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Posted May 3, 2021
Host: Pamela Smyth, Media relations
Pamela
This is a bonus episode of Beyond the Bulletin, released May 3 2021.
Pamela
Hello and welcome to a bonus edition of Beyond the Bulletin. I'm Pamela Smyth from Media Relations at the University of Waterloo. My guest is Professor Kelly Grindrod. She teaches in our School of Pharmacy and is the pharmacy lead on the region of Waterloo COVID-19 Vaccination Distribution Task Force. If my co-host Brandon sweet were here, he'd have already made that into some kind of acronym because that is a mouthful.
Now, regular listeners of Beyond the Bulletin know Kelly Grindrod was just speaking with me about vaccines on the podcast episode that came out on April 9. As you also know, much can change in the story in just a few weeks. So in the interest of keeping you updated on what's happening now and likely into the fall, Kelly is back to provide an update. But first here is our earlier conversation again, because there's still a lot of great information in there. And then afterward, Kelly and I will come back and we'll talk about what's new. How does that sound, Kelly?
Kelly
Sounds great.
Pamela
All right.
Thank you for being here, Kelly.
Kelly
Thank you.
Pamela
So, in addition to teaching at the School of Pharmacy, you work at the COVID-19 vaccination centre at the Health Sciences Campus in downtown Kitchener. What is your role there?
Kelly
So I do a lot of different things. My main role when I’m there is as a pharmacist. Managing the inventory. So when the vaccine arrives, and we get it in the fridge, we start to prepare all the doses for all the vaccinators and we manage the inventory throughout the day. And there are questions that we’re asked throughout the day about, you know, variations of vaccines. So we handle that. But then I also occasionally vaccinate as well. So sometimes I go in with a different hat and I sit with the vaccinators and I stick needles in arms.
Pamela
And it's a Pfizer location, right? They you only give out the Pfizer vaccine.
Kelly
That's right. So the Pfizer vaccine is really tricky to work with. It's very fragile. It has a bunch of transportation requirements around it. So the main sites, the large sites, so that’s the Boardwalk, the Waterloo campus site, and then the one down in Cambridge, they're all going to be Pfizer vaccines because we need that bigger infrastructure to manage the Pfizer vaccine.
Pamela
There's been a lot of criticism of the government when it comes to confusion around this rollout. But I was at the vaccination clinic at the School of Pharmacy about a week ago, and I heard members of the public saying how well organized it was, they were so impressed. How's it going?
Kelly
It's going really well. So I think the what you're talking about is very common. We often hear when people are in the clinic that it's very smooth, it's a lot less stressful than they thought. So we've just gone through a pretty, a very diverse group. So people in their 90s were the first ones to come to us. And then people in their 80s and 70s. It gets incrementally easier with each ten-year reduction in age. But you know, a lot of the folks early on, it is pretty nerve-racking for them. So we would see them come a week or two in advance, they almost come and do a dry run. They drive, they park, they walk through the door, they see how much time it's going to take on the day of. They might show up two hours early because they're quite nervous. And so we're really mindful of the fact that it needs to be really, really simple. It can't be stressful. It needs to be clear. So we spent a lot of time trying to make it just an easy experience. People are in and out and often there as a result, because they were expecting something a lot more stressful. They're quite pleasantly surprised that went easier than they thought.
Pamela
How many jobs a day are you doing?
Kelly
So we can do over 700 a day, the most we've gotten up to is 640 give or take the last couple of weeks. The last week or so we actually haven't had enough vaccine in the region to go to our maximum. So we've been doing about 450 doses a day. And that more has to do with the fact that we just weren't getting enough vaccine into the region. But the good news was we just got a lot of vaccine on the weekend. So in the coming week, for example, we'll be going up to the six hundreds and as we get even more vaccine, and we should be up in the seven hundreds, which would be great.
Pamela
Oh, that's great. That's encouraging. So that brings me to the topic of people's misperceptions and things that people really should know about the vaccine and the vaccine administration program or the vaccine rollout, I guess we would call it. Let's first talk a bit about vaccine hesitancy. So there are people out there who don't want the vaccine. What are you hearing?
Kelly
So you've got a good chunk of the population say 60 per cent, or possibly more because the number is going up, but the majority of the population who are ready to get the vaccine. You know, they just need an appointment. And there’s a lot of the people who are angry right now about how slow the rollout has been. There's people who want to be vaccinated three months ago. There's another chunk of the population who need some questions answered. There's something holding them back and so you refer to it as vaccine hesitancy. A lot of people are also talking about the need to build vaccine confidence. So these might be people who don't have confidence yet in the vaccine. That's that majority may be 20, 25 per cent of that remaining population. The people who are truly anti-vaccine are actually a very small portion of the population. So you might get maybe 5 per cent of the population. They just are a very loud group, they have a very outsized footprint. So you see a lot from them on social media, the vast majority of the population is either very willing to get vaccinated or just need some information to make the decision.
