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Strang’s flip-flop on AstraZeneca

From AZ backer to pausing doses for the province, here’s what the top doc’s said.


Update: At the COVID briefing on Friday, May 14, Strang changed his tone when talking about people who had received AstraZeneca, reassuring them that they had done the right thing by getting the first vax available to them, that they were safe and giving them information about how to monitor for potential blood clot symptoms.

fter a rollercoaster of ups and downs, today the province of Nova Scotia announced it is pushing pause on all AstraZeneca vaccination appointments, effective immediately. The move comes the day after Ontario decided to stop using the AZ vaccine.

“Over 1,000 appointments have been cancelled and our health providers are telling us that most people are choosing the mRNA,” said premier Iain Rankin at the COVID-19 briefing on Wednesday. Added top doc Robert Strang, “the decision to pause the use of AstraZeneca is based on caution, science, and the availability of alternative mRNA vaccines from Pfizer and Moderna.”

When AZ was first announced for Nova Scotia, Strang was excited about it despite the persistent concerns about blood clots. On March 5, he said “all the COVID vaccines provide good protection against symptomatic illness and good protection against severe disease.” A few days later, on March 9, he said “When your turn comes I’m asking all Nova Scotians to step up and get their vaccine,” and “All the vaccines are basically equivalent in their ability to protect people from severe disease.”

When appointments for AstraZeneca vaccinations opened on March 16 in Nova Scotia, they were limited to people who were either 63 or 64 years old. This tight age restriction seemed prescient when, two weeks later, the National Advisory Committee on Immunization issued a warning against using AZ on people younger than 55. “This does not mean that vaccine isn’t safe or isn’t a good vaccine,” Strang said March 30. “It means we are seeing something rare in a certain subset of the population that we need to monitor and to get more information about.”

NACI eventually cleared AZ for use in people 30 years old and up, and on April 30 Nova Scotia made it available to everyone between 40 and 64, before today pushing it to the back of the shelf for the more widely available and apparently “better” vaccines from Pfizer and Moderna that use messenger RNA technology. Just yesterday the province opened eligibility for the mRNA vaccines to every Nova Scotian aged 40 and older.

To date, Strang said the province has not had any reported cases of vaccine-induced immune thrombotic thrombocytopenia, or VITT, which typically occurs within the first 14 days post-vaccination.

“Because we now have mRNA vaccine into the 40+ age groups, it doesn’t make sense to continue to offer the AstraZeneca vaccine because the mRNA vaccines don’t have the same safety signal,” Strang said Wednesday when explaining why AZ is being held back. “We have sufficient supply of the mRNA vaccines and we’re now in the age group where we can use that preferentially.”

For Nova Scotians who received one of the 57,576 AstraZeneca shots administered since March, Strang’s words might not be reassuring. “We’ve always in Nova Scotia taken that people may have a choice on vaccine products,” he said. “But we made sure that they had informed consent about the various risks and benefits of the various vaccine products, and we’ve been very clear that AstraZeneca has some unique risks to it.”

For the hundreds of 40-and-up-year-olds who have AZ appointments booked for the weeks ahead, Strang says those will be changed to mRNA as soon as public health works on calling those people. “Their age eligibility now completely overlaps,” he said.

In total, the province expected to receive 182,000 doses of AZ, according to data from late March. Strang couldn’t say exactly how many were expected to arrive this month, but says they will now be held back by the federal government. “They’re very happy to, they will be holding onto Nova Scotia’s allotment,” he said—until we make a decision on whether we need or want it.

But Rankin says it won’t affect Nova Scotia’s vax rollout. “This will not take us off-course, to be clear,” he said, yet again stressing the June target. “Our vaccine plan continues to roll out on schedule.”

There are nearly 2,500 doses of AZ sitting in pharmacy freezers across the province, which Strang said will expire at the end of June. Before then, the province hopes to hear back from NACI about whether they can be used as second doses.

“We’ll get information on this before we’re at the timeframe where we’ll be needing to give people a second dose of vaccine, which is starting in early July,” Strang said. “We’re going to make decisions before we need to start putting needles in people’s arms for the second dose.”


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