Impatience as clock ticks on AstraZeneca expiry

Impatience and a lack of clarity persisted Thursday over the fate of thousands of doses of the Oxford-AstraZeneca vaccine set to expire in the coming weeks but answers could be coming within days.

Several provinces have stopped giving the COVID-19 shot over concerns of rare, fatal blood clots. Health authorities were still trying to decide whether to resume its use and if using a different vaccine for second shots makes sense.

At the same time, Ottawa has been distributing hundreds of thousands of AstraZeneca doses to the provinces, some of which are sitting on soon-to-expire stockpiles. Deputy chief public health officer Dr. Howard Njoo said vaccine wastage was largely an issue for the provinces to sort out.

Justin Bates, head of the Ontario Pharmacists Association, said an announcement that had been expected on Thursday would now likely happen in the coming days. The association, he said, was in confidential discussions with the province about using the AstraZeneca, something he said should be done.

"Absolutely. We have a shared objective with the ministry to ensure that we use, wherever appropriate and feasible, all of the AstraZeneca remaining doses."

Ontario is banking on a steady increase in vaccinations for its three-phased reopening to start, tentatively in mid-June. Health Minister Christine Elliott indicated on Thursday the province was leaning toward using AstraZeneca for second doses.

"We are waiting for the final recommendations (from experts) on what we should do with the AstraZeneca vaccine," Elliott said. "Data from the U.K. indicate that any problems with the second shot are far less."

Quebec, which on Thursday said it just received 148,000 doses from the federal government, has stopped using the vaccine for a first shot. The province did say the new shipment would likely be reserved for second doses for people aged 45 and older but it was not clear when that would happen.

Dr. Deena Hinshaw, chief medical officer in Alberta, said the province had about 7,000 doses, expiring at the end of June.

Federal Health Minister Patty Hajdu said earlier this week the vaccines would not go to waste but Ontario, which has about 31,000 unused doses, is up against a May 31 expiry date. Similarly, Manitoba has also reported having about 7,000 AstraZeneca doses that need to be used before month's end.

"Provinces and territories are weighing their options very closely in terms of second doses for those people who have received AstraZeneca for a first dose," Hajdu said.

Bates said it would take a concerted effort to get the shots in arms, if approved, before expiry involving reaching out patients to schedule an appointment. They would also need to provide informed consent around dosage intervals and relative risks, which he said were far outweighed by the potential benefits.

"We're just waiting for direction," Bates said. "We can move quickly."

More than 2.1 million people have had AstraZeneca. Health authorities said there were about two-dozen confirmed cases of vaccine-induced thrombotic thrombocytopenia, or VITT, the rare but serious blood-clotting disorder.

The National Advisory Committee on Immunization, known as NACI, was still awaiting data from a study on giving a so-called mRNA vaccine as a second dose for AstraZeneca.

Njoo said advice on whether provinces can mix and match vaccine brands should be ready in the first week of June.

It was up to the provinces to decide whether to offer a second dose of AstraZeneca, an mRNA, or a choice between the two. Preliminary results from the U.K. study on mixing and matching were promising, he said.

"It bodes well for individuals who have received the first dose of AstraZeneca having that choice, and at the end of the day it comes down to making an informed decision," he said.

Brig. Gen. Krista Brodie, in charge of the federal distribution program, said Health Canada would destroy any expired doses.

Dr. Irfan Dhalla, an internal medicine specialist in Toronto, said this week people should be able to choose whether to get AstraZeneca, either as a first or second dose, or wait for another brand known as an mRNA vaccine. They might have good reasons to choose AstraZeneca for one or both shots, he said.