British Columbia health officials remain hesitant about whether the fourth doses of the vaccine will be available to the general population as immunity to COVID-19 wanes and the potential for more transmissible variants to emerge in the future.
The BA2 Omicron variant has already fueled the sixth wave amid BC’s relaxed public health measures, and limited data and testing reporting has made it difficult to track its progress.
The BC Center for Disease Control now provides only new statistics per week, and COVID-19 PCR testing is strictly limited to those in high-risk settings, while encouraging the use of rapid at-home tests for the general population instead.
Last week, according to the county’s latest May 12 report on the pandemic, 59 more people died after testing positive for COVID-19. There are currently 596 people in hospital, of whom 54 are in the intensive care unit.
With uptake rates for the third booster vaccine already low, experts say a robust fourth-dose campaign will be key to overcoming future variables without the need to reintroduce key preventive measures — such as the mandatory masking and vaccine card program — seen during the first waves of the pandemic.
The National Immunization Advisory Committee recommends IV injections, or second boosters, for those over 70 years of age, Indigenous peoples over 55 years of age, people in long-term care and assisted living, and those who are clinically considered to be at high risk. All of these people are currently eligible for a fourth dose of the vaccine in British Columbia
“There is really good three-dose protection for most people, up to age 80 but especially up to age 70,” British Columbia District Health Officer Dr Bonnie Henry said in a COVID-19 update on May 10. “This is where we target this fourth dose.”
Other counties are moving more quickly toward the fourth dose, as immunity from booster shots and previous infections wanes within three to four months. In Quebec, all adults are now eligible for a fourth dose, and Ontario has lowered the age requirement to 60 years.
The NACI has not yet recommended IV injections for the general population under 60 years of age.
Henry said Tuesday she is still reviewing the evidence, but adults will likely be offered a fourth chance by fall.
“We don’t know yet whether we will all need another dose of the vaccine when we fall or if protection from the three doses will carry most of us,” Henry said.
“We need to find that balance as to whether you need it and for how long the protection will last.”
But whether British Columbians are willing to roll up their sleeves for the fourth time to dramatically raise the community’s immunity remains to be seen.
Only 61 percent of eligible residents over age 18 got their first booster dose, compared to more than 88 percent of eligible people who got two injections.
So far, more than 78,000 people have received a fourth injection in British Columbia, less than 10 percent of those who qualify.
Research has shown that three doses of the vaccine are necessary to protect against the Omicron variant and its subvariants, and that getting the first booster dose provides significantly greater protection from hospitalization and critical illness than two initial doses of the vaccine.
According to Dr. Brian Conway, MD, medical director of the Vancouver Center for Infectious Diseases, decreased booster uptake may be partly a result of pandemic fatigue, but it’s also a matter of communication and credibility.
“We haven’t done a good enough job of getting people to understand that with Omicron, you need three shots,” Conway said.
At first, it was not known that immunity to COVID-19 vaccines would wane within months. But as evidence and understanding change to support getting at least one booster dose, some people may have been misled by initial assertions that it was a two-dose vaccine.
“We didn’t know the truth at the time,” Conway said. “And we haven’t done a good enough job explaining the variables and explaining the diminishing efficacy.”
Conway added that while relaxed protective measures may indicate lower risks, vaccination is key to reducing an individual’s risk to themselves and others.
British Columbia’s Minister of Health, Adrian Dix, said Public Health is working to increase drug uptake, as well as vaccinations among school-age youth, which has stopped at around 55 per cent. Children are still at risk of suffering severe outcomes and developing COVID for a long time as a result of the infection.
Conway said increasing the rate of third doses should be a priority while the evidence around fourth doses is reviewed. He added that focusing too much on whether or not everyone might need could also hurt uptake of the vaccine.
“I think we’re going slow until everyone gets a fourth dose,” Conway said.
“And if we end up…with everyone east of the Alberta-B.C border getting their fourth shot, we can speak more urgently.”
Corona virus vaccines