Pamela
But there are also people who are just afraid of needles.
Kelly
That is so common. It depends, on any given day in the clinic, you know, I was in a couple of days ago, oh, probably every other person mentioned to me that they were afraid of needles. And so the difference is, and I found this very interesting, a number of people have said, “Oh, I haven't gotten a flu shot in 20 years, but I'm here, oh, my doctor’s going to be so happy I actually showed up.” So for those folks, they often have to work up the courage to actually get there to get the needle. But the other part of that is we use very tiny needles. And people don't realize that they keep mentioning on the news, they use such big needles, and it's just so stressful. We actually have to use these very tiny needles for this fragile Pfizer vaccine. And most people don't even feel it. And if you tell someone that you're nervous, or you tell someone, “You know, I don't like needles,” we're pretty good at this. So I usually get the person in the room with me to distract. And they just say, “What are you going to do this weekend, or how's the weather?” and by the time you started answering, I've got the needle in and out of your arm. So we've learned to help people. We really want people to come back for the second dose. It should be a good experience.
Pamela
I personally can't watch a needle going in, I'm fine if I have to get a needle, but I don't like to watch it.
Kelly
No, and this will probably be one of the biggest take-homes I'd have for people in the media. It's really important that we actually shift away from images of needles going in arms to more than you know, like putting a Band-Aid on her arm after it's been done that might be much more comfortable with the fact that it's done. It's very short. It doesn't have to be these constant images of needles. So if you are someone who doesn't like you know, it's extremely normal. We see people like that all day long every day. It's one of the most common things I think we're encountering. But it really isn't a big deal. We get you in and out. And it's a pretty painless needle.
Pamela
I have read stories about vaccine hesitancy, particularly among seniors. Is that real?
Kelly
Absolutely. So I think just like any population, they have their own reasons, they're not sure if the vaccine is safe. And they might have worries that they might be afraid of needles. A surprising one that I've come across, though, and I think this is because it's different from any other vaccine where it's going age-based. So again, we're starting with, we're starting with 90-plus, we're starting with 80 plus and 70 and into the 60s, they are ready to go themselves. But their adult kids might not want them to go. Their adult kids might be a long ways off from getting the vaccine. So the older person may have actually thought about this a lot more. You know, they knew that they were going to go next week. So one thing that we're hearing from adult kids is they're calling their parents and they're saying, “I don't trust this vaccine. I don't think you're ready for it yet.” And the adult parents are saying the older parents are saying, “I'm going,” you know, “I haven't seen I haven't been out of this house in a year. I appreciate you buying me my groceries, I appreciate you waving from the street, but I can't live like this anymore. I've talked to my doctor, I've done my own research, I'm going.” And so they're having to actually overcome a surprising barrier. So their adult children won’t drive them to the vaccine clinics. So they have to call a sibling, or they have to call a friend, or they have to call a taxi because their adult children won't let them go. So I'm finding that surprising that there's this generational gap where a lot of older people are very pro-vaccine because they have lived at home in fear because they've been the highest risk of severe complications, right? So for them, it's an easy decision. They've also often lived through polio. They remember the polio vaccine issues. And what it was like to live through it and what it was like when the vaccine came out, so they're not necessarily as hesitant in that way. And it might be their kids who are actually the ones resistant to it.
Pamela
Wow, that is surprising. Also, they're used to their family doctor, maybe somebody they've had for decades. And now they're going to some big, I guess they assume impersonal vaccine clinic.
Kelly
So the vaccine clinics, our vaccine clinic is family doctors, it's family doctors and nurses from family doctors offices and lots of medical students and pharmacists. And so a lot of people you recognize someone when you go in a lot of the volunteers at the clinic, our University of Waterloo faculty and staff and retired folks from the universities in the community. So a lot of different people from community. I'm finding when people come in, they're recognizing people, they're recognizing neighbors, they're seeing people that they know. So it actually is very much a community place. We often describe the vaccine clinic is the happiest place in town. You know, people come in, they're cheering they're very happy. They're celebrating we've had people stand up and say, “Yay, thank you!” And, you know, it's just it's really wonderful. So it actually does tend to feel it isn't necessarily in personal if people are friendly and we're excited to have people come to us.
Pamela
Another thing we're hearing is that the vaccine came about so quickly. We're not used to having a vaccine show up so quickly. And now we've got several on the market and available, should that be a concern for people?
