Dear Colleagues,

I am sure you have heard yesterday’s announcement on the pause on further use of the AstraZeneca (AZ) vaccine as a first dose. The Ontario Ministry of Health announced that this decision was made “out of an abundance of caution” and after reviewing cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), linked to the AZ vaccine.

These shifting sands make it difficult to plan. What remains unchanged is that your patients who have been vaccinated, including with AZ, have done the right thing by protecting themselves and others around them. It is clear more than ever we have a critical role in helping strengthen vaccine confidence. For the many of you getting anxious calls from your patients about the AZ vaccine, here is a brief script you can adapt for your practice. Of note: 

• What the pause means for second doses is not yet clear, but in one to two weeks Canada expects to have information from the Com-Cov study in the U.K., which is looking at the safety and efficacy of mixing and matching combinations of vaccines. Early data on side effects show that mixing doses results in more significant side effects, but not severe enough to land people in hospital, and immunogenicity data is still to come. 

• We are also awaiting direction from the MOH for those who received the AZ vaccine and are eligible for their second dose at a shortened interval. 

• A reminder to you and your patients of the importance of recognizing and diagnosing VITT early – here is updated guidance from Ontario’s COVID Science Table for VITT in an outpatient setting, and simple graphics from science communicator Dr. Samantha Yammine (aka ‘Science Sam’) to sum up what symptoms to watch for.

Two things to do if you are administering AZ in your office: 

• Keep any remaining AZ vaccines in your fridge and safe. More details are coming from your local public health unit and/or MOH about how these vaccines will be returned or whether second doses will be offered sooner than the four-month interval. 

• Cancel first-dose AZ vaccinations. These patients can be rescheduled to receive a mRNA vaccine when these are available through the public health clinics, pharmacy and, hopefully, primary care. 

For those of you who were providing AZ vaccines to your patients and your communities over these past number of weeks, and all of you counselling your patients through this constantly changing landscape, thank you for your amazing work. Your hard work has helped protect so many patients through this third wave.

OCFP Vaccine Survey Update

Thanks to those who responded to the brief survey in my last update. It is clear that all of you have a deep desire to support vaccination of your patients and are doing so in many ways – through educating patients, supporting mass vaccination and, for some, vaccinating in your office. We recognize the barriers, including your office space, IPAC, competing clinical demands, and the heavy administrative lift to get ready to vaccinate, including COVaxON.

Our survey indicates that there continues to be untapped potential for vaccination efforts through family physician offices. 

• About one-third of you are already involved in providing vaccines in office; one-third of you would like to be involved; and one-third of you do not feel that you have the capacity to do so at this point given the administrative requirements, among other factors.

Update on mRNA Vaccines in Primary Care 

The OCFP has been calling for the expanded use of mRNA (Pfizer and Moderna) vaccines in primary care. Currently, only a small number of practices across the province have access to these vaccines through their public health unit or hospital. I am pleased to learn that, as of this week, we now have a commitment from the MOH for primary care to receive some of the Moderna and Pfizer allotments that are arriving between now and the end of May. 

The PHUs are charged with identifying practices that can support a significant throughput of vaccines, and able to set up vaccination quickly given there will be perhaps a week’s notice before receiving the vaccine. We expect PHUs will reach out to practices who have been vaccinating with AZ. We will continue to advocate for access to vaccines for all those who wish to vaccinate in office. If you are interested, please reach out to your local PHU. 

On a related note, given Health Canada’s authorization of the Pfizer vaccine for ages 12 to 17, we have heard some regions are getting ready to vaccinate youth within this group and would expect this to ramp up, dependent on vaccine supply. 

COVID Vaccines and Patient Care 

• Our most recent CoP session, on May 7, with Dr. Allison McGeer and hematologist Dr. Menaka Pai was well attended and answered many of your most pressing vaccine questions – including on pregnancy, second doses and VITT/blood clots. A full log of these excellent Q&As, along with a related resource list and session recording are available here (see Past Sessions, May 7, 2021). 

• Bookmark our next CoP on Friday, May 21, 8-9 a.m., co-hosted with the U of T Department of Family and Community Medicine. Guests will again include Dr Allison McGeer, as well as family physician Dr. Nili Kaplan-Myrth with stories highlighting her successful vaccination work in the community. 

• If you have COVID-positive patients who must be monitored at home, you may want to consider the MOH [email protected] Monitoring can be undertaken at the practice level or you can coordinate efforts with other primary care clinics, depending on your local needs and geography. 

• MOH guidance for pregnant women includes a statement on vaccination in the first trimester: “If the vaccine is administered during the first trimester, there is no evidence to suggest the termination of the pregnancy based on teratogenic risk.” 

• The Centre for Effective Practice has an updated after-care sheet for vaccination with Pfizer and Moderna. 

Other Resources 

• The CFPC and the Foundation for Advancing Family Medicine are offering a new grant opportunity to support racialized communities in Canada, with applications accepted from May 10 to June 11, 2021. Find more information in the news release and details on the application process on this CFPC webpage. 

With World Family Doctor Day approaching on May 19th, I am looking forward to sharing your successes. You can follow us on Twitter (@OntarioCollege) or our website where we will be showcasing amazing examples of the contributions Ontario’s family doctors have made across the province.  

Sharing with you this little guy who came in the mail to me today as a thank you for helping to keep patients and communities safe. Small gesture but it means a lot and a reminder of just how much our work matters to so many.  

Liz