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Q&A: B.C. medical health officer on COVID-19 vaccine side effects

Dr. Meena Dawar with Vancouver Coastal Health Authority is encouraging people who haven't received a COVID-19 vaccine to have a "heart-to-heart conversation" with their local pharmacist to see what product would work for them.
AJ_WattGettyImages Vaccine hesitancy
If you have vaccine concerns, talk to a professional you trust, such as your family doctor or pharmacist, says a medical health officer.

Overall, most folks in our province have pulled up their sleeves for a COVID-19 vaccine.

More than 90% of B.C.'s total population has had at least one jab, and more than 87% has had two doses, while 53.5% have had their booster.

For those who have not been fully vaccinated, one concern often raised is “vaccine injuries,” or side effects, of getting the vaccines. 

The Squamish Chief connected with Dr. Meena Dawar, a medical health officer with Vancouver Coastal Health Authority, for a conversation about side effects and weighing the risks. 

What follows is an edited version of that conversation.

Who can't get a COVID-19 vaccine? 

I don't think there's any reason unless someone has major allergies, why people couldn't have one of the available products because we have so many products available now. 

For example, you can't get immunized with a Pfizer vaccine if you have known anaphylaxis to a component of the Pfizer vaccine. But then you could have the Moderna vaccine.

Can you go over how vaccine side effects are monitored and reported?

I think starting with the premise that the principle of vaccine safety is actually fundamental to vaccine trials and to vaccination programs. 

So, when vaccinations are in the clinical trial phase, there are a number of trials that occur: Phase 1, Phase 2, Phase 3, and so on.

In each of those trials, the first indicator monitored is vaccine safety. You start small and you go big, and as more and more people are included, vaccine safety is proactively monitored. People get a logbook, essentially, to report on their adverse events after immunization, and then all of that information is reviewed by the licensing bodies — for us, it's Health Canada — before a vaccine is approved for you.

And then, after a vaccine has gone into an immunization program, public health continues to monitor vaccine safety because, of course, we're now offering vaccines to millions of Canadians. And so, there's a potential for rare side effects that may not have been detected in clinical trials. And now, we can watch for them, detect them, report them, and make decisions if we need to.

And the reports are available on the BC Centre for Disease Control website, correct?

We publicly post those reports. They are available not only to health-care providers but also to members of the public. One caveat about this report is that those are Adverse Events Following Immunization (AEFI). 

What those reports don't comment on is whether the side effects are caused by the vaccine or not. Because that requires some assessment at the individual and population level.

We actually do two things with side effects. One is the vaccine safety surveillance functions. So, we report them to the BC Centre for Disease Control (BCCDC) so it can monitor them at the population level. Then the BCCDC reports them to the Public Health Agency of Canada, so they can be correlated at a national level. And then the third function is actually the clinical function, which is with the individual who experienced the adverse event. We look at if it is safe for them to have a subsequent dose or not. And we answer that for them directly.

So you're saying those effects on BC Centre for Disease Control site are ones that haven't even been investigated to prove for sure that it is related to the vaccine, right?

Absolutely. And I think that's the most important conversation. 

So, beyond monitoring, which is important to do, how do we determine whether something is caused by the vaccine or not?

The most common adverse events are actually allergic in nature. And those are probably caused by the vaccine. We know all medications and all vaccines can cause allergic events. We expect them, and we are prepared to manage them. 

The injection site reactions are likely caused by the vaccine. Again, we expect that when we put a needle in someone's arm, a small proportion of people will react either to the needle and where it went in, or to the agent or the drug that was given to them in that needle. We can fully expect that a proportion of individuals will get redness, soreness, pain at the injection site, perhaps swelling of the lymph nodes. So we expect all that and we report all that. 

With headaches, the pins and needles feeling, Bell's palsy, fever, and diarrhea, those were also reported in the trials and are expected as well. With the rarer effects, it's harder to tell, was this a vaccine? Or was this something else? 

