A Gatineau, Que., man who developed a severe skin condition after receiving a COVID-19 vaccine says he's ready to give up on Canada's health-care system and seek treatment abroad.
Mohammed Tisir Otahbachi, 29, received his first dose of the Moderna vaccine on July 15, 2021, at a Walmart pharmacy in Gatineau. Ten days later, small acne-like blisters appeared on his right hand.
Otahbachi, who goes by his middle name, told CBC he had never experienced any kind of skin problem before. He tried a topical cream suggested by a pharmacist, but it didn't work.
While serious complications from COVID-19 vaccines are rare, Otahbachi had a sneaking suspicion his shot might have had something to do with the rash. Nevertheless, he was eager to receive his second dose and returned to the same pharmacy for another Moderna jab on Aug. 13, 2021.
"Two days after that, like 48 hours later, almost the whole of my body — my hands, arms, my legs, even my back — it was [hit with] the same thing, and it started burning a little bit. There was some pain," Otahbachi recalled.
"I recognized there is something happening on my body because of the vaccine."
Couldn't find a doctor
Accompanied by his father, Otahbachi, who has no family doctor, went to the Gatineau Hospital. After waiting 23 hours and learning it could be many more, they left.
Otahbachi said he tried every doctor's office he could find in Gatineau, then began calling medical clinics in Montreal, Mirabel, Terrebonne and even Quebec City, more than 400 kilometres away. None were accepting new patients. Numerous attempts to book an appointment at a local walk-in clinic proved equally fruitless.
By then it was September, and Otahbachi's skin condition was worsening. He had been working as a mover and Uber driver, but the painful rash that covered much of his body cost him both jobs.
"I couldn't work because my body was burning. I was not able to touch anything, even the water," said Otahbachi, who was reduced to washing with baby wipes.
Increasingly desperate, Otahbachi began searching for a doctor in Ontario, where Quebec residents must pay out of pocket for some health-care services.
His wife, Fatima Outaleb, was working from home for a major insurance company, but the couple was expecting a baby and money was tight.
'I was dying'
With a loan from his father, Mohammad Tawfiq, Otahbachi finally managed to get an appointment at a medical centre in Ottawa. He was prescribed a hydrocortisone/anti-fungal cream and tablets used to treat bacterial infections, and referred to a dermatologist. The dermatologist prescribed him antihistamine tablets and more ointment.
None of the medication helped. By that point it was March 2022, more than eight months since Otahbachi's first vaccine dose.
"At that time I was dying, I needed any solution," he said. "The pain I was in, you cannot imagine it. I couldn't sleep [for] many nights, months, weeks ... my normal life was done."
Throughout his ordeal, Otahbachi noticed something else: none of the doctors he had consulted appeared willing to acknowledge any possible link between his vaccination the previous summer and the sudden onset of his skin condition.
One doctor he visited suggested his condition was an allergic reaction to his gloves, or the shampoo he'd been using for years.
"The doctors that I've been to, they were very worried and scared to mention or say my condition ... is because of the COVID vaccine. They were very worried about that," he said.
Severe reactions rare
Moderna acknowledges a "remote chance" that its COVID-19 vaccines will cause severe allergic reactions, including "a bad rash all over your body," but says such symptoms typically occur within a few minutes of injection.
The Public Health Agency of Canada notes that serious adverse reactions to COVID-19 vaccines are extremely rare, representing just 0.011 per cent of the more than 95 million doses administered in this country as of Dec. 9.
Still, there have been 20 reported cases of erythema multiforme, a skin reaction that can be triggered either by an infection or by some medicines, in people who received the Moderna vaccine.
Other studies have noted "growing evidence" of a link between COVID-19 vaccines and various cutaneous reactions including pruritus (itching), urticaria (a raised, itchy rash), angioedema (swelling) and morbilliform (measles-like) eruptions.
Both Outaleb and Tawfiq told CBC that prior to receiving the COVID-19 vaccine, Otahbachi had never experienced any sort of skin ailment.
Allergist notes possible link
That spring, Outaleb gave birth to the couple's first child, Julia, in Winchester, Ont. For pediatric care, they were referred to a family physician in Ingleside, Ont., about 100 kilometres from their home. (Unable to find adequate maternity care near Gatineau, Outaleb had also turned to Ontario.)
