Canada’s National Advisory Committee on Immunization (NACI) is lowering its age recommendation for Oxford-AstraZeneca’s COVID-19 vaccine to younger age groups.
NACI now recommends the vaccine be used in people 30 years of age and older, “if the individual does not wish to wait for an mRNA vaccine and the benefits outweigh the risks,” said Shelley Deeks, NACI’s vice-chair.
Previously, NACI’s guidance said the shot should only be used on those aged 55 and older.
Deeks said NACI “weighs the benefits” of the vaccine against the risks associated with COVID-19 infection. She said data from Europe and Health Canada’s previous safety assessment were considered in making the new recommendation.
“NACI continues to analyze the data as it becomes available and continues to monitor the data,” she said.
While NACI still encourages Canadians to get the vaccine that becomes available to them, given varying provincial guidelines, the committee said individuals 30+ could wait for an mRNA vaccine should certain conditions be met, including how long it may take to receive an mRNA vaccine.
Ethical and equitable prioritization of the rollout still remains the strategy, said NACI Chair Caroline Quach, but that people have an individual choice because of the very rare risk of VITT (vaccine-induced immune thrombotic thrombocytopenia), which has been seen in a very small percentage of AstraZeneca recipients.
“If someone decides not to take the AstraZeneca vaccine for some reason, that person should not be put at the end of the list,” she said.
“The bottom line is, like everything, a risk-benefit analysis. We do agree we want to vaccinate Canadians as quickly as possible.’
This week, several provinces lowered their minimum age requirement for AstraZeneca’s COVID-19 vaccine as the virus continues to proliferate in their jurisdictions.
As of Tuesday, those aged 40 and older in Ontario and Alberta can get the shot. British Columbia and Manitoba also dropped the age requirement to 40 as of Monday. As of Wednesday in Quebec, those 45 and over are eligible for the shot. Saskatchewan has also lowered its age eligibility to 40.
The reasons for the decisions by the provinces largely line up — opening the eligibility means more shots in people’s arms as infections rise and, based on growing data, the benefits of getting the vaccine still largely outweigh any risks.
It is ultimately up to provinces and territories on how to distribute the vaccines they receive. Deeks acknowledged recommendations may vary by jurisdiction due to “rapidly changing COVID-19 epidemiology,” as well as local vaccine logistics and equity considerations.
“These may change over time,” she said.
Federal Health Minister Patty Hajdu reiterated on April 18 that provinces and territories are, in fact, free to use the vaccine on anyone over 18 — which has been Health Canada’s official guidance since it approved AstraZeneca in February.
Health Canada’s guidance remains unchanged. NACI’s guidance — which is only a recommendation — does not override the conditions of the vaccine’s approval.
Up until now, the NACI guidelines stood at 55-plus. That guidance was initially set in March as Canada and other countries investigated possible links to rare blood clots reported in a small percentage of AstraZeneca recipients.
Those events continue to be a very rare side effect of the vaccine. Canada has reported four cases out of more than 700,000 doses administered, the latest reported in Ontario.
Though there is enough evidence to say the vaccine may cause very rare blood clots, Health Canada says the shot is still extremely safe and very effective and will remain on the Canadian market. Health Canada updated the label on the AstraZeneca and Covishield vaccines in March to add information about the very rare reports of blood clots.
The U.K. regulator recently said, like Health Canada, that the vaccine remained safe for everyone, but the British version of NACI recommended it not be given to people under 30, who have the lowest risk for severe illness from COVID.
When asked how Canadians could decide whether they should wait for an mRNA vaccine, Deeks said it may depend on a range of things, including how infected their community is with COVID-19, whether a vaccine is available to them now, and “how much they’re worried about adverse events.”
“We’re all worried about that in a slightly different way, and they’ll need to make a decision one way or another about where that risk-benefit lies for them about receiving a vaccine now or waiting for a vaccine later,” she said.
“Risk perception and risk tolerance is actually a very individual thing.”
Dr. Bonnie Henry, B.C.’s provincial health officer, offered a clearer message:
“Especially in areas where we have a lot of transmission with this virus — take the vaccine that is offered to you. They’re safe, they’re effective, they work, and it will protect you and your family,” she said.
“With what we’re dealing with right now, my colleagues across the country would say the same.”
— with files from The Canadian Press
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