Kelly
So that's one of the most common questions I've gotten. And that's one of the most common reasons why people are uncertain. So for example, they may want to get the vaccine, but they don't feel ready to get the vaccine yet because they feel like it's happened too fast. So they're not anti-vaccine, they're just not sure. So the thing to know about this is that the technology that is being used in all the different kinds of vaccines, so the four different vaccines approved for use in Canada, they're either an mRNA vaccine, which is Moderna, and Pfizer, or they're a viral vector vaccine, which is AstraZeneca, and Johnson & Johnson. So each of those were being researched for quite some time over the last decade, especially. But a lot of this research goes back decades, like multiple decades. And the researchers who worked on this had a really hard time getting money to fund this vaccine research. It was slow going. So they might have an idea, they might apply for money, they have to wait to find out if they got it. They might have to try multiple times, it takes years, they finally get a bit of money. They run a small trial. They use those results to try and get a bit more money to test it and more people. And they have to wait years, and on and on it went. And so the viral vector vaccines actually, that was the Ebola virus vaccine that came out about a year or two years ago. Now, that was a viral vector vaccine, just like AstraZeneca and Johnson & Johnson. That's the technology used for the Ebola virus vaccine, which some people if you don't follow this kind of stuff, you may not have realized that or heard that. The mRNA vaccine, so the Moderna and Pfizer. This is the first mRNA vaccine that we've had on the market. What was wonderful is in the pandemic, when it shut the global economy down. This is huge. I mean, this is monumental. What happened, the world all of a sudden got together, put so many resources into it, they ran these trials together, it was transparent. Governments worked together, drug companies worked together. And we have put so many resources into this, that it sped up the research, they were able to overlap trials, no one was begging for money, no one was asking for money. They designed these things to be done quickly. Your trial is going to be long and slow if there's not a lot of disease. Tons of COVID around. That sped the trials up. So all these things actually made things go faster then. For me, the way to think of it is imagine if it was always like this, because what has happened, the people who are researching the mRNA vaccine, have actually said they're now researching mRNA vaccines for cancer. They're also looking at vaccines for Zika. They're looking at it from malaria, they're looking at a vaccine for HIV. So because of the pandemic and because it moved this technology finally into a vaccine that the world could actually use. Now we have a technology that can all of a sudden treat all these other things potentially. So it's actually pretty incredible. It was upside of the pandemic with unprecedented organization, cooperation and funding for science.
Pamela
It took a little bit of a blow because regulators in Europe and Britain indicated that there's a strong possibility of blood clots being associated with the Oxford AstraZeneca vaccine. Four cases per 1 million or something. Is that is that correct?
Kelly
It seems to be about that. Maybe two to four per million. It's very uncommon.
Pamela
So Canada is and some other countries are recommending it only for older people.
Kelly
There's a couple of things to know about this. The first is that the process that we're seeing right now, where the side effects are being looked at, and they're trying to figure out if in fact, the side effect is caused by the vaccine and it's not some coincidence, that there seems to be a growing consensus, it is quite possibly from the vaccine. It's not just a coincidence. But the whole process is that this is actually a system working in the way it was designed to work, which is that anytime you have any new drug comes to market, whether it's a diabetes drug, it's a blood pressure drug, it's an arthritis drug, it's a new vaccine, you do trials. And about, say 30 or 40,000 people or 100,000 people or 10,000 people, it depends on the drug and what you're trying to do with the vaccine. And that's it, and then it gets approved, and we know what the majority of side effects are going to be. But there's always the possibility of one in a million side effects and one in a million side effects you're not going to catch in the clinical trials. So we have really robust systems that are set up to track drugs and vaccines after they're out in the public to watch for those rare and unusual side effects, for any alerts that there's something wrong here. So that's what came up with this recent possible side effect with the AstraZeneca vaccine. Where in Europe, they had some reports of this in younger people especially. Why not in the UK? But the UK was vaccinating mostly older people, and Europe was vaccinating mostly younger people. So then the next question was, is this side effect in younger people and not older people or is Europe’s system better than the UK system? So there were some questions there. In Canada, we had just started rolling it out, so we actually haven't seen these things yet. The difference was in Canada, they said, “Okay, knowing this, the cases are all in younger people, we're going to use the vaccine only in older people.” And it's a really effective vaccine. It's an excellent vaccine. So we may or may not actually see these cases here in Canada. That decision to use it for older people may actually mean that we don't end up seeing it. But the thing to always note about is COVID causes a lot of blood clots. One of the biggest complications for COVID is blood clots. Early on in the pandemic, one of the presenting symptoms for a lot of people with COVID, when they're younger, was strok, because COVID was causing clots in young people. So we're balancing this potential side effect with AstraZeneca, which is blood clots very rarely, maybe, you know, three or four and a million at most, to the fact that COVID itself is causing a lot of blood clots. One in 100, people who, who don't get sick enough to go to hospital, one in five to one in 20 who get sick enough to go in hospital. So that's really that’s where the benefits really still vastly outweigh the risk.
Pamela
I did see one media report recently about people are not showing up for appointments, they're shopping around for vaccines.
