Monday , 17 January 2022

COVID-vaccine Q and A with Dr. Kristin Klein

As the province’s rollout of COVID-19 vaccines continues and more appointments to receive one become available in the Lakeland Region, area residents are asking questions about the safety of the vaccines.

Lakeland Connect’s Meredith Kerr sat down with Dr. Kristin Klein to get answers to some of those questions ahead of her immunization appointment.

Dr. Klein is a Medical Officer of Health for Alberta Health Services.

The following is a transcript of their conversation on April 15.

You can also view the full interview on our Lakeland Connect Facebook page.

Q: Alberta currently has three vaccines available: two are mRNA vaccines produced by Moderna and Pfizer-BioNTech, the third is a viral vector vaccine which uses a modified version of another virus. Is there a best vaccine to get?

A: I think my general advice is that the best vaccine to get is the one that you can get. So the different vaccines have different eligibility right now. All of those vaccines have been tested globally and by Health Canada and have been approved to be safe and effective. And all three are very effective at preventing severe illness and death from COVID-19.

Q: Normally when a new vaccine is introduced, it takes many years of testing and trials before it is approved. Why is the COVID-19 vaccine available within a year and how do we know it’s safe without that long-term information?

A: Typically what happens for the vaccine authorization process is that all of the big companies will do their clinical trials, starting with very small amounts of people and an increasing number of participants that are in the trials. And then they’ll submit that information to Health Canada, who looks and make sure the vaccines are safe and effective based on the data that they get. Then they’ll approve the vaccine. We have a very robust system in place for actually doing those approvals.

The things that were a bit different for the COVID vaccines is that the companies that were doing the clinical trials actually gave that information to Health Canada on an ongoing basis. So they didn’t wait until everything was completed before submitting. And Health Canada was able to access the data from the trials as they were ongoing so it just really sped up the whole process for review.

It’s the same information they required from the companies before the approvals were granted.

The other difference for the approval on this is obviously you need to have a number of people get the infection to be able to determine if the vaccine works or not. And fortunately, or unfortunately, because of the rates of COVID-19 that we’re seeing globally there were just so many cases to be able to actually conduct those trials and see that the vaccines were really effective, a lot quicker than I think the companies were initially thinking.

There are definitely no shortcuts taken. And all of the checks and balances were in place. But there were just some pieces that lined up to make it a little bit more efficient than some of our other regulatory approvals.

Q: When the vaccines were approved by Health Canada, the second dose of Pfizer was to be given three weeks later, the second dose of Moderna was four weeks, and the second dose of AstraZeneca was approved for up to three months later. What do we know about how effective those vaccines are going to be with the delayed dosing schedule?

A: When companies make those recommendations it’s to make sure the product can be licensed and available as quick as possible. With a narrower vaccine spacing, the trials could be completed earlier and approved.

When we look when at what we know about vaccines overall, we know increasing the spacing between doses doesn’t decrease the effectiveness of the first dose and oftentimes increases your body’s response when we do get a second dose. So based on what we know about vaccines in general, and then some of the other principles that are really important, that went into that consideration both at the National and Provincial level to make sure we can immunize as many people as quickly as possible.

[Vaccination] not only protects that person but protects everyone around you. So by having more people get one dose it protects the people that have only had one dose plus the broader population. So it’s really an important strategy when we’re trying to move towards herd immunity and control the disease overall.

What we’ve seen in the real world studies now that we’ve had a bit of time to look at how it works, is the effectiveness of just a single dose of our mRNA vaccines in particular is very, very high.

Q: How dangerous is COVID-19 for pregnant women?

A: Generally, younger, healthy, people are at pretty low risk of a severe outcome, like needing to be hospitalized, or go in ICU from COVID. Pregnant women are at an increased risk compared to non-pregnant women of the similar age. So it definitely increases their risk, which is the reason that immunization is recommended for that group. However, they wouldn’t be as high risk as someone who was very elderly, with chronic conditions.

Q: What about for their unborn babies when they are still in the womb, or when they are newborns?

A: We don’t have a lot of information about COVID infection in newborns. There haven’t been a ton of cases in newborns so far. But anybody that that is very, very young, obviously doesn’t have a fully developed immune response yet, so they would be vulnerable to COVID-19. We haven’t seen a lot of severe cases in babies, but definitely, it’s important to protect babies that can’t be immunized themselves.

