A syringe is prepared with COVID-19 vaccine at a clinic in Montreal, on March 15, 2021.Paul Chiasson/The Canadian Press
A unique Montreal vaccine pilot project targeting parents of young children in districts struck by a COVID-19 variant could be a model for other focused vaccination campaigns, local health officials say.
This week, Montreal’s public-health department started vaccinating parents of young children attending schools and daycares in a small area of Montreal with one-quarter of the city’s confirmed variant infections. The two-week project is one of a few exceptions to the province’s age-based priority list for the vaccination campaign.
Public-health officials are trying to use vaccines to break the chain of transmission among parents, their young children, and the rest of Montreal to test whether they can prevent the B.1.1.7 variant from spreading rapidly from the hot spot to the rest of the city.
“We are basing it on the previous use of vaccination in other infectious disease to shut down transmission. We don’t know if it works with this disease,” said Dr. David Kaiser, a public-health and preventative medicine specialist with Montreal public health. “If it works – if we can use vaccines to put a box around an area experiencing an outbreak – it will provide valuable information and an important tool.”
A first dose of vaccine has gone to nearly 80 per cent of Montrealers aged 70 and older – those most at risk of serious illness and death – while people in their 60s are currently being vaccinated, allowing the city’s public-health officials to start looking at new objectives.
Canada pre-purchased millions of doses of seven different vaccine types, and Health Canada has approved four so far for the various provincial and territorial rollouts. All the drugs are fully effective in preventing serious illness and death, though some may do more than others to stop any symptomatic illness at all (which is where the efficacy rates cited below come in).
- Also known as: Comirnaty
- Approved on: Dec. 9, 2020
- Efficacy rate: 95 per cent with both doses in patients 16 and older, and 100 per cent in 12- to 15-year-olds
- Traits: Must be stored at -70 C, requiring specialized ultracold freezers. It is a new type of mRNA-based vaccine that gives the body a sample of the virus’s DNA to teach immune systems how to fight it. Health Canada has authorized it for use in people as young as 12.
- Also known as: SpikeVax
- Approved on: Dec. 23, 2020
- Efficacy rate: 94 per cent with both doses in patients 18 and older, and 100 per cent in 12- to 17-year-olds
- Traits: Like Pfizer’s vaccine, this one is mRNA-based, but it can be stored at -20 C. It’s approved for use in Canada for ages 12 and up.
- Also known as: Vaxzevria
- Approved on: Feb. 26, 2021
- Efficacy rate: 62 per cent two weeks after the second dose
- Traits: This comes in two versions approved for Canadian use, the kind made in Europe and the same drug made by a different process in India (where it is called Covishield). The National Advisory Committee on Immunization’s latest guidance is that its okay for people 30 and older to get it if they can’t or don’t want to wait for an mRNA vaccine, but to guard against the risk of a rare blood-clotting disorder, all provinces have stopped giving first doses of AstraZeneca.
- Also known as: Janssen
- Approved on: March 5, 2021
- Efficacy rate: 66 per cent two weeks after the single dose
- Traits: Unlike the other vaccines, this one comes in a single injection. NACI says it should be offered to Canadians 30 and older, but Health Canada paused distribution of the drug for now as it investigates inspection concerns at a Maryland facility where the active ingredient was made.
How many vaccine doses do I get?
All vaccines except Johnson & Johnson’s require two doses, though even for double-dose drugs, research suggests the first shots may give fairly strong protection. This has led health agencies to focus on getting first shots to as many people as possible, then delaying boosters by up to four months. To see how many doses your province or territory has administered so far, check our vaccine tracker for the latest numbers.
While most of Canada’s COVID-19 vaccination programs are designed to protect older and at-risk individuals, the Montreal vaccine pilot’s main objective is to stop transmission instead among younger, healthy adults by using scarce vaccines in a targeted way.
“We learned in the first and second wave that hot spots will go later into the east and north of Montreal,” said Dr. Mylène Drouin, Montreal’s director of public health.
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About 85,000 people live in the four postal codes in the strip of Montreal’s west side in the Côte-Saint-Luc and Côte-des-Neiges areas, but they account for more than a quarter of the city’s variant cases. Eighty-six per cent of cases in the area have links to a daycare or school.
Within days of the project beginning on Monday, parents, teachers and other school and daycare staff booked more than 80 per cent of the 12,000 available vaccination appointments over the next two weeks.
“I wasn’t highly motivated to get the shot at first, but a group of us discussed it Saturday and I changed my mind,” said Imad Daoudi, a 42-year-old married father of three children aged 12, 8 and 6. “The vaccine is the only way out of this.”
The selected neighbourhoods are a demographic slice of Montreal: The west end is a relatively well-off anglophone suburb of single-family dwellings, whereas poorer families who overwhelmingly rent apartments and speak French make up the east end. The neighbourhoods share at least one common trait, according to census data – about half of area residents are immigrants.
Public-health officials say area residents also share family connections to the United States, where several people caught the B.1.1.7 variant and brought it back to Canada before stricter federal travel and quarantine controls were in place. Travelling carriers of the variant infected their children, where it then spread in schools and daycares.
Variants present an advantage for an experiment like the one in Montreal, Dr. Kaiser said, noting variant cases are subject to screening and genetic testing, so public health can track their spread.
Donna Litvack, 50, a mother of two teenage boys who got her shot early this week, said some parents are sheepish about admitting they got the vaccine. In determining who would be eligible for the pilot, public-health officials drew lines that separated friends, neighbours and nearby schools, provoking some jealousy and blame, she said.
“If you look at the big picture, it’s obviously a great thing that public health is trying,” Ms. Litvack said. “But obviously it’s not just a global picture – it works for my reality, too. There are a lot of angry people out there. I wouldn’t normally expect to get backlash from my own friends over something like this.”
Dr. Kaiser said deciding who would be included was a difficult part of designing the project, given the continuing scarcity of doses. He pointed out the 12,000 vaccines allocated to the pilot mean about the same number of 60-year-olds will have to wait a bit longer for their shots.
But if the project works to halt transmission, the method could save lives and provide another tool on top of mass vaccination, locally focused strategies and mobile efforts, Dr. Kaiser said.
“We need to have flexibility in our approach,” he added. “This could be part of that package.”
Under questioning from the Conservatives' Michelle Rempel Garner in the House of Commons, Prime Minister Justin Trudeau says he'll press top European leaders to make sure Canada isn't affected by tougher export controls on COVID-19 vaccines. Rempel Garner sought an absolute guarantee that no doses would be held back.
The Canadian Press
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