The Confused & Pissed-Off Person’s Guide To Getting The “Preferred” Vaccine In Canada

Photo: Courtesy of Marta Fernandez Jara/Europa Press.
UPDATE: Ontario and Alberta won't be giving first doses of the AztraZeneca vaccine anymore. Ontario attributed the halted rollout due to the rare risk of blood clots, calling it a cautionary measure, while an Alberta spokesperson said there are no new imminent shipments. Its remaining supply will be used for second doses.
Original story follows.
Canada’s vaccine rollout has never been accused of running smoothly. Still, this week brought whole new levels of WTF (!!!!) with updated recommendations relating to the AstraZeneca vaccine. In a nutshell, the National Advisory Committee on Immunization (NACI) said that given the very small risk of blood clots associated with the AZ and Johnson & Johnson vaccines, some Canadians may want to wait for the “preferred” options — i.e., Pfizer and Moderna, now known on Twitter as the cool kid vaccines.
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Which — yes! — feels like the polar opposite of the whole “the best vaccine is the first one you’re offered” spiel that our government has been peddling over the last several weeks. And has at least 1.7 million Canadians wondering whether we’ve injected ourselves with an inferior and potentially dangerous product. So what gives? Should people who got the AZ vaccine be worried? Who should I be annoyedpissed…furious at? And if I haven’t been vaccinated yet — what’s the plan for moving forward?
Our best jab (haha) at clearing up the confusion and inspiring vaccine confidence below.

The government was all, "the best vax is the first vax." Now they’re saying that some vaccines are worth holding out for. What the hell?  

It’s true the messaging doesn’t quite line up. Also true that this is really more of a communications fumble. The updated guidelines came from NACI, a team of experts who usually spend their time nerding out over science behind the-scenes. Under normal circumstances, NACI makes recommendations to the Public Health Agency of Canada, which would then determine the best ways to communicate new information — in this case, the very rare instances of VITT blood clots (a rare but potentially fatal clotting condition) associated with the AstraZeneca and Johnson & Johnson vaccines — to the public. Only there is nothing normal about springtime 2021, so NACI’s communiqués are broadcast via televised press conference, the whole situation is covered like a Kardashian breakup narrative, and everyone is — totally understandably — freaking out.
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Why wouldn’t I be freaking out? I got the AZ vaccine and now I’m wondering if I made a mistake.

You and almost two million other #TeamAZ members who are now wondering whether last month’s celebratory vaccine selfies trend was a little premature. "I have had friends calling me all week, freaking out about whether they should have waited for one of the other vaccines," says Dr. Menaka Pai, a Hamilton, ON-based hematologist (read: blood clot specialist) and member of Ontario’s COVID Science Advisory table. Pai has been telling her friends the same thing that she tells her patients, which is that there is absolutely no reason for regret: For starters, when it comes to preventing COVID-19 (the whole point of vaccinations), there is no such thing as a better or worse vaccine. And, the chances of developing a VITT blood clot from the AstraZeneca vaccine remain extremely rare. How rare? The best estimates suggest about one in 100,000. Which, yes, are worse than the zero in 100,000 odds of a blood clot that come with Pfizer and Moderna, but so much better than the odds of catching and dying from COVID, which are the odds we should be focused on right now. 

If the odds of blood clots are so rare, why are we talking about them?

Because we are human, and not terribly good at putting ginormous numbers into appropriate context. Particularly since, turn on a TV or scroll Twitter in the last few days and you’d think blood clots were a bigger concern than COVID-19. Which could not possibly be further from the truth…but it’s likely to lead to spiked levels of vaccine hesitancy anyway. That part sucks, but there are upsides to having this information in the public dialogue. "We want to empower Canadians to make the best choices and that means having the best information," says Dr. Pai. Both because transparency is a good thing and because it could be life-saving: "VITT blood clots are very serious, but they are also treatable — especially if caught early."
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Are there signs I should look out for?

Again, this outcome is Timothée-shows-up-on-your-front-door-step-to-profess-love-level unlikely. But information is power, so here goes: Signs of a VITT blood clot include a severe and persistent headache, double vision, and the inability to move a particular part of your body. Note that headaches and flu-like symptoms are also a part of a "vaccine hangover" reaction that is extremely common and best treated with Gatorade, over-the-counter painkillers (if required), and a full season of The Baker and the Beauty. One key difference is the timeline: vaccine hangovers occur in the first two or three days, whereas VITT blood clot symptoms would present between four and 28 days after vaccination. If you’re worried or not sure, contact your healthcare provider or go to a hospital. "There is a very simple test to confirm blood clotting, so if you’re not sure, there’s nothing wrong with checking," says Dr. Pai.

NACI singled out young people as a group who may want to consider waiting for Pfizer and Moderna. Is that because we’re more likely to get blood clots?

"The latest science shows no correlation between age and risk of clotting," says Dr. Pai. The reason NACI singled out people in their 20s and 30s, she adds, is because this group may be less likely to suffer serious effects from COVID-19. Note that youth is not a silver bullet, and that a lot more young people have been seriously impacted by COVID in the third wave. NACI’s recos reference the recent risk modelling out of the UK that show the chances of a 20-something **with a low exposure risk** winding up in an ICU are pretty much equal to their chances of getting a VITT blood clot from the AstraZeneca vaccine (read: so, so low). If this is you then, yes, you can count yourself among the very small percentage of the population to whom NACI’s new guidelines may actually apply and make your vaccination decisions accordingly. 
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Other than age, how can I assess my risk?

Do you live in an area with moderate or high case rates? Do you face exposure at work? Through your kids? Do you have pre-existing health vulnerabilities or live with anyone who does? Are you mostly good about the rules but there was that one time last week where you popped into a friend's house for a quick glass of wine? These are all things that will put you in the high-to-moderate category. For these groups, NACI and every other scientific authority is still recommending the first vax/best vax approach, including the AstraZeneca option. 

If my first shot was AstraZeneca, can I choose a different one for the second?

For now, vaccine mixing is a no-go, but the science is being studied as we speak. Less because of any negative side effects and more because of supply issues. In April, Canada had an overload of AstraZeneca and a limited supply of Pfizer and Moderna, but going forward the exact opposite will be true. Which could mean more of a mix and match will be the best way to get to the finish line* (*assuming a scientific all-clear). In the meantime, some good news: the latest data suggests that instances of VITT clots with the second AstraZeneca shots are "even more rare." So if you have an option to get a second one, you probably want to go for it. 

It sounds like you’re saying the best vaccine is still the first one you can get.

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Pretty much. But hopefully you feel a little more informed to make this decision moving forward.

I do. But I still can’t book a vaccine appointment!

This week’s NACI news overshadowed the fact that a lot of people are still waiting for a vaccine (any vaccine!) and on that front at least, things are looking up. It’s going to be raining vaccines for the next couple of months — and all of them are preferred!
COVID-19 has been declared a global pandemic. Go to the Public Health Agency of Canada website for the latest information on symptoms, prevention, and other resources.

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