Kelly
We're hearing it but I have to say, at the clinic where I'm working, I haven't seen it. So if we have, say, 600 people booked for the day, we might have a couple that don't show up. And usually there's a reason. We call them on the phone, and we say, “Where are you?” And they might have just forgotten, they may be unwell. You know, they may have cognitive problems, like they might have a bit of dementia. So there are often explanations, and we expect that. We expect a couple to not show up. Another one that's common is people who aren't great with technology accidentally double-book themselves. So every day, we will see maybe one or two people who they're in the appointment thing twice because they just didn't realize they already booked themselves. So what that means for us is we often have a couple of extra doses. But no, I mean, we aren't having like if we've got 600 spots, we have 600 people booked pretty consistently. So our region, what they've been doing is if you pre-register and you’re on the pre-registration list when you're eligible. They'll send out the invites to a lot of people. And we learned that you have to send it to a lot of people to fill those spots. So if you have 600 spots, you don't send out 600 invitations. You might send out 3,000 invitations because it takes people time to actually get organized enough to book. So sometimes when they're booking, they might get an appointment the next day. Some people booking might have to wait a couple of weeks to get an appointment. But then what I often hear from people will say, you know, there's a lot of empty appointments at the end. Well, they're usually weren't actually empty appointments. They were early people. So the people who were supposed to come at 3:20 may have showed up at 1:30. And depending on their frailty or their age, sometimes we say go wait in your car. You know, if they're younger. For older people, we may just say, “You know what, just come on in, we're going to do now.” So, you know, we've tried to really work as a primary care clinic. You know, it's family doctors and nurses and pharmacists. We work with folks like this all the time, even when it's not a pandemic.
Pamela
Is there a vaccine left over at the end of the day?
Kelly
There's a perception in the public of what is happening, and then there's the reality in the clinic. So the way this works is, you know, I get there in the morning, I have 640 doses, and 640 people book. And then you know, a couple of people are no-shows. We've had no-shows as late as 20 minutes before the end of clinic. All of a sudden, you have an extra dose. So what we have to do is find people on very short notice. So early on, we tried calling people when we were in the older age group. And we realized even when they said and when they check the box in the pre-registration list that says,”Yeah, I'll come in at short notice,” often they can't. We never waste dose. But the hardest part is we always find someone eligible too. So no, we don't just give it to anybody, and we don't just take it ourselves. We have to make sure we find someone who would have had an appointment that week anyway, and find a way to get it to them.
Pamela
That's good, because some people have this idea that there's a lot of spoiled doses, doses getting thrown out. Meanwhile, these are people who really want to have the vaccine. And so they end up almost blaming the people who are eligible for the vaccine at that time, whether it's people of a certain age or people of a certain background, for instance.
Kelly
Yeah, I think that's probably one of our biggest problems right now is people who are waiting for their vaccines who haven't been vaccinated, maybe because they're not eligible. It's really hard. It's hard emotionally. I mean, the pandemic is hard, emotionally. They want to be vaccinated, they want to be vaccinated yesterday. We just have not gotten enough vaccines into Canada to be able to do everybody quickly. So another pressure is we're looking at people in the U.S., the U.S. is much further ahead than we are. We just don't have the kind of supply that they have. And a lot of this has to do with the fact that as Canadians we actually don't make our own vaccine supply, and this goes back decades. This is not a recent problem. This is going back as the ‘80s. We also don't fund research on vaccines very well in Canada. Again, this is not a current problem. This is a problem going back decades. We'd really cut quite a bit ago, we'd really cut funding to science research, and health-care research, and so we didn't have this robust ecosystem in Canada where we could just pivot really quickly and start making some new vaccines. mRNA vaccines, for example, in the technology, we didn't have the facilities to do that. So we're really relying on other places to make us our vaccines. And as we've all learned by watching the news that can be unpredictable. The other thing is the manufacturing of global supply of vaccines. That in and of itself is unpredictable. We've just seen in the news, Johnson & Johnson has had some problems with some quality at one of their factories, having to throw out millions of doses. Well, I don't know those are destined to Canada, but those are millions of doses destined for somewhere that’s not going in. And that's exactly what we experienced. So Pfizer has been pretty stable. It hasn't been enough, but it's been stable. We know what we're getting. And we can run mass vaccine clinics on that. Now people want clinics 24/7. We do not have enough vaccine to run clinics 24/7. We barely have enough to run them on working hours most days of the week. We're giving out what we're getting as soon as we get it. Moderna, which is what we send mobile teams, is also an mRNA vaccine. Excellent vaccine. It's a bit easier to move. Really unpredictable when we're going to get it and how much we're going to get. So we've had mobile teams who have had to shut down because there was no vaccine for them. And then the most recent was AstraZenica. So we got that gift of the 1.5 million doses from the US. Well, when that came in from a new manufacturer, they had to approve the factory that that came from. So that was a bit of a delay. But as soon as that came in, it went to pharmacies everywhere, and pharmacies are only given each about 200 doses. So you know, a lot of them to get rid of that within, you know, just a few days. But then there's nothing. So even for the pharmacies, they're saying, you know, they've got waitlist of 3,000 people, and they got 200 doses. So more than anything, I think so many of the problems, people are so angry, but so many of the problems that they don't see if there just isn't enough vaccine to do everybody right now.
