Meeting 44 of the CSA COVID-19 Expert Panel

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As part of the response to the COVID-19 pandemic, the Chief Science Advisor of Canada created the Expert Panel on COVID-19 to advise her on the latest and most relevant scientific developments. This information assists the Chief Science Advisor in providing current, cross-disciplinary and independent advice to the Prime Minister and government.

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Overview of discussions

Held by MS Teams on June 18, 2021

The following discussion reflects evidence and scientific knowledge up to June 17, 2021.

Participating experts

• Mona Nemer PhD, Chief Science Advisor of Canada (chair)

Disease modelling

• Caroline Colijn PhD, Simon Fraser University
• Daniel Coombs PhD, University of British Columbia

Risk and behavioural sciences

• Daniel Krewski PhD, University of Ottawa
• Kim Lavoie PhD, Université du Québec à Montréal
• Louise Lemyre PhD, University of Ottawa
• Steven Taylor PhD, University of British Columbia

Biomedical and clinical sciences

• Eleanor Fish PhD, University of Toronto
• Joanne Langley MD, Dalhousie University
• Salah Mahmud MD, PhD, University of Manitoba
• Allison McGeer MD, Mount Sinai Hospital, University of Toronto
• Samira Mubareka MD, Sunnybrook Research Institute
• Supriya Sharma MD, Health Canada
• Cara Tannenbaum MD, Université de Montréal, Health Canada Departmental Science Advisor

Participating guests

• Christine Chambers PhD, Dalhousie University

Other

• Lori Engler-Todd MSc, Office of the Chief Science Advisor (support)
• Vanessa Sung PhD, Office of the Chief Science Advisor (support)

Covid-19 in children

Transmission in children

• Two serology studies funded by the COVID-19 Immunity Taskforce (not yet published), one with teachers and the other with children in British Columbia, reportedly did not find increased infection among these two groups^{Footnote 1}. These results suggest that there has not been widespread asymptomatic transmission of COVID-19 in schools to-date. Note that:
  • In British Columbia, children under 12 years of age have been attending school as usual, while high school students have had restricted hours and reduced social mixing.
  • The data are largely from a period prior to the widespread transmission of variants of concern.
• Early data from a Manitoba study (not published at the time of this meeting) suggests that while children are half as likely to be screened for COVID-19 than adults, when screened they test positive at the same rate as adults. When symptomatic children are tested, they are less likely than adults to have COVID-19 as there are other respiratory infections that affect children.
• Children under 12 years old are not expected to be vaccinated before the start of the new school year in September; however, widespread vaccination coverage among adults and youth may confer some level of indirect protection.
  • The risk of introducing infections into schools can be low if cases among the general population are also kept low via vaccination, among other.
  • Early results from a Brazilian study have demonstrated the benefits of vaccination at the population level, even for unvaccinated children and teenagers^{Footnote 2}.
• In the context of population-level protection, it will be important to conduct surveillance of domestic and peri-domestic animals for potential reservoirs of SARS-CoV-2 that can be re-introduced into the human population. It is now known that the Beta and Gamma variants are able to infect common house mice^{Footnote 3}.

Vaccination in children

• Use of the Moderna vaccine in those 12 to 17 years of age group is currently under review at Health Canada. Moderna also has ongoing studies in younger age groups, with results expected in 2022.
• Pfizer is starting trials to test different doses of their vaccine in those 5 to 11 years of age. A submission to Health Canada could be made in September.
• Careful consideration for vaccination in children is needed due to the early safety signals regarding myocarditis and pericarditis associated with COVID-19 mRNA vaccines.
  • Current information is based mainly on data from Israel and the United States. Cases have been rare and self-limited, primarily associated with second doses and in males.
  • In Canada, there are no reported cases yet above the background rate, but this must be interpreted in the context of a low rate of second doses administered in Canada, for now.
  • Myo/pericarditis cases have been reported in association with viral vector vaccines as well, but in lower numbers compared to COVID-19 mRNA vaccines and not above the expected background rate.
  • Globally, no regulators have yet taken action or formally changed vaccination recommendations.

