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

Published on February 28, 2022

On this page

• Background
• Considerations for those planning to stay for longer in Canada to live, work or study
• Recommendations for individuals who plan on staying in Canada for longer periods of time and who are vaccinated with non-Health Canada authorized vaccines

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 are 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 and borders

In Canada, six COVID-19 vaccines have been reviewed and authorised for use by Health Canada (Pfizer-BioNTech Comirnaty, Moderna Spikevax, AstraZeneca Vaxzevria/Covishield, Janssen/Johnson & Johnson, Novavax Nuvaxovid, and Medicago Covifenz). A number of vaccines are available in other countries that are not authorized for use in Canada. These vaccines are whole virus inactivated vaccines (e.g., CoronaVac/Sinovac, Sinopharm BIBP [BBIBP-CorV], Covaxin), viral vector vaccines (e.g., Sputnik V, Sputnik Light, CanSinoBIO) or protein subunit vaccines. Some of the vaccines authorized in other countries have been reviewed and assessed under the World Health Organization (WHO)'s Emergency Use Listing (EUL) procedure. Some are still undergoing WHO EUL review and others have not been submitted for review.

The immunogenicity, efficacy and effectiveness of authorized vaccines vary and booster doses are being recommended for many vaccines.

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:

• Optimal protection against COVID-19, recognizing that the vaccine effectiveness of the non-Health Canada authorized vaccines may vary. Optimal effectiveness helps to protect the individual and those they may interact with (including in health care settings, congregate living settings, educational settings, workplaces and the community);
• Limit the reactogenicity by minimizing the number of additional doses provided.
• Provide a simple and straightforward approach that is easy to implement.

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.

• If the person has had one dose of a non-Health Canada authorized vaccine, the addition of one mRNA vaccine will be considered a complete primary series (except for those who are moderately to severely immunocompromised who are recommended to receive three COVID-19 vaccine doses as part of a primary series).
• If the person has had a two doses of a non-Health Canada authorized vaccine, the additional mRNA vaccine dose is expected to increase protection.
• For people who are unwilling or unable to receive an mRNA vaccine, Novavax Nuvaxovid or Medicago Covifenz can be used for the additional dose.

With the addition of booster dose recommendations, it is also recommended that an mRNA booster dose be administered at least 6 months from the additional dose. Novavax Nuvaxovid can be used as a booster dose for those who are unwilling or unable to receive an mRNA vaccine.

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. For people who are unwilling or unable to receive an mRNA vaccine, Novavax Nuvaxovid or Medicago Covifenz can be used for the additional dose.

• The minimum interval between the preceding dose and the additional dose should be 28 days.
• An mRNA booster dose is recommended at least 6 months from the additional dose. Novavax Nuvaxovid COVID-19 vaccine can be used as a booster dose for those who are unwilling or unable to receive an mRNA vaccine.
• Those who have already received three doses of non-Health Canada vaccines or a combination of Health Canada authorized and non-Health Canada authorized vaccines for a total of three doses do not need an additional dose unless they are due for their booster dose. They should receive their booster dose at least 6 months after their third dose.