With COVID vaccines losing effectiveness, what does it mean to be ‘fully vaccinated’?

OTTAWA—For the past six months, anyone who has tuned into a federal coronavirus briefing has heard the same refrain: get up-to-date with your COVID-19 vaccinations, and do it now.

In fact, during last week’s public health briefing, Health Minister Jean-Yves Duclos urged Canadians to get their booster shots no less than five times, framing the deed as essential to protecting individuals, workers and the economy.

What he failed to explain was why Canada — despite constant warnings that the immunity conferred by a two-dose regimen has now waned — has yet to update its definition of a “fully-vaccinated” person.

In Canada, a fully-vaccinated person is someone who has received two shots of a two-dose COVID-19 vaccine, or a single dose from a one-dose vaccine. For travellers, the definition is broadened further to include anyone who has received at least two doses of the nine COVID-19 vaccines accepted for travel.

But experts say that with two-dose vaccines losing their effectiveness, and strains of Omicron now slamming vulnerable populations, changing the definition would have had the strongest impact on vaccine uptake when mandates were in place. With that window now closed, convincing Canadians to get vaccinated just got harder.

“It’s like closing the barn door after the horses have left,” said Nazeem Muhajarine, a professor of community health and epidemiology at the University of Saskatchewan. “The mechanism to implement a new definition has been lost.”

If the purpose of updating the definition is to increase the uptake of third and fourth doses, the absence of mandates is going to make that more difficult, said Colin Furness, an infection control epidemiologist at the University of Toronto.

“We would have had way higher participation within the mandate framework that we had … and that means that there would be less illness and suffering and deaths now,” he said.

The change is also something that could have happened as far back as eight months ago, argues Dr. Amit Arya, palliative care lead at Kensington Health in Toronto.

He said changes should have been made in “real time,” when evidence made it clear — even before Omicron’s spread — that at least three doses were necessary for adequate protection.

“It just doesn’t make sense,” he said.

On June 14, the day Ottawa dropped federally-imposed mandates for certain travellers and workers, Duclos confirmed Canada was “transitioning” to a new definition.

“We’re going to take advantage in the next few weeks and months to work closely with provinces and territories to increase significantly our rate of third doses. Our rate of boosters in Canada is too low. It’s lower than all other G7 countries, and that is not good,” the minister said.

While 86 per cent of eligible Canadians have received two doses, only 56 per cent have received one booster — a number the National Advisory Committee on Immunization (NACI) says has “plateaued.”

In its interim recommendations issued last week, NACI stressed the importance of getting a first or second booster ahead of an expected fall “resurgence,” suggesting that anyone aged 12 to 64 “may be offered” a fall booster regardless of how many boosters they have already received.

Health Canada says it is also preparing for the possibility of obtaining and approving new formulations of the vaccine, including an “Omicron-specific booster.”

Despite all the guidance, there have been no updates on when a change to the definition will happen, even though the mandates — which sparked so-called “freedom” protests across the country — have largely been lifted.

The combination of ending mandates, promising to update the definition, and broadcasting the importance of getting additional doses is now sending a baffling message to Canadians, Arya said.

“It’s another example of how, through the pandemic, we’ve seen just an astounding failure of science communications.”

Indeed, Furness said the federal government’s decisions have led people to believe the pandemic is over — and that vaccination is no longer necessary.

“You’re making vaccination look temporary, and what you’re signalling to people is you can be a holdout … and eventually this will go away,” he said.

“This is where enticing people and persuading them works a lot better than compelling (them). And … if we do this differently, where you make life less convenient for people who aren’t vaccinated, but you don’t actually hit them with existential demands around their livelihoods, that’s where you get maximum impact,” Furness said.

While Furness said Ottawa must now “sell the idea” and explain the rationale behind booster doses, Arya said public health messaging should convey the realities of Omicron’s subvariants.

He pointed to the Star’s recent analysis that showed that more Ontarians aged 60 and up have died from Omicron since mid-December of last year compared to the previous two waves combined.

“We know that a third dose is absolutely essential against Omicron variants and I’m very worried that for the summer wave that we’re in, or even a wave that’s predicted in the fall … those who are under-vaccinated will pay a higher price,” he said. “It doesn’t need to happen.”

Raisa Patel is an Ottawa-based reporter covering federal politics for the Star. Follow her on Twitter: @R_SPatel

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