How the rollout of the second COVID-19 vaccine dose could look in N.B.

With more and more New Brunswickers rolling up their sleeves to receive their first dose of a COVID-19 vaccine this month, Public Health officials must now plan for how to inject second and final doses into those arms.

A large number of the second shots will have to be administered during the summer, when there's still no estimate for vaccine deliveries to the province and when vacations could complicate scheduling.

"Prioritize your summer accordingly and make sure you plan for that second dose because you want to get it when it's available to you," said Jake Reid, executive director of the New Brunswick Pharmacists Association.

Some pharmacists have been booking second-dose dates during first-dose appointments.

But that's not happening at clinics run by Horizon Health.

People who book appointments there get instructions that say, "You will receive a message indicating when and how you will be able to schedule your Dose 2 COVID-19 vaccine appointment."

Nurses administering shots at a Horizon clinic in Fredericton on Thursday were telling recipients they didn't know how or when they'd be given a date for a second dose. The box on the vaccination record people were given for "date next dose due" was left blank. 

The province's vaccination plan is to administer second doses 14 to 16 weeks after the first doses.

Reid's been part of discussions with Public Health on vaccination planning and he said a clearer picture of the second-dose rollout may start to emerge a couple of weeks from now.

Provincial spokesperson Shawn Berry said the focus now is on getting everyone a first dose by the end of June to give them some level of protection.

"When we are ready to begin second dose clinics, that will be publicly announced," he said, adding everyone will get their second dose within the planned interval "or sooner."

He said everyone should have a second dose by September.

Some pharmacists have been giving people second-dose appointments during their first shot, while others have arranged to call, email or text the recipients.

For those with appointments, there's still some uncertainty.

Individual pharmacies only find out how many doses they'll be getting two weeks in advance.

And the federal delivery schedule to the provinces, which Public Health officials use to plan clinics, only goes to the first week of July at the moment.

New Brunswick is scheduled to have received 725,125 doses by then, enough to start second shots.

But beyond that, the numbers are fuzzier.

"There's a lot of logistics to figure out, not the least of which is: will the pharmacy have the appropriate type of vaccine during the right week to be able to give those out?" Reid said. "We certainly assume that."

Add to that possible out-of-province trips by vacationing New Brunswickers, and the need for some pharmacy staff to take their own holidays, and it's a complex puzzle.

Chief Medical Officer of Health Dr. Jennifer Russell has also opened the door to shortening the 14-to-16-week interval if there's enough vaccine quantity to allow second doses sooner.

That decision will be up to Public Health, Reid said. "They could say that everyone who received the vaccine on this week, you'll now receive your second dose during this week." 

Pharmacists themselves can't give second doses before the 14-week mark even if they think they have enough in stock. "We've been told not to use any supply right now for second doses," Reid said.

Second shot likely to come from same source as the first

One thing Reid is fairly sure of is that New Brunswickers won't be able to switch from a regional health authority (RHA) clinic to a pharmacist, or vice versa, for their second dose.

That's in part because the software RHAs use to record vaccinations is not the same as that used in pharmacies. "Those systems don't speak to one another, and we wouldn't know for instance if someone had received their first dose from an RHA," Reid said.

On the other hand, research into whether someone can get a second dose of a different vaccine than their first one is ongoing.

If it's shown to be safe, "mixing and matching" may be possible, Reid said, removing some potential logistical headaches.

"That certainly would change and open up when and where you could get your vaccine."

Berry said no decision has been made on whether to give a second dose of AstraZeneca vaccine to people who got a first dose before the official guidance changed, which included many teachers and first responders.

In March, federal officials recommended not giving AstraZeneca to people younger than 55 after evidence emerged of rare cases of blood clots linked to the vaccine.

That recommendation changed again last month, saying people younger than 30 shouldn't get it.

The final decision was left to the provinces and New Brunswick so far is sticking with the age-55 threshold.

"Decisions on the type of second dose that will be offered to those who have been vaccinated with AstraZeneca vaccine will be determined based on the latest evidence and research," Berry said.