Ask the Pharmacist

Q. I heard Ontario is going to be giving booster doses for COVID soon. Who is eligible to get booster doses for COVID in Ontario now? When will it be available to the general population?

A. Ontario announced that the most vulnerable people will receive a booster dose of the vaccine (of course depending upon whether they want one, although choice when it comes to vaccines remains a very fluid situation). As we discussed in prior columns, some people that are immunocompromised do not get the same level of protection as the general population from the usual 2 doses. The following people will be offered a booster dose 8 weeks after their second COVID vaccine;

– Transplant recipients
– Undergoing treatment for a hematological cancer (eg: leukemia, lymphoma, multiple myeloma etc.)
– Taking anti-CD20 agents (eg: rituximab, ocrelizumab etc.) which may be taken for conditions such as multiple sclerosis, rheumatoid arthritis, cancer treatments etc.

Vaccine administration timing is critical in this group since they are actively being treated with medications that can reduce the effectiveness of the vaccine if they are given too closely together. It is therefore crucial to have a discussion with the health care provider (almost always a specialist) that is providing the treatment to agree on the best timing of this booster. Of course, to help protect these immunocompromised individuals, it is imperative that all close contacts (healthcare workers, caregivers, family, friends) have had 2 doses of the vaccine.

This next category of individuals may receive a booster dose 5 months after their second COVID vaccine;

– Residents of a long-term care home (eg: nursing home)
– Residents of Elder care lodges
– Residents of “high risk” retirement homes

We have already witnessed the devastation that this coronavirus has brought to the senior population living in congregated housing when the pandemic started. Now, we are learning that the immunity in this same population is waning and they are again at risk from COVID which is concerning given that Delta is running rampant throughout our country.

Waiting 5 months after the second dose for a booster is comparable to many other vaccines that utilize a third dose in their regime. The protocol for Hepatitis B vaccine (Engerix, TwinRix) is 0, 1 month and a third dose at 6 to 12 months. It is this third dose that gives the body longer lasting immunity. Another example is Gardasil, a HPV (Human Papilloma Virus) vaccine which is dosed at 0, 2 months and 6 months for people 15 years and older.

With September approaching and the return of students back to the schools, it is important to consider that the children under 12 are not able to be vaccinated. So, though we are discussing booster doses for the most vulnerable, we would be remiss to avoid discussing the under 12 population. Currently, the Delta variant appears to be affecting the younger generation more than the elderly. This is proof that the vaccines are working and thus the population that has not been vaccinated for various reasons are now the most susceptible to COVID.

It is important to remember that fully vaccinated people can still get COVID-19 and they may also transmit COVID to others, especially the unvaccinated people. Since there is not a vaccine approved as of yet for those under 12, we as a community need to do our part to protect them. That means that anybody over the age of 12 should get fully vaccinated. We also need to continue to adhere to public health measures such as;

  • wearing of masks in public spaces
  • physical distancing (2 metres apart)
  • consider outdoor venues when possible (realize we are approaching fall/winter months which will limit this possibility)
  • ensure indoor spaces are well ventilated by opening windows and/or doors
  • wash/sanitize your hands often

As we have seen numerous times, most recently in Manitoba this week, we are not yet close to the level of vaccinations needed to make these measures unnecessary anymore. There is a more than a little irony in the fact that many of those who are often most against these measures, and lockdowns in general, are the same ones whose choices with regard to vaccines continue to perpetuate our current state of affairs. It has been said many times, we are all in this together and together we can beat this. But we do need to act collectively to be able to help one another.

Many of you are pondering when a booster dose might be available for the general population. That is a question that cannot be answered at this time. It is a difficult conversation when we begin to weigh the importance of Canadians getting third doses into the general population against donating doses to developing countries whom have not yet been vaccinated with a first dose.

In next week’s column we’ll get into both sides of the argument which is as much an ethical one as it is a scientific debate. For more information about this or any other health related questions, contact your pharmacist.