Pamela
So the situation changes so quickly. Now people over the age of 18, who live in what are called hotspot neighbourhoods, who, you know, by postal code are able to get the shot. Do you think geography is the way to do it?
Kelly
Certain neighborhoods are hit hard. Certain workplaces are hit very hard. And often when we look at the outbreaks, the outbreaks are tied to manufacturing sites, warehouses, things like that. And then in those neighbourhoods what you also have is multi-generational housing, meaning that the grandparents might be living with the parents, the parents are supporting the entire family in those types of manufacturing roles. And then there's kids as well in school. And that when especially with the variants, the big concern is with the variants coming in now. It used to be that if someone came into the house with COVID, maybe a child brought it home from school or someone brought home from the workplace, the entire house doesn't automatically get it. And actually a good chunk of the people don't necessarily get it. But with the variants, everybody gets it. And you know, people are ending up in hospital more and people are getting sicker. And so it's basically a race against time right now. The people who are in the ICU, are often coming from these postal codes. So we have to work really hard to actually make sure not only do we bring the vaccine to the hotspot, neighbourhoods, we make sure the vaccine goes to the people who live in those neighbourhoods. And so there's a lot of work to be done on mobile teams and delivering it through anything from a church to a community center to a food bank, to going into the factories in the warehouses and giving it right to the people there. So that's largely what you're seeing here is a recognition that a lot of this wave, these are people who can't stay home from work, they must go to work. These are essential workplaces. They have no option to work from home. And so we know that this those kind of socio-economic factors are really driving the pandemic right now.
Pamela
I see. Okay. Is there anything else we need to know Kelly?
Kelly
I think the biggest thing is, the biggest message I've tried to give people in the last little bit is that take the first vaccine that you can get. So if you're offered a vaccine, or if you're over the age of 55, and you can get a vaccine at your pharmacy, but you have to wait a few weeks to get a different vaccine as a mass vaccine clinic. Take the first one that you can get. All four vaccines are nearly 100 per cent effective at preventing severe illness, hospitalization, and death. The question should be, “Can I get vaccinated today? Or do I have to wait?” And the one you can get today is the best vaccine that you can get. So I think more than anything, that's been the most important message I've tried to get people. They're all great vaccines.
Pamela
Okay, I'm back with Professor Kelly Grindrod from the School of Pharmacy. Kelly, one of the key takeaways from that interview is that we did not have enough vaccine in the region of Waterloo to get everyone vaccinated when it was their time. Is that still the case?
Kelly
It is. It's the case this week. It's the case right now in some of the clinics. We're not actually vaccinating each day, we're opting to, you know, as soon as we get a shipment, get as much of it out as we can the first few days of the clinic. And once we use up the supply then we don't run the clinic on those days. But the great news is, there's an awful lot of Pfizer that's slated to start coming in in the month of May. And so we're actually going to start seeing things really pick up probably about the middle of May, especially to the late later parts of May. So our supply’s almost going to double in the region. We had designed these vaccine clinics to have much greater capacity than we've been able to use so far. And we're really looking forward to when we're actually going to get to use that capacity.
Pamela
That's of course if people are willing to get the vaccine. But you've seen indications that people are really wanting to get the vaccine, correct?
Kelly
We have far more people wanting to get vaccinated than we have vaccine in the region. And so I suspect that will continue well into June. People want the vaccine. There's a lot of people that want the vaccine.
Pamela
Didn't some of our vaccine go to other regions as well?
