Archived 11: Summary of National Advisory Committee on Immunization statement of May 28, 2021

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Overview

Recommendations on the use of COVID-19 vaccines in those who are immunosuppressed, have an autoimmune condition, are pregnant or are breastfeeding

The National Advisory Committee on Immunization (NACI) has updated Recommendations on the use of COVID-19 vaccines for those who are immunosuppressed due to disease or treatment, have an autoimmune condition, are pregnant or are breastfeeding.

In early clinical trials, the above populations were either excluded from or represented by small numbers of participants. Based on this limited clinical trial data, NACI previously recommended that authorized COVID-19 vaccines may be offered to individuals in these populations in some circumstances, and on a case-by-case basis, if the benefits outweighed the risks and with transparency about the limited evidence available.

Additional evidence is now available from real world use of COVID-19 vaccines, primarily mRNA vaccines, in these populations. In May 2021, NACI reviewed safety data, as well as COVID-19 risks for these groups.

International real world data showed that COVID-19 vaccines are safe in these populations. As such, NACI recommendations for those who are immunosuppressed, have an autoimmune condition, are pregnant or are breastfeeding are now the same as the recommendations for the general adult population.

Updated recommendation: NACI preferentially recommends that a complete two-dose vaccine series with an mRNA COVID-19 vaccine (Pfizer-BioNTech, Moderna) should be offered to individuals in the authorized age group, including those who are immunosuppressed, have an autoimmune condition, are pregnant or are breastfeeding. If they are not able to receive an mRNA vaccine, for example because of an allergy, another authorized COVID-19 vaccine should be offered.

mRNA vaccines are preferred for use during pregnancy, due to recently published data from a study in the United States indicating the mRNA COVID-19 vaccines are safe in pregnant women. In addition, treating Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) during pregnancy, should it occur following the administration of a viral vector vaccine, can be complex.

Individuals who are immunosuppressed from disease or treatment should be informed that they may have a reduced immune response to any authorized COVID-19 vaccine series.

Individuals who are immunosuppressed, have an autoimmune condition, or who are pregnant or breastfeeding should be informed of the latest evidence on the safety of mRNA COVID-19 vaccines in order to make informed decisions.

Vaccine safety and effectiveness in these populations will continue to be closely monitored, and NACI will update recommendations as needed.

Recommendation on extended dose intervals

NACI has updated the recommendation on extended dose intervals in the context of increasing COVID-19 vaccine supply in Canada. In May 2021, NACI reviewed up to date information on vaccine effectiveness from Canada and the United Kingdom, where extended intervals are also being used.

Evidence suggests very good protection against COVID-19 symptomatic infection, hospitalization and death following one dose of all COVID-19 vaccines authorized for use in Canada. A second dose is still required to provide optimal and longer-lasting protection.

Canada continues to see illness and death from COVID-19. Extending dose intervals allows many more people to receive good protection from severe COVID-19 outcomes much sooner.

NACI continues to recommend that jurisdictions should maximize the number of individuals benefiting from the first dose of a COVID-19 vaccine by extending the second dose of COVID-19 vaccine up to four months after the first.

NACI continues to closely monitor the effectiveness of extending dose intervals and will continue to update recommendations as needed.

Updated recommendation: With the increase of COVID-19 vaccine supply in Canada, second doses should be offered as soon as possible, with priority given to those at highest risk of severe illness and death from COVID-19 disease after or concurrent with first doses for all remaining eligible populations.

To see the full update, including evidence and rationale for each recommendation, please visit Recommendations on the use of COVID-19 vaccines.

Quotes

“Over time, we have seen very encouraging evidence for these vaccines in populations who were not included in the original clinical trials.  Given the ongoing risks of COVID-19 exposure and severe disease in Canada, NACI is strongly recommending vaccine for these populations who are pregnant, with autoimmune, and immunosuppressive conditions along with the rest of the population.”

“Now that we are very quickly approaching the point where first doses are being offered to all eligible adults and adolescents, it is important that second doses start as soon as possible, particularly for those who are at highest risk of severe illness and death from COVID-19.  The 16-week interval was the upper limit and provinces and territories should aim to start administering second doses as quickly as regional logistics allows it.  First doses have been a highly effective starting point from a population immunity perspective, and we now need to move towards our second doses to provide more complete long-term protection.”

Dr. Caroline Quach-Thanh, NACI Chair

Next steps for NACI

NACI is actively reviewing evidence on COVID-19 vaccines on an ongoing basis, and upcoming recommendations may include new advice on:

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