Manitoba offers 3rd dose of COVID-19 vaccine to immunocompromised people

Manitoba is now offering third doses of mRNA COVID-19 vaccines to immunocompromised people and to individuals who may choose to receive a third dose for travel purposes.

Dr. Joss Reimer, medical lead of the province's vaccine implementation task force, made the announcement on Wednesday.

"For those who are immunocompromised, two doses of the vaccine may not provide adequate defence against COVID-19, particularly given concerns with the highly contagious delta variant," she said during a live-streamed news conference.

Effective immediately, third doses are available to anyone who is moderately to severely immunocompromised due to a medical condition and/or medical treatment.

They'll also be available to anyone in Manitoba who wishes to receive a third dose for travel purposes, and anyone who has previously received one or two doses of a vaccine that is not approved by Health Canada.

A complete list of the medical conditions and treatments that would result in a person being considered immunocompromised is available online.

It includes people receiving active chemotherapy (or immunotherapy) for cancer, people who have received a solid organ transplant and are currently receiving chemotherapy or other immunosuppressive therapy, anyone born with moderate or severe dysfunction of their immune system, people living with untreated or advanced HIV-AIDS, and those who are taking certain medications that severely affect the immune system.

The third vaccine dose can be provided by an individual's health-care provider, the province said.

Last week, the National Advisory Committee on Immunization started recommending third doses be given to certain immunocompromised people. 

However, the committee stressed that those shots should not be considered a "booster." NACI still hasn't reached a decision on whether it will recommend booster shots to the broader population.

Manitobans who want a third dose for travel purposes must be vaccinated by their health-care provider and go through an informed consent process, or present a prescription to a pharmacist, Reimer said on Wednesday.

The reason that option is being made available is that countries and tour operators, including many cruise lines, don't recognize the Covishield version of AstraZeneca, which is made in India. Others are not accepting travellers who received different types of vaccines for their first and second shots. 

"It's not because we have any concern about the safety or effectiveness of the schedule that people received here. In fact, we feel very strongly that the mixed schedule is a very effective way to provide protection," Reimer said.

"But we did hear from many Manitobans who were experiencing frustrating things when they were trying to plan travel to other countries who have different requirements."

For those who previously received a vaccine not approved by Health Canada, an approved third dose can be received at any vaccination supersite, pop-up clinic or mobile clinic, or from a health-care provider.

Once their mRNA vaccines (Pfizer-BioNTech or Moderna) have been received, those individuals will be considered fully immunized and can have their immunization record updated by following the process outlined on the provincial government's website.

Medical exemptions

The province is also setting out policies to guide medical exemptions to immunization requirements.

Reimer said there is only a small group of people with a "significant and legitimate medical reason" for exemptions, and the mechanism for receiving one is strict.

"I do want to be very clear that the process is not a note from your doctor," she said.

The person's situation must be reviewed by a specialist physician and then submitted to the provincial vaccine implementation task force for approval.

Based on the guidance of the task force's medical advisory committee, people in one of three situations may be eligible for a temporary or permanent medical exemption to vaccination, Reimer said.

Those are people who: 

• Had a severe reaction after the first dose of a COVID-19 vaccine (e.g. myocarditis, Guillain-Barré syndrome).
• Are receiving treatment that affects their ability to mount an immune response, meaning vaccination must be timed carefully with their treatment schedule (e.g. receiving immunocompromising treatment after a transplant, certain types of cancer treatments).
• Had a severe allergy or anaphylactic reaction to a previous dose of a COVID-19 vaccine or its components that cannot be managed by the Health Sciences Centre Allergy Clinic.

The process to submit medical exemptions will be finalized as soon as possible, along with updated clinical guidance for health-care professionals, Reimer said.

Asked how many people in the province have experienced any sort of severe reaction that would make them eligible for an exemption, Reimer said she didn't have an exact number, but it would be less than 10.

A total of 1,948,557 doses of vaccine have been administered so far in Manitoba.

The Health Sciences Centre's allergy clinic has yet to confirm a single case of a severe allergy to a COVID shot, Reimer said.

"But we do recognize that there may be a situation where they're not able to manage the allergy in a safe way and so we want that [exemption] option to be available," she said.

Passports and booster shots

The province is also developing a way to ensure individuals with a valid medical exemption are able to access the same benefits as those with an immunization card.

This work is expected to be completed in the coming weeks.

Despite the move to make exceptions, Reimer stressed the importance of vaccinations as the most effective protection against COVID-19.

"Qualifying for a medical exemption should really be a last resort," she said.

As for booster shots, Manitoba is not currently looking at those for the general population, but there could be some exceptions.

Reimer said there is growing evidence that the AstraZeneca vaccine may not provide protection as long as the mRNAs.

"That is something we are looking at regularly. We take that very seriously and are monitoring data from other countries as well as locally," she said.

"We'll continue to make changes to our recommendations as data comes in."

School and mobile clinics

Earlier this week, the province announced that Manitoba schools will host COVID-19 vaccine clinics starting next week to help ensure that eligible young people have an opportunity to get immunized.

Among those age 12 to 17, nearly 73 per cent have had one dose of the vaccine and 65 per cent have had both, which is behind the average for the province, Reimer said on Monday.

Immunization teams will attend all schools that have students who were born on or before Dec. 31, 2009, to provide first and second doses, starting in areas with lower vaccine uptake, to help reduce any barriers to immunization, the Protect MB website says.

Vaccinations will be offered during school hours and in some cases, clinics will continue to operate outside school hours for all members of the community. Parents and guardians who wish to be immunized along with their children or want to attend their child's immunization can do so during the pop-up clinics outside of school hours.

The school clinics are expected to run for four to six weeks.

A mobile vaccination clinic will be held this weekend in Winnipeg at Provencher Park, 271 de la Cathedrale Ave. It will run on Saturday, Sept. 18, from 12:30 p.m. to 4:30 p.m. in partnership with the Mex Y Can Association of Manitoba Inc.

As well, a pop-up clinic will take place in Neepawa at Yellowhead Centre Hall, 175 Mountain Ave., on Thursday from 4-8 p.m.

As of Wednesday, 83.9 per cent of eligible Manitobans had received one dose of a COVID-19 vaccine while 78.9 per cent had received two, the provincial vaccine dashboard says.

All Manitoba vaccination supersites are now offering walk-in and appointment-based vaccinations. Check the provincial website for hours and days of operation.

Those who are eligible for a vaccine — anyone born on or before Dec. 31, 2009 — can book appointments at these sites online or by calling (toll-free) 1-844-626-8222 (1-844-MAN-VACC).

Vaccine sites in the province are considered clinical areas and a mask must be worn.