Kelly
We really need to be diverting as much vaccine as we can to the places where people are getting COVID. So that includes hotspot regions, so that would be the GTA and Peele, for example, but also hotspot neighbourhoods. So right around now in the next couple of weeks, we are going to see a good chunk of vaccine being diverted to the GTA Peele area, you know, York, for example. But we're also going to see it being focused on these hotspot neighborhoods. We have a hotspot neighbourhood and Waterloo Region as well, with some very specific pockets. But once we're getting to mid-May, late May, vaccine supply isn't really going to be our issue so much anymore. That's when we're really going to push the number of vaccines we have coming in and we can get a lot of people vaccinated quickly. So by end of May, that's where you're going to start feeling that you know, this is where multiple groups are coming in, where it's not just essential workers because they’ll largely have been offered their vaccine, or it's not just older people, they'll have been largely offered their vaccine. So it's going to start feeling like it's moving a little bit faster, I think. Pfizer is extremely reliable, and they deliver large amounts, larger than we expect sometimes, which is amazing. Pfizer is very hard to work with, and it requires teams who are trained in how to use it, and that's its real challenge. So that's one of the things we're realizing is, one of the realities here is we are going to get a lot of Pfizer, we've got to maximize how we use it. We had been sending Pfizer to the mass vaccine clinics, for example. But now a lot of people are really interested and okay, well, maybe it's Pfizer we should send to pharmacies, because we're going to get a lot of Pfizer. Let's get it to where people are going and want to go. So we saw AstraZeneca come in, and that that was a bit of a surprise delivery that we got in the last couple of weeks. That went out largely to pharmacies, and we saw pharmacies blow through that supply. So huge demand. And in our region at this point, we're about three-quarters of the way through that supply in pharmacies and that didn't take much time at all. The one that's going to be coming in this week is Johnson & Johnson. So that's a first for Canada. This is our first delivery of Johnson & Johnson. That's the only-one-dose vaccine. So there's some questions around where it's going to go. We don't know yet. It's not clear if it's going to go to pharmacies, for example. But it's a one-dose vaccine, so it's also very good for high-risk populations that we think might not be able to come back for a second dose, that we're really worried about losing for a second dose. So you know, this could be people who have variable housing, for example. These could be people who have complex work schedules and demands on them where it's really hard just to get in for the first dose, let alone the second dose. So we're not really sure where the Johnson & Johnson is going to go. Moderna is the last one. So Moderna is like Pfizer. It's an mRNA vaccine. We're happy when we get it, it's wonderful to work with, we can send it on our mobile teams. It's just not all that reliable in terms of shipments. And so some weeks we get it. It's not uncommon to be dealing with a delay. But we can always get Pfizer. So everybody's kind of retooling around Pfizer now.
Pamela
We know about blood clots that can result from getting the vaccine. In particular, it's been in the news about AstraZeneca. And we know that somebody in Quebec recently, unfortunately, did pass away from getting a blood clot after getting the vaccine. What do you want people to know, despite all this?
Kelly
So this is probably one of the most challenging conversations to have around vaccines. Because when we think of a medication and having a risk, it's often you know, you can really weigh the risks and the benefits and things are clear, whereas this one is still emerging. It's still evolving. We're still learning about it. But I think the other part is, the part that's changing, is the fact that the virus is really bad right now. And when the virus is really bad, the risk of the virus is really high, and the risk of complications from the virus is really high. It's called vaccine-induced thrombotic thrombocytopenia, or VITT. What the risk is the vaccine triggers this kind of immune reaction with your platelets that causes a lot of clots at the same time as depleting the platelets, and so you also get bleeding with it. It's not the same as getting like a single clot in your calf. And so people often ask me, you know, “I've had a blood clot in my calf before, I've had a blood clot after knee surgery.” This is not the same thing. Or, “I've had a stroke.” It's not the same thing. Those things don't necessarily appear to increase your risk, either. It's unrelated. Now the rate of them, early on they said it might be one in a million. And then the rate went to about, say, four in a million. Where we seem to be at right now, based on data coming out of Norway and the UK, is somewhere around one in 100,000. It could be as high as one in 50,000. What we're also seeing, though, is we are learning how to diagnose it and recognize it to treat it. It can be managed. All of this is always in the context of the fact that COVID, we have a lot of COVID right now, and one of the ways people get really sick from COVID or die from COVID, is blood clots. So one in 100 people who get COVID get a blood clot. One in five people who are hospitalized with COVID develop a blood clot. So COVID in and of itself is a very clotty infection. It causes a lot of clots. And that's why it's very unusual. People might say, “I don't want that.” But you know, COVID itself is extremely dangerous.
Pamela
Can you mix vaccines? Like let's say I got the Pfizer for my first one. Can I get the AstraZeneca for my second one, if it's available?
Kelly
Possibly. There's research going on on that. So the idea could be okay, so people get their first AstraZeneca right now. But if we get an awful lot of Pfizer coming in, could people who got AstraZeneca for the first dose get a Pfizer second dose? Maybe one of the vaccines is better at a certain variant. Maybe they get out a vaccine that's better for specific variants more than the others. So is that a reason we could give that as a second dose? So there's research ongoing with that right now. I'd expect in the next couple of months we’d have an answer, probably starting around the time we see Canadians going for their second doses. So I think that's a great one to stay tuned and let's see what comes out of that.
Pamela
We had discussed that it was end of July that we were talking about Canadians would probably have their first dose. Do you think that's still the case?
Kelly
I think so, yes. So depending on how much vaccine comes in, in May in June, and based on what we're thinking will come in, we're going to get the majority of people who want a vaccine done early summer, hopefully. So there's going to be an awful lot of people who get vaccinated in the month of June. The question then is when can we get second doses? because second doses are going to follow those first doses by about four months. So if we're finishing up those first doses around June, we're probably going to be finishing those second doses around, let's say, October.
