Vaccine efficacy and third dose protocols top Board of Health agenda

The Board of Health for Kingston Frontenac Lennox & Addington Public Health (KFL&APH) held their regular meeting Wednesday, Sep. 22, 2021, which took place online and in person.

Amanda Posadowski, KFL&APH Program Manager for Vaccine-Preventable Disease, reported on the current state of COVID-19 in the area with a review of recent important events, a current number of cases, vaccine mandates, vaccine efficacy and third dose protocols.

Late Summer Review

In mid-August, the provincial government paused the planned exit from the Road To Reopening Plan in response to data around the Delta variant, and the experience in other jurisdictions. Ontario, therefore, remains in step three of the plan she reminded the board, “And so we’re maintaining those public health measures such as masking indoors.”

At the same time, the provincial government announced third doses for select individuals “in response to some data around some waning immunity or sub-optimal immune response.”

“September 1st,” she went on, “Ontario announced that proof of vaccination would be required for some indoor public settings, and of course implementation of that is today [September 22].”

“As of September 14th, the provincial government announced further eligibility for some third doses and as well as changes to what is defined as ‘fully vaccinated’, for people that receive doses, outside of Canada,” Posadowski continued. 

“What Ontarians need to do is to show proof of vaccination to access some indoor settings,” she said. To do this Ontarians must download or print their vaccine receipts for now. 

Eventually, however, the government will be moving to a QR code system. This will be needed to enter restaurants, bars, sporting facilities, and most places where masks are not always worn consistently. 

“Our key public health messages remain. We want people to get vaccinated, wear face coverings, wash their hands, use hand sanitizer, keep a distance, screen for symptoms and of course get tested if they have symptoms,” Posadowski reminded those in attendance.

She also updated the board on the current Pandemic statistics: Ontario saw 574 new cases on Tuesday, Sep. 21, 2021, and the new cases per day have been relatively stable over the last two weeks.

“Locally, we saw seven new cases today, with the cases that we had resolved, we remain at 34 active cases,” she shared.

As for vaccinations, “We’re really proud to say that over 86 per cent of our population who are eligible have received at least one dose, we have reached 81 per cent in adults who’ve received both doses, and we continue to push to get that number over 90 per cent,” she said.

“We’re still struggling a bit in that 25 to 35-year-old population, that’s been our hardest to get going,” she explained, but, “We think that the vaccine certificate and the mandatory workplace policies that have come up and continue to come will help to move that group to the most.”

Vaccine Efficacy

Posadowski said the data collected, “shows that vaccines are in fact working. We are seeing cases in partially vaccinated and fully vaccinated individuals but it is definitely lower than in the unvaccinated population,” she said. “We’re also seeing less serious infection, of course in people who are fully vaccinated. In our ICUs, in Ontario, the large majority are unvaccinated individuals. And same with those who are hospitalized but not in the ICU, the large majority being unvaccinated individuals.”

“Why,” asked Councillor Jeff McLaren, did charts seem to point to many fully vaccinated individuals being hospitalized (though not in ICU)?  About 5 per cent of those in the hospital had had two doses he estimated. Members asserted that they had heard this used by members of the public as a reason for not getting immunized.

Dr. Guan fielded this question, explaining, “With regards to the ICU stats, some of what they’re finding [doctors and researchers working on the front lines] are that the fully vaccinated individuals hitting ICU, are actually those with many, many, comorbid conditions and many of them are actually immunosuppressed.”

“For those folks with severely immunocompromising conditions, it seems that people need three doses to achieve optimal immunity, versus the two doses,” he explained, “and a lot of that evidence was generated because they were seeing folks who were ‘technically fully vaccinated’ hitting the ICU.”

“The vast majority of these people have some form of other medical illness going on, or they are extremely old, which in itself predisposes people to COVID, and for COVID complications,” he concluded based on the observations of his frontline colleagues.

Third Dose Eligibility and requirement

Dr. Guan explained that The National Advisory Committee for Immunization meets weekly to review the evidence and provide recommendations to all the different provincial governments and what the science supports in terms of third doses.

“Already we’ve had recommendations for those who have severely immunocompromised conditions: those on chemotherapy, as well as those in Long Term Care and in high-risk retirement homes, just because the congregate setting plus people’s age, makes people more vulnerable to COVID,” he said. “Most likely, they will look at age breakdowns. There seems to be an association, older age means that people are more vulnerable to COVID, which is not that surprising.”

To answer another question about whether everyone will require a third dose Guan said, “Maybe at some point, there might be enough evidence that it can be a population-wide recommendation but currently, the evidence isn’t there yet.”

Vaccine Passports

As of Wednesday, Sep. 22, 2021, to access certain public settings and facilities patrons will need to provide both proof of being fully vaccinated and proof of identification (such as a driver’s licence). Vaccine receipts are acceptable proof of vaccination until October 12, after which an enhanced vaccine certificate [on paper] will be available in hard copy. As well, a verification app for smartphones that will allow organizations to read a QR code connected to public health information and vaccine status will be available.

Another point was brought forward with regards to vaccine passports, why weren’t personal services like nail salons included in the list of businesses that require proof of vaccination? Locally there were a number of cases of Covid spread linked directly to nail salons.

After some discussion on the matter, it was motioned to send a recommendation to the Minister of Health and the Cheif Medical Officer of Health explaining that, “whereas, one of the major out one of the series outbreaks in KFL&A was at a non-essential personal service location [nail salon]. Therefore, KFL&A Public Health Board would recommend all non-essential personal service locations, require proof of vaccination.”

It was also resolved to encourage all organizations in KFL&A to implement a vaccination policy that encourages full vaccination.

Other Priorities

With flu season fast approaching, the Public Health Agency is not just planning for COVID potential third doses and vaccination passports. 

Dr. Guan said, “We’re also planning for influenza shots as well as all the school-based vaccinations of the four or five cohorts now that need catch-ups for the Hepatitis B, HPV, and Meningococcal vaccines, which are given at school.”