-19 and hospitalization.
Still, if there is a choice, NACI says mRNA vaccines — like Pfizer’s and Moderna’s — should be prioritized for use on seniors, but that it no longer recommends against using AstraZeneca for anyone over the age of 65.
However, that recommendation could soon change too, said NACI chair Dr. Caroline Quach.
“It’s possible, based on real-world evidence from these mRNA vaccines, that the preferential recommendation could change,” she said.
“I think people have to realize it’s not that we’re flip-flopping, we are simply trying to monitor the evidence.”
Clinical trial data shows the vaccines from Pfizer-BioNTech and Moderna were more effective than AstraZeneca’s, but Quach said data collected since all the vaccines began being widely used shows similar levels of effectiveness. She said the NACI is looking at that data more closely now.
“It’s always easier if Health Canada and NACI agree, but it doesn’t have to be. I think it’s just the first time people put so much spotlight on NACI’s recommendation, and that’s understandable, vaccines are what’s going to get us out of this pandemic, but the way we function is the way we functioned before.”
The decision reverses guidelines made earlier this month, which said Canadian seniors should not receive the AstraZeneca shot. NACI cited “limited information on the efficacy of this vaccine in this age group” as the reasoning behind the decision at the time.
Since then, several “real-world effectiveness studies” from the U.K. have been released showing that the vaccine is both safe and effective for seniors. The studies, along with similar findings from Scotland, helped inform NACI’s decision to change its recommendations.
Britain has been administering the vaccine to people 65 years and older since January.
The strategy now rests in the hands of provincial governments, who will have to decide if they revise how they use the vaccine.
“NACI will continue to closely monitor data from ongoing clinical trials and real-world use, that includes safety and will revise recommendations as needed,” Quach said.
Several European countries, including France, Germany and Italy, have also reversed their recommendation against using the shot on seniors.
Health Canada approved the AstraZeneca vaccine for use in anyone 18 years or older in late February. It became the third COVID-19 shot green-lit in Canada, joining vaccines from Pfizer-BioNTech and Moderna.
Canada’s initial 500,000 doses of the AstraZeneca COVID-19 vaccine have been manufactured by the Serum Institute in India. In total, two million doses will arrive in the country from that agreement.
The initial doses delivered last week have now been spoken for. Another 20 million doses already secured with AstraZeneca aren’t expected until sometime in April, which leaves provinces with time to reconsider how they will roll out the next batch and to whom.
According to NACI, the AstraZeneca COVID-19 vaccine has a reported efficacy of 62 per cent in those aged 18 to 64.
Blood clot concerns
The new guidance from NACI comes as several European countries – including Germany, France, Italy and Spain — have halted the use of the AstraZeneca vaccine, citing concerns over reports of blood clots in some people who received the shots.
The European Medicines Agency and the World Health Organization have both said the data available does not suggest the vaccine caused the complications.
Similarly, in a statement emailed to Global News on Sunday, Health Canada said at this time “there is no indication that the vaccine caused these events.”
“To date, no adverse events related to the AstraZeneca COVID-19 vaccine, or the version manufactured by the Serum Institute of India, have been reported to Health Canada or the Public Health Agency of Canada,” the email read.
The European Medicines Agency (EMA) launched an investigation to determine whether the shot is, in fact, connected to the reported blood clots and to assess the vaccine’s safety overall.
It said Tuesday that the benefits of AstraZeneca’s vaccine continue to outweigh the risks. The EMA’s executive director, Emer Cooke, said there was no indication that the blood clot incidents — which he described as “very rare” — had been caused by the vaccine.
He said experts are still assessing the possibility, but that the shot is still very much safe to use, and should continue to be.
Many of the European countries that chose to suspend the shot did so pending the EMA’s review. The final results of the analysis could be made available Thursday.
Authorities suspect the potential issues stem from a particular batch of the shot manufactured in Europe.
Health Canada confirmed Sunday that “none of the identified batches under investigation have been shipped to Canada.”
Dr. Howard Njoo, Canada’s deputy chief public health officer, emphasized that point on Tuesday. He said Europe is “acting in a very precautionary manner” and that the rate of these blood clot reports “is not different than among the population as a whole.”
“Our AstraZeneca supply is coming from India. It’s from a completely separate lot (batch),” he said.
“When it comes to the vaccines that have been approved here in Canada, I would take any.”
Further, speaking at a press conference in Montreal on Monday, Prime Minister Justin Trudeau offered his reassurance on the safety of the shot.
He said Health Canada regulators are “constantly analyzing all the available information about vaccines and have guaranteed those approved in Canada are safe for use.”
“Health Canada and our experts and scientists have spent an awful lot of time making sure every vaccine approved in Canada is both safe and effective,” he told reporters.
“Therefore, the very best vaccine for you to take is the first one that is offered to you.”
— With files from Global News’ Emerald Bensadoun, The Canadian Press and Reuters
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