COVID-19: Recommendations for those vaccinated with vaccines not authorized by Health Canada for those staying in Canada to live, work or study

Individuals who have received COVID-19 vaccines not authorized by Health Canada do not qualify for the fully vaccinated traveller exemption. For requirements to enter Canada, consult COVID-19: Travel, testing, quarantine and borders.

Published on August 17, 2021

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Background

The Public Health Agency of Canada’s (PHAC) COVID-19 immunization recommendations for individuals previously vaccinated with COVID-19 vaccines not authorized by Health Canada is intended to support local, territorial, and provincial, decision-making by public health departments and health care professionals. Provinces and territories are responsible for designing and delivering immunization programs in their regions. PHAC’s immunization recommendations for previously immunized individuals does not impact the Government of Canada’s definition of fully vaccinated travellers or current border requirements, such as quarantine and testing.

For requirements to enter Canada, please consult COVID-19: Travel, testing, quarantine and borders

In Canada, four COVID-19 vaccines have been reviewed and authorised for use by Health Canada (Pfizer-BioNTech Comirnaty, Moderna Spikevax, AstraZeneca Vaxzevria/COVISHIELD, Janssen/Johnson & Johnson). A number of vaccines are available in other countries that are not authorized for use in Canada. To date, these vaccines are either whole virus inactivated vaccines (e.g., CoronaVac/Sinovac, Sinopharm/BBIBP, Covaxin) or viral vector vaccines (e.g., Sputnik V, Sputnik Light, CanSinoBIO). Some of the vaccines authorized in other countries have been reviewed by the World Health Organization (WHO) and added to their Emergency Use List (i.e., CoronaVac/Sinovac and Sinopharm/BBIBP), some are under review by the WHO (e.g., Sputnik V and Covaxin) and others have not been submitted for review.

The vaccine immunogenicity, efficacy and effectiveness of authorized vaccines vary. While many of these vaccines appear to be performing very well based on available data, others have lower effectiveness. For vaccines where effectiveness is lower, particularly with regard to the Delta variant, or where effectiveness appears to be waning, some countries are recommending additional doses of the same or a different vaccine. (See Appendix A for additional details on efficacy, effectiveness and/or immunogenicity of some non-Health Canada authorized vaccines, publication in peer reviewed journals is limited for many of the vaccines, and information from pre-prints and press releases must be interpreted with caution).

Those planning to stay in Canada for longer periods of time to live, work or study (e.g., newcomers to Canada, returning Canadians, international students, longer stay foreign nationals) provide an opportunity for optimized protection against COVID-19. Although any individual coming to Canada can acquire and/or transmit SARS-CoV-2 infection to others, those staying for longer periods of time are at higher risk as they may live in congregate settings (e.g., dormitories, settlement houses, work camps), work in high-risk settings (e.g., health care, other essential services), attend school, and/or live in communities with other newcomers. Therefore, additional approaches were considered for those who have received only non-Health Canada authorized vaccines and are planning to stay in Canada to live, work or study.

Considerations for those planning to stay for longer in Canada to live, work or study

In consultation with the Council of Chief Medical Officers of Health and considering advice from the National Advisory Committee on Immunization, the Public Health Agency of Canada (PHAC) considered a number of approaches for updating the vaccinations for those who received only non-Health Canada authorized COVID-19 vaccines and are planning to stay in Canada for longer periods of time. PHAC’s selected approach aimed to balance the following:

Offering one additional dose of an mRNA vaccine for those who have had a complete or incomplete course/series of a non-Health Canada authorized vaccine fulfils these criteria.

This recommendation will be revisited as further evidence becomes available.

Recommendations for individuals who plan on staying in Canada for longer periods of time and who are vaccinated with non-Health Canada authorized vaccines

Individuals planning to stay in Canada for longer periods of time (i.e., to live, work or study in Canada) who have received one or two doses of a non-Health Canada authorized vaccine should be offered one additional dose of an mRNA vaccine soon after arrival in Canada.

Appendix A: Overview of immunogenicity, efficacy and/or effectiveness of common non-Health Canada authorized vaccines (as of July 19, 2021)
Product Type of product and number of doses WHO Emergency Use List Immunogenicity Efficacy Effectiveness
CoronaVac / Sinovac

Inactivated;

2-dose series

Yes
  • 6 fold lower than convalescent serum

Source: COVAX presentation February 25, 2021 – Slide 8 (see Appendix B)

  • Two-dose immune response of CoronaVac similar to one dose of Pfizer-BioNTech Comirnaty

Sources: Zee JST et la. Hong Kong Medical Journal; Lim W et. A. The Lancet Microbe.

  • A two-fold reduction in neutralizing titres in people who received two doses of Pfizer-BioNTech Comirnaty would result in 98% above a “protective” threshold and only 53.1% for two-doses of CoronaVac
  • 51% in Brazil (large trial of health care workers)
  • 65% in Indonesia (smaller trial of general population)
  • 84% in Turkey (larger trial mainly of the general population)

Source: WHO review

  • 67% in cohort study in Chile

50% in test negative study in Brazil

Source: WHO review

Study in Serrana, Brazil showing very good herd effect by vaccinating almost all adults

Some media reports of lower than expected effectiveness and additional doses with other vaccines being offered for some group; Thailand, Indonesia, Singapore

Sinopharm / BBIBP

Inactivated;

2-dose series

Yes
  • Comparable to convalescent serum

Source: COVAX presentation February 25, 2021 – Slide 8 (see Appendix B)

78.1% in a large clinical trial in the United Arab Emirate (UAE) and Bahrain

Source: Kaabi NA et al. JAMA

Comparison of COVID-19 death rates in Bahrain (60% of vaccine is Sinopharm) versus Qatar (mRNA vaccines) show much higher COVID-19 death rates in Bahrain.

Source: Alhinai and Elsidig, International Journal of Infectious Disease

Media reports have raised concern about effectiveness in several countries, including New York Times article discussing Seychelles, Mongolia, Bahrain and UAE.

Covaxin / BBV152

Inactivated;

2-dose series

No

Similar to convalescent serum

Source: Khoury DS et al. Nature Medicine (see Appendix A)

Lower than Covishield after second dose

Source: Singh AK et al. Preprint

77.8% in a large randomized trail

Source: Ella R et al., preprint

No information provided
Sputnik V

Adenoviral vector;

2-dose series

Adenovirus 26 for first dose, Adenovirus 5 for second dose

No – review ongoing No information provided

91.6% in large randomized trial

Source: Logunov DY et al. The Lancet

97.6% in Russia

97.8% in UAE

94.8% in Kingdom of Bahrain

Sources: Press releases April 19, 2021; June 29, 2021; June 10, 2021

Sputnik Light

Adenoviral vector;

1-dose series

Adenovirus 26

No No information provided

73.6% based on day 15 to 21 after first dose of Sputnik V in clinical trial

Source: Logunov DY et al. The Lancet

79.4% based on effectiveness of those who only received one dose of Sputnik V in Russia

78.6% adjusted effectiveness in Argentina, ages 60-79 years

Sources: Press releases May 6, 2021; June 5, 2021

CanSinoBIO

Adenoviral vector;

1-dose series

Adenovirus 5

No – submitted for review No information provided

68.8% in large multi-country trial

Source: Press release March 22, 2021

No information provided
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