Public health measures in schools

• Guidance is needed on evidence-based safety measures in schools.
  • Recommendations from the Royal Society of Canada^{Footnote 4} will soon be available. Several studies funded by the Canadian Institutes of Health Research will also provide evidence for informing next steps for effective health measures in schools. A rapid response $3M+ funding opportunity was launched in early June “Understanding and mitigating the impacts of the #Covid19 pandemic on children, youth and families in Canada”^{Footnote 5}.
• There have been diverse approaches to managing schools across the country. Schools in some jurisdictions have remained completely shut down, while others have reopened and were able to manage the outbreaks that occurred. Learning from these different experiences is important so that best practices can be developed and implemented in time for the new school year.
• It will be important for schools (and other large workplaces) to know what proportion of their staff and students are vaccinated in order to plan and make decisions about testing and other measures. However, in some jurisdictions workplaces are not permitted to ask for vaccination status because that is considered private health information.
  • There is precedent for requesting vaccination information:
    • In British Columbia, schools and public health authorities work together to collect information on measles vaccination coverage in schools to prepare for potential outbreaks.
    • The Ontario Privacy Commissioner has ruled that whether or not an individual has received the influenza vaccine is not considered health information because vaccination status does not reveal any information about that person’s health.
    • Federal, provincial, and territorial privacy commissioners have issued a joint statement^{Footnote 6} on the disclosure of vaccination information on vaccination certificates.
  • One possible approach is to conduct surveys in an anonymized and aggregated way such that no individual person’s information is known to their employer. A “prefer not to answer” option could be included. The iCare^{Footnote 7} study has been partnering with institutions and workplaces to collect similar data through anonymous surveys.
  • In Manitoba, efforts are underway to link their immunization registry with school attendance databases.
  • It may also be important to known how many individuals have been previously infected and recovered.

Loosening restrictions while promoting vaccination

Communication around public health measures

• It is important to empower people to understand that the main goal of public health measures is to reduce person to person transmission to prevent serious illness and death, rather than simply setting rules for people to follow.
  • Local public health restrictions are different everywhere. If there is good understanding of the general principles behind public health measures, individuals can consistently make the best decisions for themselves.
  • For example, the government may allow ten people to gather in a backyard, but individuals should still be mindful of the behaviour of who they are gathering with (e.g., are they vaccinated, do they engage in risky behaviour).
• Integrating “choice” into the communication framework could support informed decision-making. For example, start with vaccination as the most effective measure that an individual can take to prevent COVID-19, then build scenario-based options on top of that (e.g., wear a mask, maintain physical distance, go outside). A simple, visual decision-making flowchart could be helpful.

Communication to address vaccine hesitancy

• Because access to vaccine continues to be a challenge in some parts of the country, it is not yet known what the upper limit of vaccine acceptance is.
• Better understanding of which groups (beyond age and gender) experience challenges accessing vaccine would be helpful in determining how best to remove barriers.
• It was suggested that approximately 8-10% of the population are not interested in vaccination and objections to vaccines pre-dates COVID-19. This group should not be the focus of vaccination efforts.
  • Individuals in this group tend to exhibit psychological reactance and react strongly to compulsory measures in general.
  • Some have family members who they perceive to have been harmed by vaccines.
  • Some hold core beliefs that are not likely to be changed.
• There is a significant subgroup of “watchful waiters” who need more information to make their decisions. Messages that could successfully convince them include:
  • Unvaccinated individuals are more likely to get infected with SARS-CoV-2 and suffer from COVID-19.
  • If there is anxiety about new vaccine technology, individuals could wait for new upcoming vaccines that use platforms that are closer to traditional technologies.
  • The consequences of long COVID are not fully understood, but they are significant and possibly more severe in younger people.
  • A key effective message is to get vaccinated to protect vulnerable people around you.