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Preparing for a âpotential resurgenceâ
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When should you receive a 4th dose?
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The reason for this decision may be down to timing, with updated vaccines on the horizon that may be more resistant to Omicron subvariants, and a quieter period of COVID activity in the summer buying us time before another vaccine deployment is needed.
But NACI guidelines also recommends that eligible people wait six months after their last dose for a second booster, adding that the timing âmay need to be balanced with local and current epidemiologyâ and that âshorter intervalsâ may be needed if another wave occurs. struck.
âWhen we start to see BA.4 and BA.5 leading to an increase in cases, I think we should be nimble and expect to need to get the callbacks â but itâs that waiting game,â Otto said.
âThe longer you wait to get the vaccine, the newer it is and the more powerful it is in the next wave. So you donât want to get it months before the next wave â Canada should really push for vaccines. at the beginning of a wave.â
Otto said Canada will likely see another wave driven by BA.4 and BA.5, but how bad it gets and if it has already started is not yet clear, although some provinces like Ontario and British Columbia find a recent increase in COVID sewage monitoring.
Updated vaccines may be insufficient
Virologists and immunologists also worry that repeated boosters with COVID-19 vaccines tailored to the original strain of the virus may no longer be sufficient, and that updated vaccines may be needed to mitigate another potential wave within months. coming.
Modernaâs bivalent vaccine is a strategy that many are pinning their hopes on, but experts fear that targeting the original Omicron strain may not be enough due to to research showing a lack of cross-protective immunity against the very different BA.2.12.1, BA.4 and BA.5.
This experimental vaccine combines Modernaâs original vaccine with protection against Omicron, and while preliminary data has shown to seem to work, it has not yet been tested in the real world against the other sub-variants.
WATCH | Modernaâs vaccine targeting Omicron shows promise:
Toronto pulmonologist Dr. Samir Gupta explains how Modernaâs planned new vaccine could provide broad protection against multiple mutations in the coronavirus. Modernaâs dual-variant booster is currently in testing.
âI donât think weâre going to see any major benefit from boosting with an Omicron-specific booster than just regular boosting with the (original) strain,â Otto said.
âAnyway, the boost helps because it increases antibody levels, but I donât think it increases them much more in a way that will help us neutralize Omicron.â
âWe need better long-term strategiesâ
University of Toronto immunologist Jennifer Gommerman says Omicron-specific boosters may be effective against real-world Omicron subvariants, but only if the virus doesnât throw something else at us within months. coming.
âIf Omicron is basically all the tricks the virus has left behind, then of course I think it makes sense to do Omicron-based vaccinations because we now have a very different virus than we had at the start. of the pandemic,â she said. .
âThe problem would be if the virus still had enough real estate to create a new version of itself that was really different from Omicron â so that wouldnât be what we would want to take.â
Alyson Kelvin, a virologist at the Canadian Center for Vaccinology and the Vaccine and Infectious Disease Organization in Saskatoon, said whether or not a bivalent vaccine would protect against the Omicron subvariants currently circulating is a âhuge questionâ.
âAt this point, I think we should expect new variants, whether itâs a new sub-line of Omicron or a whole new variant,â she said.
âWe need better long-term strategies and personally I donât think a bivalent vaccine is, from what weâve seen of the virus, a sustainable strategy. Itâs about figuring out how we can cover more variations at a time to anticipate what the next variation is going to be.â
Gomerman said nasal boosterswhich are not yet available, will likely protect against infection better by targeting a different arm of the immune system â but while several are in development, including by a team of McMaster College, they could still be years away.
WATCH | McMaster University is developing nasal vaccines against COVID-19:
Professor Fiona Smaill of McMaster University in Hamilton, Ont., is conducting trials for two new inhaled aerosol drugs intended to serve as COVID-19 booster vaccines.
New variants could alter the booster schedule
Canada must now decide whether the goal of its strategy with current-generation vaccines is to protect against severe COVID or to try to prevent transmission altogether, Gommerman says, until a new vaccine or a variant changes the game.
âIf your goal is to prevent infection, weâll just have to keep pacing forever,â Gommeman said. âBut if the goal is to protect the vulnerable, then weâve already done that.â
Gommerman said she would not receive a fourth dose unless she knew there was a compelling public health reason to do so â such as if COVID levels were rising, vulnerable groups were at risk and the delay aligned against decreased immunity to infection.
âBut I know that my immune protection in the form of immune memory is going to keep me from going to the hospital,â she said. âIt wonât necessarily prevent me from being home for a week, but it will prevent me from going to the hospital and thatâs what vaccines were designed for.â
Otto said new variants will likely continue to emerge, given the âhuge amount of diversity of the virus that is maintained globallyâ and the fact that Omicron emerged independently of other variants like Alpha, Beta and Delta.
âWeâre already seeing this substantial evolutionary change in Omicron â and all Iâm saying is donât overlook the other strains that are still circulating around the world,â she said.
âWeâre in a part of Whac-A-Mole, and we donât know where the next mole is going to be.â



