LDr. Mesana is calling for all healthcare workers in contact with patients to receive the second dose of COVID-19 vaccine without delay. Since March 12, the University of Ottawa Heart Institute has experienced four outbreaks of COVID-19 affecting 15 patients and 14 staff. Staff at the Ottawa Hospital Civic campus were also infected, despite having received a dose of the vaccine.
Health Canada initially recommended that the manufacturer’s instructions be followed, i.e. between 19 and 21 days between two doses for Pfizer-BioNTech, between 21 and 28 days for Moderna and between 28 days and 12 weeks for AstraZeneca. However, due to the vaccine shortage, the National Advisory Committee on Immunization (NACI) has recommended extending the interval between the first and second dose to four months. Conservative Party Health Critic Michelle Rempel Garner asked Dr. Caroline Quach-Thanh, President of NACI, “Would you have made that recommendation if there were more stocks?” To which Dr. Quach-Thanh replied: “Of course not”.
Dr Mona Nemer said: “I am not aware of the data showing that there is efficacy beyond two months after the first dose”.
The problem affects not only front-line health care workers, but also the elderly. Dr. Marc Romney, a professor at the University of British Columbia, found that residents of long-term care facilities had a weaker immune response than that of younger people. He said protection for some older people, not only in long-term care facilities but also in the community, may be only partial after their initial dose. According to Kelly Grant of The Globe and Mail, several new studies published overseas suggest that a single dose of vaccine may not offer as much protection as hoped for the elderly, cancer patients and those who have received transplant.
For many reasons, our vaccine supply is insufficient. Globally, we have fallen to 64th place in our per capita immunization rate. Thus, due to the shortage of vaccines, Ottawa and the provinces are asking us to resort to practices that do not conform to approved indications for the protection of our patients and our fellow health professionals.
Selon the Mayo Clinic (Mayo ClinProc, Oct 2012; 87[10] 982-980 by Christopher M. Wittich et al), more than 20% of prescriptions are for non-conforming use.
With respect to potential negligence, the article asks four questions:
1) Did the FDA approve the original drug?
2) Has the misuse been thoroughly peer reviewed?
3) Is the improper use medically necessary for the treatment?
4) Is this a non-experimental use of the drug?
It is also relevant to mention an article from the CMPA entitled “Managing the risks of improper use of drugs and medical devices”. (P1203-15-F, September 2012)
It defines non-conforming use as “the prescription of different dosages or frequencies. Lengthening or shortening the duration of treatment, or the use of routes of administration other than those indicated on the drug label. “
In order to reduce the risk of liability, the CMPA recommends “to assess whether the medical literature (eg, organizational guidelines for medical specialists) provide sufficient support for the improper use of the drug or product. . “
If an oncologist drastically altered an accepted chemotherapy regimen or an internist prescribed a much higher dose of antihypertensive than stated in the Product Monograph, how would the CMPA defend it?
Clearly, Ottawa and provincial and territorial health ministers should quickly reverse their decision to extend the interval between the first and second dose of the vaccine to four months, at least for healthcare workers, other workers. essentials, the elderly and patients with underlying chronic diseases.
If a massive influx of vaccines occurs over the next few weeks, it should be possible.
All it takes is political will.
Charles S. Shaver, physician in Ottawa, was born in Montreal. He has served as chair of the Section on General Internal Medicine of the Ontario Medical Association.
The opinions expressed in this article are hers.
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