Pamela
And do we know that four months is an okay time lag between jabs?
Kelly
We don't know. We don't know that one month is an okay is the best time between jabs either. So the real challenge is we don't know the best time to get the second dose. With the Pfizer and Moderna vaccines, the reason they did the 21- or 28-day second doses is because you could get trials done really fast that way. And it seems to work. There’s two ways of looking at immunity. One is when people have had COVID infections, they can check, you know track their immunity and know how long it lasts. We know after a COVID infection, there's some immunity that lasts, you know, upwards of six months or more at least. I mean, we only have so much time because this has only been going on for so long. Vaccines also seem to have a pretty good response at the beginning after the first dose. And it does seem to continue for months after. We don't expect it to be a rapid drop at say, you know, two or three months where you get a great response in month one, and then you have no immunity by month two or month three. We're not thinking that's going to happen. Now, AstraZeneca is a little bit different, though. So AstraZeneca, you could give the second dose between four and 12 weeks after the first dose, and it actually might work better if you hold that second dose until 12 weeks. So in Canada, they're all being given at four months after right? At 16 weeks after. But even with AstraZeneca it actually might be a good thing. AstraZeneca might have a better response when you give that second dose later. So it actually fits pretty well with that Canadian delay.
Pamela
So let's say we all have our first shot by the end of the summer, what can we do then?
Kelly
That's the million-dollar question. Everybody wants to know that. So right now things are trending in the right way. If they keep going in the same way we might find that we actually get to have a good summer virus-wise, numbers-wise. So that's the first question. It's not even about vaccines, it's about virus. Where are we at with the virus. By the summer do we have the community spread controlled enough that we don't have a ton of people out in workplaces, for example, you know, family gatherings likely to have COVID? Separate from that you've got all your first dose people in my mind. What that means it's probably not as much as what people think. So it probably it might mean comfortable gatherings outdoors. So the first thing that might go is not having to wear a mask outdoors. Outdoor dining opening up, we might see that first. We might start to see gatherings, you know, slightly larger gatherings allowed. So I think we should expect a very gradual opening up, probably not unlike what we've seen previously. The problem was when they opened up previously, that often led us into the next wave. The hope would be as they do that over the summer, and we've got large portions of people at least partially vaccinated, that it doesn't trigger another wave. That's what we're waiting to see. When we're really looking at not having these restrictions anymore, is probably in the new year. Probably, once we get through December 2021. After the new year, into 2022, that's probably when we're going to start. I'm hoping things will start to feel more normal again.
Pamela
Oh, really? That late? Oh.
Kelly
Yeah, I suspect. For sure, I suspect, remember, we haven't started vaccinating kids yet, right? And kids are a big part of this equation. So you know, there's a good chance kids are going back to school in September masked. And that that's going to persist until the majority of people have their second doses. We've just been talking about the fact that there's a really good chance kids won't go back to school this year, given the variants and given the level of spread. And one of the goals, some experts have said one of the goals is to get teachers at least and educators and school staff with at least one dose before we restart the school year. And that's not likely to happen very soon. So the thing that I'm finding is people want this to be done, and they want to go back to normal. And because of that, in their minds, the timeline is sped up that it's going to be sooner. “I can only keep doing this for one more month, I can only keep doing this for two more months.” If we think of it more along the lines of like, “Okay, let's just get through the rest of this year. This is a vaccine year. 2021 is the year of vaccination.” And once we get through that, and the majority of the population is fully vaccinated, including children, then I think we're going to start to see a much more realistic return to normal. The people who have second doses right now are the earliest health-care workers. So these are your ICU, hospital, emergency department, etc. They've often been given two doses, and your long-term care folks have been given two doses. Who we're doing right now with two doses is people who are getting active cancer treatment, and people who have received a transplant in the past. They're also getting their earlier second doses. Everybody else is waiting. So a really common question, really common question that pharmacists and doctors are getting is, “Well, I'm not going to be around for when you scheduled my second dose. I'm going on a trip. Can I get it earlier?” Absolutely not. You’re going to have to wait. So we're hearing that a lot. They worried a lot about their first dose. And when they got their first dose, they were just happy to get it. And now people are starting to think forward to okay, when is their second dose?
Pamela
Yeah, and maybe people shouldn't be planning trips right now.
Kelly
I get a lot of questions from people about trips. You know, they're going to take a trip in the summer. They canceled their trip in the fall. Are they going to have to cancel it, and in my mind, you know, it's a good year. Again, if we think about things not really returning to normal for the rest of the calendar year, until December, it's still going to be a year of staycations. It’s still going to be a year of camping. It's still going to be a year of exploring the Canadian landscape. It's probably not going to be the year for the great European vacation or cruise. But those should come back. It's just not likely it's this year because this year is about vaccinating people. And what we're seeing, another side to this is how the virus is doing in other parts of the world. Canada has one of the fastest vaccination rates at the moment. So yes, we're absolutely at the top of the list when it comes to how fast we're vaccinating. We have good vaccine, and we're getting it out as soon as we get it. A lot of countries don't actually have any access or very little access to vaccines. So we also have to wait for them and try to support them.
