At Montreal's Jewish General, nurses feel 'cheated' after province postpones second dose

Some nurses at Montreal's Jewish General Hospital who received a first dose of the Pfizer-BioNTech COVID-19 vaccine told CBC they are disappointed and frustrated with the Quebec government's decision to postpone their promised second dose.

"I felt like I was being cheated. I wouldn't have done my first vaccine if I knew I was not going to take the second," one nurse told CBC News.

CBC spoke to three nurses at the hospital. They asked not to be named because they fear speaking out could put their jobs at risk.

"That was like the last straw for a lot of us — kind of the icing on the cake to an overall horrible year," said another nurse, who also said the decision has him considering a career change.

We're the ones dealing with these patients 24/7.  We're the ones putting ourselves at risk. I just want to feel like we're valued and we're protected- Nurse at Jewish General Hospital

"We were promised it was going to go by protocol, it was going to follow what Pfizer said needed to be followed," a third nurse said.

"Now the government just decided to do what they want, and it takes away a lot of the trust." 

The nurses concerns echo those of residents at the Maimonides Geriatric Centre in Côte Saint-Luc, who have sent a lawyer's letter to the province insisting they receive their second dose as soon as possible.

Government initially insisted on second dose

All three nurses CBC spoke to received their first dose of the Pfizer-BioNTech vaccine before Christmas, with the understanding they would receive the second dose within 21 days, as recommended by the manufacturer.

All three said when they were given their appointments for the first dose, they were given appointments for the second dose at the same time.

"They were the ones who insisted it be at a certain day and a certain time so that I got my doses 21 days apart," one nurse said.

On New Year's Eve, the provincial Health Ministry put out a statement explaining it was changing its vaccination strategy and that it would no longer retain enough doses to administer a second dose to those who'd received the first.

The next day, all staff at the CIUSSS du Centre-Ouest de l'Île de Montréal, the health agency that includes the Jewish General Hospital, received an email from CEO Lawrence Rosenberg.

The email stressed that the policy change came as a result of a directive issued by the province, and it gave no indication of when people might receive their second dose.

"The vaccine that would have been used for the second dose will now be redirected, so that additional people can receive their first dose," Rosenberg said in the email, a copy of which was obtained by CBC.

"Please rest assured that this change will not affect your health or well-being," the email continued. 

"In fact, research has shown that the Pfizer vaccine achieves 90% effectiveness two weeks after the first dose has been administered."

The statement also said the decision was supported by Pfizer.

Vaccine manufacturer contradicts government

Pfizer told a different story in a statement emailed to CBC.

Christina Antoniou, Pfizer Canada's director of corporate affairs, said the company did a study to evaluate the vaccine's effectiveness in a two-dose schedule with the doses separated by 21 days. 

"The safety and efficacy of the vaccine has not been evaluated on different dosing schedules as the majority of trial participants received the second dose within the window specified in the study design," Antoniou said.

"Although partial protection from the vaccine appears to begin as early as 12 days after the first dose, two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95 per cent," she said.

"There are no data to demonstrate that protection after the first dose is sustained after 21 days."

Nurses anxious

The nurses CBC spoke to are concerned that the government is suggesting that it has Pfizer's blessing to delay the second dose, even though Pfizer's statement seems to contradict that.

"If it was endorsed by Pfizer I'd be a lot more comfortable with it. That part is what makes us have a lot less trust in the whole system," one nurse said. "I'm worried it's going to be less effective."

"We're the ones dealing with these patients 24/7. We're the ones putting ourselves at risk. I just want to feel like we're valued and we're protected," another nurse said.

"I don't know what they're doing. They're playing with us," the third nurse said.

INSPQ defends decision

Dr. Gaston De Serres, an epidemiologist at l'Institut national de santé publique du Québec (INSPQ), which the province consulted when making the decision to postpone the second dose, told CBC the nurses have nothing to worry about.

"We have with the first dose a very good protection, and this protection is unlikely to wane after 21 days," De Serres said.

De Serres said Pfizer shared its research with the INSPQ, which did its own analysis of the data.

Pfizer's analysis of its own data was flawed, De Serres said, because it rated the effectiveness of the vaccine during the two-week period after it was first administered to trial patients.

"The usual analysis of a clinical trial you exclude that period of 14 days," De Serres said.

"When we did the analysis from day 14 onward up to the second dose, we found that the first dose provided a 92 per cent protection," De Serres said.

"It was 94 per cent after two doses. We're talking pretty much the same ballpark order of magnitude."

De Serres said the purpose of the second dose is simply to prolong the period of immunity, but that the first dose should provide months of protection, if not more.

"Our immune system is meant to have a long memory. We have lots of experience with vaccines showing that the decline in protection is not abrupt. It normally happens over years," he said.

De Serres acknowledged that for this specific vaccine the institute doesn't know exactly how long a first dose will protect people, and that, in a sense, the nurses and others who've received one dose will be guinea pigs.

"This is why there needs to be a monitoring of how effective the vaccine is and how waning happens, if it does happen," De Serres said.

He said the INSPQ will study this and, based on what it finds, it will decide when or even if the nurses and others who received a first dose will require a second.

INSPQ brushes off concerns about consent

All the nurses CBC spoke to said they made the decision to get the first dose of the vaccine based on the assurance that they would receive the second dose within the time period recommended by the manufacturer, and that they feel their consent was betrayed.

De Serres dismissed their concerns.

"One has to consider the consent of those who would be denied a first dose if a happy few have two doses, when we're in the middle of a crisis where hundreds of health care workers are becoming sick daily," he said.

One of the nurses CBC spoke to said her greatest concern was that the government's abrupt change of plan would undermine confidence in the vaccine among health care workers and the public generally.

"I worry about all the people who are on the fence about the vaccine.  I think the government's not sticking to the protocol and keeping their word is going to make a lot of people end up refusing it," she said.

De Serres said that analysis "lacked substance."

"In a pandemic we have to change lots of things in our strategy because the knowledge changes," he said.