December 9, 2023

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You may not use the 4th: Why Manitoba refuses to loosen criteria for COVID-19 vaccine doses

In Ontario and Alberta, anyone 18 or older can go out get a fourth dose of a COVID-19 vaccine five months after they received their third jab.

In Quebec, anyone 18 or older can get that fourth dose three months after their third.

Manitoba is not following suit. Dr. Brent Roussin, the chief provincial public health officer, said this week the province has no plans to expand fourth-dose eligibility beyond the current criteria.

Right now, that’s limited to any Manitoban 50 or older, Indigenous people 30 and up, and adults with serious health issues or compromised immune systems.

Dr. Alex Wong, a Regina infectious disease doctor, said restricted access doesn’t make sense.

“Given the relative lack of uptake of vaccine in general combined with the availability of the vaccine in large amounts, I don’t see any practical reason why any province should restrict access to fourth doses,” he said Friday via email.

But Roussin offered several reasons Manitoba  is staying the course on eligibility.

For starters, he said, fourth doses don’t offer much more protection against COVID-19 for people who are not at risk of hospitalization or death if they contract the illness.

“Looking at severe outcomes, we see those who have that initial booster [their third shot] are still well protected against severe outcomes,” Roussin said at a Wednesday vaccine briefing.

“The fourth dose isn’t showing us significant benefit outside those who are high risk, and … [they] are already eligible for that fourth dose.”

WATCH | Dr. Brent Roussin on why Manitoba isn’t expanding 4th-dose eligibility now:

Why Manitoba is delaying a 4th dose campaign now

Dr. Brent Roussin says the province is hopeful a bivalent vaccine will be available soon to roll out in Manitoba.

Roussin went on to say what more Manitobans really ought to do is get their third COVID vaccine shots — something he said would go a long way to providing more people with better immunity.

This province continues to lag behind most others when it comes to third doses. Only 44.3 per cent of Manitobans are triple vaxed, compared to a national average is 49.3 per cent, Health Canada says. Among the provinces, only Saskatchewan and Alberta have lower triple-vax rates.

“The larger issues fall around encouraging people to go and get their doses done,” said Regina’s Dr. Wong. “There’s so little enthusiasm for it and so little effective messaging from policy makers and the like.”

Holding out for better vaccines

Nonetheless, Roussin’s exhortations to improve third-dose uptake come in contrast with complaints this spring Manitoba has not done enough to extol the benefits of booster shots.

Logically, however, the failure to convince reluctant Manitobans to get a third dose does not explain the rationale for denying willing Manitobans a fourth dose.

Roussin provided a second reason for maintaining fourth-dose criteria: A better vaccine may be on the way.

“In early fall, there’s a real chance of a bivalent vaccine that we begin our fall campaign with, that is going to be very likely more effective against the newer variants that we’re dealing with,” Roussin said Wednesday.

The COVID-19 vaccines currently available are “monovalent” vaccines, which were developed with the original strain of the virus in mind. 

A bivalent vaccine, like one Moderna is developing, would target specific portions of the virus seen in both the original strain and newer strains.

“Because there’s going to be a three- to six-month interval between doses, a large fourth-dose campaign right now could potentially delay the receipt of a possibly better vaccine in the fall,” said Roussin.

However, this is something of a straw man. No one is calling for a large campaign right now.

As Health Minister Audrey Gordon said this week, the province is planning a booster push for the fall, when the weather gets colder, more activities move indoors and COVID-19 can spread more easily.

There are, however, some Manitobans who have expressed a desire to top up their immunity now even though they know a better vaccine may be on the way. Many people in their 40s, for example, received their third doses eight or nine months ago and are concerned about waning immunity.

“Even if I got a 20 per cent efficacy increase, that would be better than zero,” said Alan Simpson, a 46-year-old Winnipeg resident who is too young to receive a fourth dose, but wants some peace of mind because he’s worried about conveying COVID to his elderly parents.

In essence, Manitoba Public Health is providing something of a mixed message to most adults in this province.

In March, when the province eliminated mask mandates, Roussin said it was up to Manitobans to make their own decisions about what level of risk they’re willing to tolerate as they go about their daily lives.

Now in July, Roussin is effectively telling Manitobans who desire a fourth dose they are not free to make a decision about personal risk tolerance.

He said he based his decision on recommendations from the National Advisory Committee on Immunization. But so did his counterpart in Ontario: Canada’s largest province only recommends fourth doses for adults in one of the COVID risk categories.

But Ontario also just so happens to allow all other adults to get that second booster if they choose to do so.