ROI – Priority Second Dose for the Immune Compromised Community

Those who follow my blog know that in December 2019 I was blindsided with a cancer diagnosis. I wish to start this post with a heartfelt shoutout to all the brilliant medical professionals who have taken care of me for the past sixteen months. Maintaining quality care for patients with life-threatening diseases while concurrently redesigning the health system to cope with the COVID pandemic is beyond impressive. It is the stuff of miracles. I feel safe, proud, and blessed to live where I have ubiquitous access to health care which is extending my time on this blue dot we call planet earth.

On Friday, April 23rd I got the first vaccine (Pfizer) dose. The process was efficient, professional, and every person involved was caring and left me with a feeling of being in safe hands. I am scheduled to have my second dose on August 6th as prescribed by the NACI which concludes that the second does can be offered at up to a 105-day interval. This is based on the clinical trials which I understand for the most part only included healthy individuals. More recently, there is growing evidence that those living with compromised immune systems do not have the same protection if there is a delay beyond twenty eight days getting the second dose.

After getting the shot, there is a fifteen minute observation period to ensure there are no side effects. The nurse on duty shared that:

  • Protection from COVID is not immediate. It takes about two weeks for the vaccine to reach its maximum efficacy.
  • After the first dose, the protection is effective for about 84% of the population.
  • After the second dose, it is effective for about 96% of the population.

In case you don’t understand how a vaccine protects you here is a short tutorial.

We pass our lives in an environmental cocktail filled with stuff we need to live and other stuff which can be lethal. To survive the lethal stuff, we have evolved an immune system which is a complex network of cells and proteins that defends the body against infection. An important property of the immune system is that it keeps a record of every microbe it has ever defeated so it can recognize and destroy the microbe quickly if it enters the body again.

A vaccine safely teaches the immune system how to defeat COVID should you come in contact.

I was elated to be vaccinated until I got home and a friend alerted me to a story on CTV news titled “Cancer patients could be at risk if second doses delayed beyond three weeks, experts say. β€œThe study shows that three weeks after one dose of the vaccine, an antibody response was found in 39 per cent of people with a solid cancer and just 13 per cent of people with blood cancer,” Tina Crosbie, President of CAPhO, said in the statement. It further reported that in the normalized population, healthy people who are not immune compromised, β€œAn antibody response was found in 97 per cent of the healthy volunteers tested.”

This data implies that many immune compromised people, like myself, have a much greater change of being infected even after vaccination. This does not appear to be the case if we get the second dose within twenty-eight days of the first. I would argue that we will add a huge resource burden to the health system if we are required to wait four months for the second shot.

The growing body of evidence indicates that the efficacy of my vaccine when I get my second shot on August 6th will be about 43%. By comparison it is 96% for the normalized population. However, if I get the second shot at the recommended 21-28 days, my protection will be comparable with the rest of the population.

In a May 4th CBC article, “Advocates ask if immunocompromised patients will be prioritized for 2nd vaccine shot,” it states that this concern was communicated with Dr. Strang’s office about the disadvantage of a delayed second dose for vulnerable groups. To date I’m not aware there has been any official response.

Yesterday I learned that in Ontario, appointments for those in cancer care are made by a patient’s Oncologist and the second shot is scheduled at a 21-28 day interval to ensure the highest possible efficacy. That seems like a reasonable solution. I think it worthy of consideration here.

Since my diagnosis in December 2019 , I have had first rate health care which includes: blood work, multiple types of scans, radiation treatments, chemo treatments, appointments with specialists, surgery in May, twenty-one days in the hospital to deal with complications and infections from my surgery and about half of that in Step-down or ICU. I suspect the cost on my care is in the range of hundreds of thousands of dollars.

That is a huge spend which was paid by our health care system. Although there is no cure for my type of cancer, my treatment will extend my life. First and foremost, I wish to express my gratitude and thanks all the wonderful medical professionals I’ve encountered throughout this journey. My rambling here is not meant as a criticism of our system.

With that said, I wish to advocate that those in the immune compromised community get priority for the second dose. This is clearly self-serving but it is in the best interests of the whole community for us to have comparable protection. To repeat, the evidence suggests to me that after the second dose on August 6th, my efficacy with be about 43% compared to the normalized population of 96%. That means I have more than a 50/50 chance of becoming infected even after being vaccinated. It is pretty much a guarantee that I will end up in hospital and likely back in ICU.

To me, there seems to be a pretty strong argument that it is in all our interest to allow priority for the immune compromised community. To have comparable protection as the normalized community will ensure more treatment resources are available for everyone. The ROI (return on investment) on prioritizing the second shot should translate to a huge financial savings as it will keep us out of the hospital.

If this is not a clear argument, let me share a story about a colleague who had shingles a few years ago. The cost of that vaccine is about $300 and at the time it was not covered by our organization’s health plan. Although he has recovered, he will be medicated for the rest of his life to cope with the pain which will never go away. Those drugs will cost thousands of dollars annually. A $300 vaccine verses the annual cost of drugs for years to come; you decide the better business proposition.

Clearly my elevated risk of contracting COVID is my most significant concern. My hope is appealing to the bean counters might help tip the scales so all of us living with compromised immune systems have the same fighting chance of avoiding COVID as the rest of the population.

On a final note, my request to you is to help me get the attention of authorities to allow us priority access to the second shot.

And let me say again, my treatment in our health care system since my diagnosis in December 2019 has been absolutely remarkable. I count my blessings to live in Nova Scotia where I know I’m getting world-class care. Kudos to all the brilliant and caring medical professionals I have encountered. I hope I am worthy of your investment to keep me alive.

As always, thank you for being a support pillar. You inspire me every day.

Peace, Love and Laughter
Phil

3 Replies to “ROI – Priority Second Dose for the Immune Compromised Community”

  1. Phil, Janet and Family, I will continue to pray and send positive thoughts that you receive the second vaccine shot in a much shorter time that is scheduled for you. β™₯οΈπŸ™πŸ»πŸ€žπŸ»

  2. Wow, Phil! I’d start a campaign to have everyone call their MP or provincial rep. 105 days between shots is absurd. When I got my first dose of Pfizer (in Massachusetts), it came with a card to set up my second dose 21 days later. Now 2 weeks after that I’m as immune as I’m going to be. Granted the US got moving on this more quickly than Canada, but surely there should be some prioritization, as you suggest! I’m not immuno-compromised in any way, so I’m low risk, but boy, you should get shot #2 as quickly as you can. Hang in there and stay strong!

    David

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