Pamela
Speaking of other countries. The situation in India, in particular, is really, it's dire. And the US has indicated that they will supply that country with the raw materials so that they can make vaccines. And they have plans to release 60 million doses of AstraZeneca to other countries as well. What does that mean for us?
Kelly
In a global pandemic, you have to vaccinate the world. And the richest countries have taken the most vaccines for themselves. And I think what we've seen even these places that are having, you know, India is a great example. India makes a lot of the world's vaccines. And yet it's finding itself in the most precarious position of any of the countries in the world right now. It's terrible what's going on there. So, there is a real urgent need to shift focus of global vaccination to India and divert supplies there. AstraZeneca is actually running this as a nonprofit. They're not getting profit from the vaccine. And it was meant to be the vaccine that could be transported. It was designed that way. It's the one that can go anywhere. It's the one that's easy to use. It's the world's vaccine. And so it makes a lot of sense to be making sure that as much AstraZeneca goes to India as possible because it's the easiest one to use and transport. Canada doesn't rely a lot on AstraZeneca. We've just had some come in and all the Gen Xers and the 40-somethings, you know, they enjoyed their doses, and they got vaccinated probably a month to six weeks ahead of when they were probably going to be otherwise, which is great. But Pfizer is really the one that we work with the most. So I'm not sure it's going to have a huge impact having our AstraZeneca sent there. I actually think it's probably in our best interest. When you've got a virus raging like that there's a really good chance you're going to get some serious variants emerging. It seems to be a very serious variant. And you can get even more serious variants the longer that goes on as well. So it's important that we support them in vaccinating their people.
Pamela
I did see in the news, you know, people in the UK, and they're out and about without a mask, and I thought, “Aw! How did they get that way?”
Kelly
I think if you look at countries like the U.S. and the UK, they're ahead for two reasons. They're ahead because they make and research their own vaccines, and they got out of the gate first with vaccines. They also had a huge amount of infection. So they started off with a fairly high baseline rate for people who had immunity because they had been infected with COVID. And then they added on top of that a lot of vaccines quickly. So Canada, we were lucky and that we didn't have as much infection. So we were able to control it a bit better. And we were a bit slower on the vaccine rollout. So that puts us months behind the U.S. and the UK and why we can't quite compare. We’re starting to see bigger events happening in the U.S. in the UK. And as much as that would be nice, they also paid a huge price to get there a little bit earlier. I think Israel is another one. Israel seems to have done the best in the world in terms of vaccinating. And watching how they're doing in terms of opening up that might be a better comparison for Canada. Things will start to become clear over the summer. My best advice for people is just be patient. Don't get ahead of yourself. Hopefully, this summer is a good one. Let's aim for a good New Year.
Pamela
What else before we go Kelly?
Kelly
The next couple of weeks, I think are still going to feel like they're dragging a bit. But just keep in mind come late May things should really pick up really quickly. If you can help people get vaccinated, that is one of the most important things you can do to get us opened up as much as possible starting maybe in the summer, you know, and through the fall is just help people. People need help. If you speak different languages, and there's people in your community, and maybe through your church or your place of worship, helping people in those communities who might have a language barrier get registered, that would have a huge impact for a lot of people's lives.
Pamela
How do we do that? How do we help people get registered?
Kelly
So you can if you've got someone's information, so their name, their contact information. You can go into the pre-registration link. So if you're in Waterloo region, for example, you could go into our region's registration link and input their information. You could do the same for other places as well. So if you're in York, or if you're in Peel, or if you're in the GTA. So I think as long as if you've managed to get yourself a vaccine, using the same mechanisms to get somebody else in your life a vaccine as well. Maybe you've got one through a pharmacy. Maybe you're watching Twitter's vaxhunters Canada, and you're seeing you know, someone in your life and they're waiting for a dose and you see that there's doses leftover and a walk-in clinic, letting that person know, I think that would make a huge impact.
Pamela
That's great advice. Thank you so much, Kelly for coming back. It's always wonderful to talk to you and really appreciate you sharing your expertise.
Kelly
Thanks so much.
Pamela
Well, that's it for this bonus episode of Beyond the Bulletin. You can find all of our past shows on soundcloud.com. To ensure you don't miss an episode, please subscribe to the Beyond the Bulletin Podcast wherever you get your podcasts, and recommend us to your colleagues and Waterloo alumni. You can reach us at bulletin at uwaterloo dot ca. Stay safe everyone. And thanks for going beyond the bulletin.