COVID-19 Vaccine Bulletin - Porcupine Health Unit

COVID-19 Vaccine Bulletin
Thursday, April 1, 2021

With the surge in COVID-19 cases, including the increased predominance in cases of variants of concern
across the province and in neighboring health units, there is much uncertainty and cause for alarm.
Whether you are awaiting COVID-19 vaccination or have received one or two doses of the vaccine,
diligence in using all public health measures at all times remains crucial to not only protect yourself but
also in preventing the spread of COVID-19 to vulnerable populations who are at increased risk of severe
illness, hospitalizations and death:

    •   Limit close contact (less than 2 metres) to members of your immediate household,
    •   Remain physically distant from others (at least 2 metres away),
    •   Follow provincial gathering limits indoors and outdoors,
    •   Wash your hands with soap and water, or use hand sanitizer frequently,
    •   Masks that cover your nose, mouth and chin must be worn in all indoor public spaces,
    •   Wear a properly fitted mask that covers your nose, mouth, and chin indoors and outdoors when
        unable to maintain a physical distance of 2 metres from those who do not live with you,
    •   Frequently clear commonly touched surfaces, and
    •   Cover your nose and mouth when coughing and sneezing.

Planning
Many community partners from across the Porcupine Health Unit district have been vital to the success
of the COVID-19 vaccine program planning and distribution. While the Ministry requirements are
outlined in Ontario’s Vaccine Distribution Implementation Plan, these collaborative efforts have ensured
meaningful considerations are brought forward during planning phases for the COVID-19 vaccine
program rollout in all communities and that decisions made are ethical and effective.

All the planning and decision making that occurs behind the scenes must be in line with human rights
protection and prevent COVID-19 among vulnerable populations. The principles outlined in the Ethical
framework for COVID-19 vaccine distribution included in planning efforts are:

    •   Minimize harms and maximize benefits: Reduce overall disease and deaths by protecting those
        at highest risk, as well as promoting social and financial well-being and protecting vital public
        services.
    •   Equity: Reduce inequalities in illness and death and distribute vaccines without stigma or
        discrimination and respect the human rights of all people.
    •   Fairness: Ensure people within each phase of the provincial vaccination program has equal
        opportunity to receive the vaccine.
    •   Transparency: Ensure decisions made are communicated clearly to the public.
    •   Legitimacy: Decisions made are based on scientific data, shared values and input from diverse
        population groups and ensure decisions achieve anticipated benefits.
    •   Public Trust: Enhance confidence and trust in the immunization plans.

The Porcupine Health Unit:
   •   The following documents from the Ontario Ministry of Health and Long-Term Care must be
       reviewed before receiving the COVID-19 vaccine:
           o COVID-19 Vaccine Information Sheet
           o What you need to know about your COVID-19 vaccine appointment
           o COVID-19 Vaccination Recommendations for Special Populations
   •   The Porcupine Health Unit COVID-19 vaccine clinic schedule can be found under the COVID-19
       Vaccine area of the health unit’s website.

   •   Initially, healthcare workers were immunized in sequence according to the Ontario’s Guidance
       for Prioritizing Health Care Workers for COVID-19 Vaccination document. All levels of healthcare
       workers are now eligible to receive the COVID-19 vaccine.
   •   Appointments continue to be required for all COVID-19 immunization clinics. To view upcoming
       clinic dates and to register, visit the COVID-19 vaccination booking system. COVID-19 vaccine
       appointments for eligible individuals may also be booked by calling the Porcupine Health Unit at
       705-360-4819 or 1-800-461-1818.
   •   The health unit continues to ensure access to the COVID-19 vaccine for populations included in
       Phase 1 of the provincial vaccination plan.
   •   COVID-19 vaccine clinics are beginning for some of the “primary priority” groups in Phase Two of
       the provincial vaccination plan.

•   The health unit will follow the Ontario Government’s Guidance for Prioritization of Phase 2
        populations for COVID-19 Vaccination to plan for vaccine clinics across the region.
    •   The rollout of the COVID-19 vaccine distribution plan continues to be dependent on the vaccine
        supply received from the provincial government.
    •   COVID-19 vaccine clinics in communities across the health unit district will continue to be
        announced through local media, on Facebook and on the health unit’s website as more vaccines
        are received.
    •   Planning is always underway in preparation for successive population groups that will become
        eligible for vaccination in coming weeks to ensure a seamless transition throughout each
        population groups identified in Ontario’s COVID-19 Vaccine Distribution Plan.
    •   If you or a loved one are eligible but are experiencing barriers to accessing the COVID-19 vaccine
        clinics and need support, call the health unit at 705-360-4819 or 1-800-461-1818.

Vaccine Rollout & Announcements
On March 26, 2021, the province of Ontario issued a news release announcing that booking of COVID-19
vaccine appointment for individuals 70 years of age and older will be beginning in Toronto as of March
27, 2021. It is important to recognise that for various reasons, such as initiation date of the COVID-19
vaccine program and vaccine supply received from the government, each health unit across the province
is at a different stage in the vaccine program distribution rollout. COVID-19 vaccine appointments are
not yet available for residents 70 years of age and older in the Porcupine Health Unit area. The health
unit is currently providing access to COVID-19 vaccines for individuals aged 75 years and older.

Exceptions to Extended COVID-19 Vaccine Dose Intervals
The Vaccine Clinical Advisory Group (VCAG) consists of clinical and public health physician experts who
provide recommendations for the Ontario COVID-19 vaccine program. This group supports the National
Advisory Committee on Immunization (NACI) guidance on increasing the interval between doses of
COVID-19 vaccine up to 4 months for most populations. It was previously announced that the following
populations groups will still receive the second dose of COVID-19 vaccine between 21 to 42 days:

    •   Long-term care homes, retirement homes, Elder Care Lodges and Assisted Living residents who
        are at the greatest risk of both exposure to COVID-19 and serious illness and death.
    •   Remote and isolated First Nation communities given the potential seriousness of COVID-19
        infection in these communities with limited available health care facilities and resources.

