Not everyone wants a Pfizer or Moderna COVID vaccine. Why not offer them something else?

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Nearly five million eligible Canadians have so far chosen not to be vaccinated against COVID. In an attempt to sway some, to move the vaccine needle further amid a fourth wave of this tiresome virus, some provinces are seeking doses of the single-shot Janssen (Johnson & Johnson) vaccine.

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Alberta Premier Jason Kenney this week received a promise of 20,000 doses from the federal government. Saskatchewan is also “actively pursuing” a supply of Janssen. Both provinces share the unenviable position of having the lowest vaccination rates in the country, and burning COVID fires.

The message had filtered through to Kenney that it might help to offer those holding out a “fresh choice,” a government source said, “something different” than the mRNA vaccines, Pfizer-BioNTech and Moderna.

The federal government is trying to provide the requested doses as quickly as possible, and is offering all provinces and territories the option of acquiring the J&J shots, Health Minister Patty Hajdu said Friday. “Canadians are tired, and I think everybody wishes that the pandemic was over.”

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J&J is a viral vector vaccine like AstraZeneca, which Alberta and other provinces stopped offering in May after the National Advisory Committee on Immunization said Pfizer and Moderna were the preferred vaccines, because of a rare risk of a blood-clotting disorder. Before then, thousands of AZ appointments went unused in Alberta, while in Ontario, people anxious for the shots hustled to find a pharmacy amid confusion and news reports of the potential side effects. Critics accused NACI’s characterization of the mRNA vaccines for triggering buyer’s remorse and brand shopping.

The Janssen vaccine was authorized for use in March, but in August, Canada announced it was donating 10 million unused doses to low-income countries, because, with plentiful supplies of Pfizer and Moderna, there was little demand from the provinces for anything else, procurement minister Anita Anand said at the time. The sole shipment of 330,000 doses delivered in late April had been quarantined for months over worries of possible tainting at a Baltimore production factory. They were ultimately returned to the company.

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It’s not clear how much offering up J&J shots will sway vaccine holdouts. Back in May, even most anti-vaxxers trusted Pfizer and Moderna more, according to polling for the Association for Canadian Studies. The idea of “a vaccine but not an mRNA” or a one-shot deal may now hold some appeal for the hesitant. Some have already travelled to the U.S. for the J&J jab.

“It’s a good vaccine,” Toronto infectious diseases specialist Dr. Isaac Bogoch said. He doesn’t know whether it’s fair to still bill it as a once-and-done shot. The company recently reported that a booster shot, a second dose, sharply increased antibody levels. “But it’s not an mRNA vaccine, and we have approved it,” Bogoch said. “It’s not a bad idea, as long as you have an honest conversation with people about what the risks and benefits are, and one of the risks, of course, is a pretty severe blood-clotting event.” Thrombosis with thrombocytopenia syndrome, or TTS, causes unusual blood clotting and low platelet levels in the blood, increasing the risk of strokes or heart attacks. Based on U.S. data, it’s estimated that one in 300,000 people vaccinated with Janssen’s COVID vaccine may develop TTS, compared to one in 100,000 vaccinated with AstraZeneca.

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The risk of TTS doesn’t appear to be associated with mRNA vaccines. But myths and misinformation about the vaccines abound — that they can modify a person’s DNA and permanently change who they are, or make women sterile — and that can lead to a lot of anxiety and irrational thinking. Pfizer and Moderna use genetically engineered messenger RNA to instruct the body’s cells how to make the spike protein SARS-CoV-2 uses to latch onto and invade cells. Once the genetic code is delivered, the mRNA is broken down, and never enters the nucleus of cells where human DNA is stored. “Your body doesn’t have the cellular machinery to reverse from RNA to DNA. It’s kind of like speculating you could flap your arms and fly without feathers,” said Amir Attaran, a professor of law and health policy at the University of Ottawa. “You don’t have the machinery to do it.”

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But there are understandable concerns around myocarditis, a rare risk of heart inflammation with a risk calculation that seems to change almost daily.

People are hesitant for their own reasons. The ultimate goal is to get as many people vaccinated as possible, Bogoch said. “If it would get more people vaccinated, and people can make an informed decision, I think it would be really wise to have an alternative, if people wanted it.”

The alternative might come with Novavax, if or when Health Canada ever approves it. The company recently announced, in a press release, that, in a study involving 30,000 volunteers, its protein-based COVID vaccine was more than 90 per cent effective against a variety of wily variants. Like shots against whooping cough and shingles, Novavax uses purified pieces of the SARS-CoV-2 virus to spur an immune response. Canada has a contract for 52 million doses of it. The Trudeau Liberals signed a deal to have the vaccine produced at a Montreal facility. But while the company said in an email that “active conversations with various regulatory agencies” in key markets, including Health Canada, are ongoing, it’s likely to be months before doses are made available in Canada. “If you build a better mousetrap but all the mice have been caught,” Attaran said, “what’s the point?”

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Ontario hasn’t made any requests for the J&J vaccine. “Both mRNA vaccines are safe and effective and provide a high level of protection against COVID-19,” Alex Hilkene, a spokesperson for Ontario’s health minister, said in an email.

In the U.S., where some 15 million Americans have been vaccinated with J&J, the biggest factors motivating the unvaccinated to get inoculated have been rising hospitalizations and deaths, or knowing someone who got seriously sick or died, according to polling by the Kaiser Family Foundation.

All vaccines authorized in Canada are “really, really good,” Attaran said. “Humans are made of twisted timbers” and there’s not a single explanation for why some are refusing mRNA. Some say the technology is “too new,” though researchers had been working on it since the SARS-1 outbreak of 2003.

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Still, hesitancy isn’t unique to the mRNA COVID vaccines. People refused to take the live, attenuated — weakened — polio vaccine, because it was live, Attaran said. “There’s always an excuse for hesitation that can be built around any technology,” he said.

“I just see this as the latest in that long history.”

According to Health Canada, as of Sept. 17, of 16,090 individual reports of adverse events following vaccination against COVID (0.029 per cent of all doses administered), 4,288 (0.008 per cent of all administered doses) were considered serious.

Of 191 deaths reported after vaccination, 74 were deemed “unlikely” related to vaccination, 69 couldn’t be assessed because of insufficient information, 42 were still under investigation and six deaths followed a diagnosis of TTS after an AstraZeneca injection.

National Post