Ontario opens fourth doses to all adults, but Moore says some may want to wait

TORONTO — Ontario is widening access to fourth COVID-19 vaccine doses to all adults, but the province’s top doctor says some may want to wait for a new shot that’s expected to better target Omicron variants.

Chief Medical Officer of Health Dr. Kieran Moore said Wednesday that anyone aged 18 and older who had their first booster five months ago will be able to book a fourth shot – or second booster – starting Thursday. 

But he noted that young residents who don’t have underlying health conditions can choose to wait for the fall, when vaccines specifically targeting the Omicron variant may become available.

“While my call for arms remains the loudest for the most vulnerable in our communities, we’ve made the decision to expand the eligibility for second boosters,” Moore said.

Most residents aged 18 to 59 have strong protection against the virus more than six months after their first booster, he said, but expanding fourth-dose eligibility will ensure they can make an “informed decision” looking at personal risk factors, pointing to smoking or diabetes as examples.

“It’s not a ‘should,’ it’s absolutely a ‘may’ depending on your personal circumstances,” Moore said of second boosters. 

He encouraged Ontarians to speak with their health-care providers about whether getting a second booster “is right for them.” 

Those who choose to get a second booster this summer may have to wait five months for their next shots, or three if they are immune suppressed, Moore said.

The province will likely start vaccinating high-risk individuals with anticipated bivalent vaccines earlier in the fall, so most Ontarians likely wouldn’t be eligible until closer to November or December anyway, Moore said. The National Advisory Committee on Immunization is currently awaiting more evidence on bivalent vaccines.

Ontario had been under pressure to expand eligibility for fourth doses beyond people aged 60 and older, immunocompromised individuals and Indigenous adults. Quebec opened second booster access to all adults in May, while New Brunswick, Nova Scotia, Newfoundland and Labrador and Prince Edward Island also recently announced plans to lower the age threshold for fourth doses.

Moore said Ontario wanted to encourage the most vulnerable to get boosters, and for people to catch up on earlier COVID-19 vaccines before opening up eligibility.

The province is currently experiencing a summer wave of infections driven by the BA.5 Omicron subvariant that Moore said could peak within the next two weeks.

Some welcomed the expansion of fourth doses. 

Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, tweeted her support of the expansion, while calling for a reinstated mask mandate. 

Justin Bates, CEO of the Ontario Pharmacists Association, said pharmacists have been fielding more questions about availability and effectiveness of the fourth shots amid the BA.5 wave. 

Pharmacists are anticipating a rush in the first few weeks after access widens, Bates said, with a better sense of demand expected in the coming days.

“We would ask patients to understand that we’re doing everything we can to turn this back up, but it’s going to take a few days to get all the supply,” he said.

Interim New Democrat Leader Peter Tabuns said Ontario should work to “reduce barriers” for vulnerable people by ensuring the role of family doctors in the rollout and in-home vaccinations for those who need them. 

“We need to make it as easy as possible for people to get their shots, and not repeat the usual inconvenient and confusing vaccine rollout that may have contributed to five million Ontarians skipping their first booster,” Tabuns wrote in a statement. 

About 60 per cent of Ontarians had received third COVID-19 shots according to data made available last week. 

Dr. Michael Warner, an intensivist at Michael Garron Hospital in Toronto, said Moore’s messaging around the fourth shots was unclear, and many Ontarians between 18 and 60 may have come away thinking they don’t need fourth doses.

He also noted that many people, especially those who don’t have a family doctor, may not be aware of their health status when deciding whether to get a fourth shot. 

“For the patients that I’ve cared for in the ICU with COVID-19, many of them thought they were healthy,” he said.

Warner said he thinks it makes sense for people to get a fourth shot this summer because it’s unclear how much protection they will have when, or if, bivalent vaccines become available. 

“It’s riskier to wait for something that may never happen, an Omicron-specific shot, that you may not be able to get in a timely manner when some type of wave or wavelet happens in the fall,” he said.

Some Toronto residents who had otherwise kept up with COVID-19 vaccinations said they were unsure about whether to get a fourth dose. 

Sherry Yuan Hunter said her family all received third doses, but that they would likely spend some time discussing whether to make appointments for the fourth shots. 

“Making it available is probably a good thing, everyone has to make their own decisions, but at a personal level, I don’t know what the right thing to do is anymore,” she said. 

Christopher Fladd, a researcher at SickKids hospital, welcomed the news and said he would likely get the shot soon, even with his curiosity about the bivalent vaccines expected later this year.

“I will probably get this when it’s available,” he said, adding that he’d like to see more public health measures like masks in public spaces still in place. “I just think that people have become a little bit complacent and that they’ve probably dropped their guard.”

Moore said he wasn’t currently considering recommending a return to mask mandates or other public health restrictions that were lifted earlier this year, though he said residents should consider masking in indoor crowded spaces “if they feel it’s right for them.” 

Ontario also announced Wednesday it would extend a program providing free rapid antigen tests for COVID-19 through venues that include grocery stories and pharmacies until Dec. 31. 

– With files from Tyler Griffin.

This report by The Canadian Press was first published July 13, 2022.

Holly McKenzie-Sutter, The Canadian Press