On March 26, 2021, the Ministry of Health released the VCAG Recommendations on Exceptions to
Extend Dose Intervals for COVID-19 vaccines document. The VCAG has identified populations for which
there continues to be limited available information on vaccine efficacy and effectiveness who are at
higher risk of poor outcomes from COVID-19 infection and who may have inferior immune response to
vaccines because of underlying medical conditions. While considering Ontario’s vaccine supply
constraints, the VCAG has outlined recommended dose intervals for these populations:

    •   Pregnancy: The extended dose interval (up to 4 months) is believed to be appropriate for
        pregnant individuals as clinical trials for other types of vaccines administered to this population
        have demonstrated a normal immune response

•   Immunocompromising conditions and immunosuppressive therapies: Individuals in this
        population group were generally not included in COVID-19 vaccine clinical trials and the immune
        response to the vaccine could be highly variable for the diverse populations included in this
        category. THE VCAG was able to review evidence and make recommendations on the dose
        interval for only select sub-populations. There is a risk of poor immune response to COVID-19
        immunization for other subpopulations which the VCAG will commit to ongoing review of
        evidence to inform recommendations for additional sub-populations.
            o Transplant recipients should receive the COVID-19 vaccine at the dose interval indicated
                 in the product monograph.
            o Individuals with malignant hematologic disorders and non-hematologic malignant solid
                 tumors receiving active treatment should receive the COVID-19 vaccine at the dose
                 interval indicated in the product monograph.
    •   Age: The extended dose interval is believed to be appropriate for older individuals as available
        real-world data shows that the first dose of the COVID-19 vaccine provides substantial
        protection against severe disease, hospitalization, and death in the older adult population.

AstraZeneca COVID-19 Vaccine – NACI Update
In response to rare reports of blood clots after receiving the AstraZeneca vaccine in Europe, the National
Advisory Committee on Immunizations (NACI) is now recommending that the AstraZeneca COVID-19
vaccine not be used in adults under 55 years of age at this time due to possible safety concerns.

This recommendation is a precautionary measure while Heath Canada completes an updated evaluation
of the benefits and risks of this vaccine. No adverse events related to the AstraZeneca vaccine have been
reported to Health Canada.

Cases reported in Europe have mainly been in women under 55 years of age. However, cases in men
have also been reported and further assessment is needed to determine if women are in fact at higher
risk than men. As there is an increased risk of hospitalization and death due to COVID-19 in older adults
55 years of age and older, and it appears that the risk of blood clots after vaccination is rarer in this age
group, this population may still receive the AstraZeneca vaccine with informed consent.

This recommendation will continue to be re-evaluated and updated as further data becomes available.

NACI will assess the available data and research to determine the type of vaccine that is recommended
for the second dose in those under the age of 55 who have already received 1 dose of the AstraZeneca
vaccine.

Individuals receiving the AstraZeneca COVID-19 vaccine should be made aware of the potential adverse
event of blood clots and seek medical attention if symptoms develop between days 4 and 20 after
receiving the vaccine. Symptoms include:

    •   shortness of breath,
    •   chest pain,
    •   leg swelling,
    •   persistent abdominal pain,
    •   neurologic symptoms like sudden onset of severe or continual worsening headaches, blurred
        vision,

•   skin bruising (other than where the vaccine was given),
   •   petechiae (red or purple discolored spots containing blood on the skin).

To date, the province of Ontario has only administered the AstraZeneca vaccine to individuals 60 years
of age and older. In response to NACI’s updated recommendations, Ontario will not be using the
AstraZeneca vaccine for individuals under 55 years of age while Health Canada complete its evaluation.

Resources
The Porcupine Health Unit wants to keep you informed about COVID-19 vaccines. Our website now
includes a COVID-19 Vaccine page with more information on approved vaccines, vaccine safety and
other general information.

Our COVID-19 Information lines remain open. Call us with any COVID-19 related questions you have at
705-360-4819 or 1-800-461-1818.

Moving forward
COVID-19 vaccines are safe and effective. The Porcupine Health Unit urges everyone who is eligible to
receive the COVID-19 vaccine to get immunized as soon as possible. Vaccines are another important tool
that will help fight this pandemic. Waiting a few weeks or a few months to receive the vaccine could
have serious consequences, like:

   •   Getting COVID-19 infection and needing to self-isolate
   •   Getting COVID-19 infection and having complications (severe illness, hospitalization and even
       death)
   •   Spreading COVID-19 to others

The Porcupine Health Unit continues to recruit staff and volunteers to support COVID-19 vaccination
across the district:
    • Visit Employment (porcupinehu.on.ca) to learn about employment opportunities or call 1-800-
        461-1818. Individuals who are seeking employment with the health unit should email
        information and resume to careers@porcupinehu.on.ca.
    • Community partners and independent volunteers are of great value to the rollout of COVID-19
        vaccines across the district. Email vaccinesupport@porcupinehu.on.ca with your offer of
        support.

Additional Information
Getting a COVID-19 vaccine in Ontario | COVID-19 (coronavirus) in Ontario

COVID-19: Protecting Yourself (porcupinehu.on.ca)

Ethical framework for COVID-19 vaccine distribution

Vaccines and treatments for COVID-19: Vaccine rollout - Canada.ca

Ontario’s COVID-19 Vaccine Distribution Plan