What I'd like you to think about is when you provide nearly 11.5 million doses of vaccine to less than five million people, because children under five are not eligible, essentially, the entire B.C. population is getting immunized in a year — in the absence of a vaccination program, medical events were going to occur in the B.C. population anyways.

In five million people, some of these events were going to occur because of other causes. And so the real question is, did the rate of these events go up because of vaccination or not? And to be able to answer that question actually takes a lot of work. And it takes an understanding of what the rate may be in the absence of a vaccination program.

So what is the risk from the disease versus what is the risk from the vaccine? 

That is part of the consent process, and so absolutely, COVID-19 infection is a serious infection overall. I think we've seen that the risk of death or what we call case fatality is about 1%, overall.** It's higher, of course, in individuals over 80 (11.8%)  and lower in individuals under 50. And fairly low in young people. The risk is proportional to age.

But the benefits outweigh the risks in a big way. And that's why we continue to offer them.

The reason we offer vaccines is because the illness that we're trying to protect people against is severe and life-threatening, and that's why we want to protect people.

And then vaccines have to be safe because we're essentially giving vaccines to healthy individuals. 

It's not like giving medications to people who are ill, where you can accept more risk.

Vaccines are offered primarily to well individuals, and so that safety threshold has got to be very, very high for us to offer the vaccine.

There are parents who wonder why they should get the vaccine for their children if their risk is low. What do you say to that?

I think the conversation about young children is a bit more nuanced. Where I get the guidance is actually from the National Advisory Committee on Immunization (NACI). Because they are the experts across the country who come together who look at the data on both the illness and the vaccine and produce a recommendation. And the recommendation is tiered.

The initial NACI recommendation was a permissive recommendation saying children may be offered a vaccine or may have received a vaccine. And then it strengthened a couple of months down the road to should be offered the vaccine. I think that's important.

When NACI strengthened the recommendation, it said to me that there's greater evidence of benefit now and that evidence came from the U.S. where it became clear that children were at risk of Multi-System Inflammatory Syndrome, following COVID infections. Now, it's rare.

I don't have a rate for you on how common it is. The recommendation said it was infrequent, but because that is a more severe condition, NACI then strengthened their recommendation from children may be immunized to children should be immunized. And so I think that speaks to the fact that experts are saying it's really worth your while, parents, to protect your children, because of the small — but important — risk of a severe condition if unvaccinated children contract COVID-19.

Can you frame the comparison of other allergic reactions folks have — like to peanuts or shellfish or other things people react to — versus the vaccine — to weigh how much of a risk is involved? 

I don't go down that path. And I'll tell you why. With food allergies, people make the choice.

The vaccine is something we are offering to them. And the individuals who are now left unimmunized are those who have lots of concerns.

And because of vaccine mandates and travel restrictions, and so on, unfortunately, those choices that are individual choices for their own personal protection, have now had an impact on whether they can get on a plane and so on. It's gone into a realm that we've never gone before. So I would rather not frame the risk over choices they have control over.

Fair enough. Anything else you would like to say about side effects? 

I think the message is that COVID vaccines are safe and we've offered 11.5 million doses to British Columbians. We know what kind of risks occur.

There are some frequent risks such as local injection site reactions and we know how to manage those. And then there are some rare risks, but they're extremely rare, like the risk of myocarditis and pericarditis. And they're in young people. We know about it, and now we preferentially offer Pfizer to them.

But the bottom line is that for people who are concerned about the side effects, we have a number of products now for individuals, as opposed to in January 2021. There are a number of products available.

I would encourage individuals to have a heart-to-heart conversation with public health, or their local pharmacist to see what product would work for them and to really just engage in an honest conversation about their concerns in a safe environment. So we can see if we can help them be immunized.

~With a file from Glen Korstrom/Glacier Media

**Please note, this story has been corrected since it was first published. Initially, it had the case fatality for COVID as 2 to 2.5%. The doctor was quoting pre-omicron data and, after publication, recalculated it to include omicron, which lowered the figure.

The "about 1%" is based on the BCCDC situation report. Total deaths = 2,979/ total cases — 354,027 * 100 = 0.84%.