Ask the Pharmacist

Q) It seems to me that the vaccine committee or whatever they’re called and the various public health officials seem to be disagreeing about whether we should take the first vaccine offered or wait for the “good” one. Which side of the fence do you fall on?

A) That is indeed the question of the week and one I would rather pass on even touching as there are a bunch of really smart and well-meaning people on either side of the ledger when it comes to this debate.

But one thing that has happened to me, infrequently but it bothers me when it does occur, is when a health care professional refuses to tell you what they would do, were your roles reversed. I do think the patient should be the one to make the decision, after being informed of all likely ramifications, but I also feel strongly that the experts should, in the vast majority of cases, state which way they would go, and why.

Sometimes, it’s a really difficult choice, when it comes to treatment options, but that doesn’t mean we should shy away from it. So, in that spirit, and at the risk of offending some who will, with a lot of justification, disagree with my opinion, I will tell you my views at the end of this article. Before I run down the merits of each side of this argument, let me first stress that, despite the flurry of headlines this debate has generated, there is a very good chance that in the words of a famous playwright this might well be “much ado about nothing”.

That is because the first vaccine that most of us are likely to be offered is one of the two MRNA ones (Moderna or the Pfizer version) also known widely, at least to my patients, as the “good ones”. This is due to the fact that both viral vector vaccines approved in Canada are having massive supply issues that aren’t likely to improve anytime soon.

The Johnson & Johnson (J&J) vaccine has been marred by sloppy production errors at their plant in Baltimore (a problem with cross contamination) to the point that it has yet to be given to anyone in Canada. The lone shipment of 300,000 doses brought into Canada is under quarantine and still being investigated.

As for the AstraZeneca vaccine, we have as a country almost completely used up our supplies and have no further shipments expected in the near future as India, our main source of that brand of vaccine, has decided to keep the doses themselves in order to help battle their own catastrophic outbreak.

Meanwhile, the delivery of the two MRNA vaccines is ramping up to the point that experts expect that every eligible Canadian (including those all the way down to age 12) will be able to receive a dose by the end of July. Pfizer will be delivering two million doses a week this month and that will grow to 2.4 million a week in June. A million doses of Moderna are due to arrive the week of May 17th with more to follow.

The government is hoping for 655,000 doses of the AstraZeneca vaccine before the end of the month but that supply is far from certain and is dwarfed by the numbers coming in from Pfizer. So, don’t sweat this decision too much. You are far more likely than not to get jabbed with an MRNA vaccine going forward.

Now, back to our original question. The case for taking the first vaccine offered is simple. They all work really, really well at keeping you alive. No one at this point in time should have any doubt that even some young and completely healthy individuals will die if they contract this virus or survive but perhaps never come close to recovering their quality of life. After having any of these vaccines, the risk of being killed by COVID-19 or requiring hospitalization is virtually zero.

The efficacy of these vaccines makes some of our other vaccines (like the shingles shot) look like placebos. Yes, the viral-vector vaccines have blood clot issues which are serious. But they are very rare (1/100,000 in the 40 year old crowd, 1 in 60,000 for those in their 30’s) present with symptoms and can be treated effectively if you recognize and seek treatment for these symptoms. As a reminder, the risk of a blood clot from the birth control pill is 1 per 1,000 and most of us don’t bat an eye about this when it comes to our teenage daughters.

The other main argument for taking the first one offered is that it is your duty as a citizen/ neighbour/ relative to protect those around you who cannot be protected either because they cannot take the vaccine for health reasons or because their immune response to the vaccine is substandard. There is something altruistic about undertaking an action for the betterment of others, and immunization is one of them. Waiting to see what happens to others before deciding is selfish, in my opinion. There are those who are completely dependent on us to keep them safe and that will only happen if enough of us get immunized to achieve herd immunity or as close as we can get to that level.

The United Kingdom which has used the AstraZeneca vaccine extensively has COVID case numbers and hospitalizations which we should be jealous of. Now the argument for perhaps waiting to get one of the two MRNA shots is just as compelling to me.

First off, as rare as the risk of blood clots is with the two viral-vector vaccines, I think we can all agree that no risk is better than a .001% risk.

Second, while the clinical trial conditions under which the Astra and J&J vaccines were conducted were far more adverse than those endured by Pfizer & Moderna (in particular the likelihood that by the time the viral-vectors were being trialed there were undoubtedly some patients included that had the harder to treat variants of concern), it is still more likely than not that the latter two vaccines are more effective (just perhaps not 30% more effective as the numbers would have you believe). Less risk, likely more effective, equals a better vaccine. Case closed.

But wait, there’s more positive news on the side of the MRNA’s which does not generate a lot of discussion. It turns out it is much easier and quicker (as in a matter of weeks only) to alter the MRNAS should the case become necessary. So, if we get a variant that is truly resistant to our current vaccines, once a new target on the virus is identified (right now we target its so called crown) new vaccines can be produced literally within weeks. That is a major advantage.

We will discuss next week whether we can take a different vaccine for our second dose (quick spoiler, likely yes) but staying with the same brand of vaccine is preferred as that strategy has the most scientific data supporting it. So, which decision would I advise you to do?

At the risk of adding to the confusion, the statement from our experts, the National Advisory Committee on Immunization looks to be prudent. If you live in an area like most, if not all of Grey-Bruce, where COVID cases are relatively uncommon, and you are able to work/ study from home, I would wait for the Pfizer or Moderna vaccine (which, once again to belabour the point, is likely the first one you will be offered anyway). If I lived in Peel or York or lived in Kincardine but came to work most days with a number of other individuals or was exposed to the public (like say if I worked in a pharmacy in Kincardine for example), I would gladly accept the first vaccine that was offered to me, regardless of brand.

I’m sorry if this confuses the issue for some and is less simplistic than the “take the first vaccine offered” advice, but I find most decisions in life are complex and must be assessed according to one’s own situation to be properly made. For more information about this or any other health related questions, contact your pharmacist.