Q: Why are pregnant women eligible to receive the vaccine, but also being advised to talk to their healthcare provider first?

A: The clinical trials that were done of the vaccines that we’re using here, they didn’t have pregnant women in those trials in large numbers. So there wasn’t enough evidence to say that the vaccine was 100 per cent safe and effective in those groups just because they weren’t included in the trials.

Initially at the national level with the National Advisory Committee on Immunization, they recommended in the abundance of caution not to immunize that group. As more and more evidence emerged, and there’s more and more COVID infection the risk-balance tips because the risk of getting COVID-19 is higher.

Immunization is a great way to protect pregnant women from getting the infection. So at both the national level and the provincial level, the recommendation now is that pregnant women can be immunized.

We ask that they have that conversation with their doctor, just really talk about what that means for them and that we don’t have the evidence from the trials. There’s not a lot of knowledge that we have so far on it, but there’s not a reason to think it’s not safe and effective for them. It’s really their own risk perception and risk tolerance if they want to get immunized or not.

Q: The recommendation in Alberta is to receive a vaccine against diptheria, tetanus, and pertussis (whooping cough) during the third trimester of pregnancy. Is there a best time in pregnancy to get the COVID vaccine?

A: In the case of pertussis, the mum is really getting immunized to protect the baby because babies are the highest risk of having severe outcomes from pertussis. By immunizing the Mom, what we’re trying to do is actually have the Mom’s antibodies transfer to the baby while the baby’s still inside. It protects them in those early days after they’re born before they can get immunized themselves. It’s really a strategy to protect the baby.

For COVID-19 we’re more focused on the mom and the risk for COVID in the mom. So there isn’t a specific time that we would say to get immunized, anytime in pregnancy would be appropriate because we don’t want the mom to get infected during her pregnancy. Anything you do to protect the mom is also going to protect the baby who could then be in contact and it reduces the chance of either of them being infected moving forward.

Q: Measles, mumps, rubella is another vaccine which people sometimes need an additional dose of in adulthood, but is not given during pregnancy because of concerns for the impact on the baby. Why are the DTaP and the COVID vaccine safe to give during pregnancy but the MMR isn’t?

A: I’ll just call it the MMR vaccine. That’s what we call a live vaccine. And what it does, it takes a weakened form of those viruses and it actually replicates inside the person to create the immune response. And because of that, we don’t recommend it for people that are pregnant because there’s a potential risk that it could harm the pregnancy or the baby because of the way that the vaccine elicits that immune response.

For the COVID vaccines, they don’t work like that. They’re not live vaccines. What they do is take a little piece of the outside of the COVID virus that then is recognized in your body and then you produce antibodies. There’s no virus that is growing or replicating. So there’s not the same type of theoretical potential risk to the baby. It’s the same as any other what we call inactivated vaccines, where it’s safe to have at any time in pregnancy.

Q: Can you give COVID to someone else if you get vaccinated?

A: There’s no way of passing COVID on after you’ve gotten the COVID vaccine.

Q: Is there anything else people should know about the COVID-19 vaccine?

A: If you want to know anything else about the vaccines, the best and most up to date information is on our website, AHS.ca or the Alberta Health website that talks all about the FAQ’s, who’s eligible, some of the common questions.

The information is always changing and evolving and that’s the best place for the current status.

If anybody has questions, they also can talk to their health care provider obviously, or call HealthLink at 811.

And just a reminder that even if people are immunized, we still want every Albertan to follow the public health advice. So physical distancing, handwashing, masking and all of that are still in place, even after getting immunized as we learn a little bit more about how the vaccines work in the real world and are sure that they prevent all types of transmission.

About Meredith Kerr

Meredith Kerr moved to St. Paul for a career in journalism and morning radio in 2014 expecting to stay for six months to a year. Since then, she has put down roots in the form of a husband, a mortgage, two babies, and a poorly behaved dog. She continues to work as a reporter until such time as she finishes her book and becomes fabulously wealthy from the royalties. Meredith also serves as a member at large on the St. Paul Library Board and volunteers as a Beaver leader for the 1st St. Paul Scout Group.