Have received so many concerned messages from people who I recommended get vaccinated with AZ just last week.

I’ll be honest, this is tricky and complex. I’ll try and explain my thoughts as best as I can, and as always, be as balanced as possible.
Everything in life has risks. Literally everything. There isn’t a single medicine where you don’t do a risk vs benefit analysis. To live is to take risks. Risk at pop level may differ from individual.

@MPaiMD and I take a stab at explaining this here:

The risks here:

Vaccine: 1/50k - 1/100k chance of a serious blood clot.

Covid: depends on area, age, exposure risk. And if/when you have access to an mRNA vaccine. Risks to immediate family if you bring Covid home. Risks of longtime health impact.
So if a person goes into a vaccine clinic and is offered to pick from AZ or mRNA *at the same time*, what do you choose?

mRNA, because the benefit vs risk profile is better.
If a person living in an area with high Covid cases and/or high exposure risk goes in to a vaccine clinic and they only have AZ - what do you do?

AZ, because benefits far outweigh risk.

What if mRNA going to come later? Still AZ.
If a person works from home but lives in a high Covid area - remember exposure in community still exists. What do you do?

Slightly more complicated, but likely AZ benefits still outweigh risks.
If a person lives in a low Covid area such as the Atlantic and has the ability to wait for an mRNA without dire repercussions, what do you do?

Here, benefits of AZ might NOT outweigh risks. Perhaps better to wait for mRNA without the increase in Covid risks as outlined above.
On vaccine hesitancy:
Yes, this messaging is going to add to a lot of hesitancy.

But not being transparent and not allowing people to make informed decisions based on personal risk-benefit will also add to vaccine hesitancy down the road.
On equity:
We are telling people living in hot spots w high exposure - ie predominantly racialized essential workers - to take on a risk of a (rare) side effect bc the govt didn’t do enough to protect them.

Had we controlled Covid, then perhaps decision would be easier/clearer.
But none of this is straightforward. We need to #SciCom better, with nuance & compassion. What we have, instead, are disjointed + conflicting responses. At a time when Canadians are scared & overwhelmed, this is doing worse for confidence - both on vaccines & pandemic leadership.

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More from @SabiVM

23 Apr
I did a few interviews on what is happening in India 🇮🇳 right now.

I cried during each & every one of them.

This is one of them. Vaccine distribution has been inequitable not just here in Canada, but also globally. Vaccine nationalism is killing. 🧵

India has shared majority of vaccines manufactured. One of the largest suppliers into COVAX, 65M doses already + 2B by end of year.

Meanwhile, only 10% of the Indian population vaccinated.

While US blocked raw supplies for India to manufacture these vaccines.

Like they blocked access to our vaccines.

And are sitting on 40M unused AstraZeneca vaccines that they think are not good enough for them.
Read 4 tweets
10 Apr
New infographic: What’s Vaccine Efficacy? Should we be comparing numbers? How does it differ from Vaccine Effectiveness? What does it mean on an individual level?
Vaccine Efficacy is a measure of how well a vaccine works in clinical trials – specifically, the percent reduction of disease by comparing two groups – one that receives the vaccine and one that doesn’t, under favourable and tightly controlled settings.
But the definitions of primary efficacy endpoints varied between studies. Pfizer tested if any one symptom 7 days after vaccine, Moderna tested if any one symptom 14 days after vaccine, AZ varied between each trial site (!!!), J&J only counted if moderate to severe Covid-19.
Read 8 tweets
1 Apr
1/ The current situation in Ontario:

- Highest ICU occupancy
- Seeing younger patients hospitalized
- Mostly essential workers with still no sick pay
- Vaccinations not reaching those most impacted by Covid
- Inequitable roll-out

Image: @DrKaliBarrett
2/ ICUs seeing younger and younger patients. Today, 150 critical care physicians wrote a letter voicing their concerns.
Image: @COVIDSciOntario
3/ Essential and frontline workers, majority racialized, have borne the brunt of the pandemic. A year in and not much has been done to protect them.
Image: @COVIDSciOntario
Read 5 tweets
28 Mar
Over the past month, I’ve helped organize half a dozen vaccine townhalls for racialized communities, with goal of improving vaccine confidence.

These were widely broadcast (including TV) & have impacted many who were fearful or undecided but are now educated + empowered. 1/ 🧵
I’ve received many questions on how we organized these vaccine education townhalls.

Sharing a few things that I’ve learnt doing these with the hopes that others will be inspired to do so in their communities. 2/
Read 10 tweets
26 Mar
This is an excellent brief by the incredible people on the Ontario Science Table @COVIDSciOntario on guidelines re: the AZ blood clot - how it presents and a very helpful diagnostic decision-tree. Key points below:
First & foremost given we are in the third wave: per Health Canada, benefits of AZ in protecting Canadians from COVID-19 continue to outweigh risks.

1 in 100 Canadians who get COVID-19 need intensive care. 1 in 5 Canadians who are hospitalized with COVID-19 develop blood clots.
Called ‘vaccine-induced prothrombotic immune thrombocytopenia’ or VIPIT. VIPIT very rare, occurring in anywhere from 1 in every 125,000 to 1 in 1 million people.

Important: VIPIT does not develop through the same process as usual types of bleeding or clotting problems.
Read 5 tweets
25 Mar
I often talk about @WHO 3Cs of Vaccine Hesitancy model: Confidence, Complacency and Convenience.

Why is this important?

Because vaccine hesitancy is driven by many factors. A multi-pronged approach is necessary to drive effective and meaningful uptake of vaccines. Image
The first C is ‘Confidence’ - not just efficacy and safety of the vaccines, but also trust in health systems and policymakers. It includes tons of education, transparent communication and also repairing eroded trust in racialized communities. Image
The second C is ‘Complacency’ - occurs when the perceived risks of vaccine-preventable diseases are low. Often due to the prevention paradox, when a successful immunization program brings with it a survival bias that lends to fading of memories of past hardships. Image
Read 4 tweets

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