British Columbia health officials are still undecided on whether fourth vaccine doses will be made available to the general population as immunity to COVID-19 wanes and the possibility of future, more transmissible variants looms.
The BA2 Omicron subvariant has already fuelled a sixth wave amid B.C.’s relaxed public health measures, and limited data reporting and testing has made its progression difficult to track.
The BC Centre for Disease Control now only provides new statistics weekly, and COVID-19 PCR testing is severely limited to those in high-risk settings, with use of at-home rapid tests for the general population encouraged instead.
In the last week, according to the province's most recent May 12 report on the pandemic, 59 more people have died after testing positive for COVID-19. There are currently 596 people in hospital, including 54 in ICU.
And with lower rates of third shot booster uptake occurring already, experts say a robust fourth dose campaign will be key to weathering future variants without B.C. having to reintroduce major protective measures — such as mandatory masking and the vaccine card program — seen during the first waves of the pandemic.
The National Advisory Committee on Immunization recommends fourth shots, or second boosters, for those over age 70, Indigenous people over 55, people living in long-term care and assisted living, and those who are deemed clinically extremely vulnerable. All of these people are currently eligible for a fourth dose of the vaccine in B.C.
“There is really good protection from three doses for most people, up to age 80 but especially up to age 70,” said B.C. provincial health officer Dr. Bonnie Henry at a COVID-19 update on May 10. “That’s where we’re targeting this fourth dose.”
Other provinces are moving more quickly towards a fourth dose, as immunity from booster shots and previous infection wanes within three to four months. In Quebec, all adults are now eligible for a fourth shot, and Ontario has lowered the age requirement to 60 years.
NACI has not yet recommended fourth shots for the general population under age 60.
Henry said Tuesday she was still reviewing the evidence, but that it was possible adults would be offered a fourth shot by the fall.
“We do not yet know if all of us will need another dose of vaccine come the fall or if protection from the three doses will carry most of us through,” Henry said.
“We need to find that balance of whether you need it and how long the protection will last.”
But whether British Columbians will be willing to roll up their sleeves a fourth time to significantly bump community immunity remains to be seen.
Just 61 per cent of eligible residents over 18 have received a first booster shot, compared to more than 88 per cent of eligible people who got two shots.
And so far, just over 78,000 people have received a fourth shot in B.C., less than 10 per cent of those eligible.
Research has shown that three doses of vaccine are essential to protection against the Omicron variant and its subvariants, and getting that first booster shot provides significantly more protection against hospitalization and serious illness than two initial doses of vaccine.
According to Dr. Brian Conway, medical director at the Vancouver Infectious Diseases Centre, low booster uptake might partly be a result of pandemic fatigue, but it’s also an issue of communication and credibility.
“We’ve not done a good enough job to make people understand that with Omicron, you need three shots,” said Conway.
At first, it wasn’t known that immunity from the COVID-19 vaccines would wane over a matter of months. But as the evidence and understanding changed to support getting at least one booster, some people may have felt misled by initial assertions it was a two-dose vaccine.
“We didn’t know the truth at the time,” Conway said. “And we’ve not done a good enough job of explaining variants [and] explaining waning efficacy.”
Conway added that while relaxed protective measures might signal lower risk, vaccination is the foundation of reducing one’s own risk to themselves and others.
B.C. Health Minister Adrian Dix said public health is working to increase booster uptake, as well as vaccinations among school-aged youth, which have stalled at around 55 per cent. Children are still at risk of suffering severe outcomes and developing long COVID as a result of infection.
Conway said increasing the rate of third doses should be the priority while the evidence around fourth doses is reviewed. Focusing too much on whether or not everyone may need one could also be harming vaccine uptake, he added.
“I think we’re slow-walking to everyone getting a fourth dose,” said Conway.
“And if we wind up… with everyone east of the Alberta-B.C. border getting fourth shots, then we can have the talk with a little more urgency.”
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