On their first visit with their newborn daughter, the doctor, Michael Bensimon, noticed Otahbachi's blisters.
"[He] said, 'What's that on your hands?'" Ohtabachi recalled. "He told me, 'This is because of the COVID vaccine, yeah?'"
Bensimon referred Otahbachi to Ottawa allergist Antony Ham Pong, who on Aug. 29 provided him with a letter confirming that Otahbachi suffered "a severe blistering, weeping peeling eczematoid skin reaction" shortly after receiving the Moderna vaccine.
"There appears to be a significant temporal relationship to receiving the vaccine and his skin symptoms," Ham Pong wrote. "While there is no absolute proof that the COVID-19 vaccine caused this condition, the time relationship ... strongly suggests that the vaccine played a role in bringing these symptoms on."
Ham Pong told CBC he has seen cases of hives among other patients who received the Moderna vaccine, but those mostly occurred after booster shots. He said to his knowledge, Otahbachi's case of chronic dermatitis appears relatively unique.
"You have to have a number of people reporting this to say, OK, there is a link," Ham Pong said. "From my point of view, we're trying to manage his condition, whatever the cause of it."
Armed with that letter, Otahbachi reached out to his MP Greg Fergus and his MNA Mathieu Lévesque, whose offices assisted him in applying to Quebec's vaccine injury compensation program for financial relief.
It was a long shot. By the end of last March, 125 claims had been filed since the onset of the COVID-19 pandemic, of which only eight had been evaluated and only three had resulted in payouts. (It's not known how many of those claims were related to COVID-19 vaccines, though the program's administrators acknowledge a spike in applications since the pandemic was declared.)
I'm wasting my time, I'm wasting my health, I'm wasting my body. - Tisir Otahbachi
In late October, Otahbachi received a reply from Quebec's health ministry informing him that to complete his claim, he'd need to obtain a letter from a physician practising in that province. He was back to square one.
"I was dying for over four or five months to find a doctor in Quebec, and I couldn't," he said.
Doug Angus, a professor emeritus at the University of Ottawa's Telfer School of Management and an expert in health economics and policy, called Otahbachi's ordeal a "classic example" of a chronic shortcoming of Canada's health-care system.
"This image that we have of a Canadian health-care system being portable from one province to another province is kind of a fallacy," Angus said. "It's frustrating for people who, like this individual, get caught right in the middle of it."
Otahbachi has now paid hundreds of dollars to consult doctors in Ontario, not including the cost of his prescriptions that aren't covered by Quebec's health insurance plan.
Quebec's health ministry declined CBC's request for an interview about Otahbachi's case, but wrote in French in an email that "the declaration of a clinical event related to vaccination ... does not constitute a claim under the compensation plan."
The ministry reiterated that the physician representing the claimant before the medical review committee that assesses claims for compensation "must have a licence to practise in good standing and be a member of the Collège des médecins du Québec."
Earl Brown, a professor emeritus of virology at the University of Ottawa, said diagnosing such cases can be extremely difficult for physicians.
"Sometimes they don't know what caused it, and so they don't feel they can associate it with the vaccine. But you have to be careful you don't rule things out when you have no reason to rule them out," he said. "Those are tricky situations, but I think it happens all too often."
According to Brown, some medical professionals may be extra cautious because they don't want to fan the flames of the vaccination debate.
"There's a big nervousness about amplifying negative stories about vaccine," he said. "People are very careful because the anti-vaxxers will take anything and run with it, whether it's on-base or off-base."
Last fall, Ham Pong suggested one more possible option to ease Otahbachi's suffering: injections of a drug called dupilumab, approved by Health Canada in 2017 under the brand name Dupixent.
The hitch with Dupixent was the cost. At more than $1,000 a shot, and with biweekly doses required for at least a year, Otahbachi was staring at a $30,000 prescription that he couldn't possibly afford.
While Ham Pong explored the possibility of getting the drug covered for his out-of-province patient, he referred Otahbachi to another allergist at The Ottawa Hospital who was able to at least get him started with samples.
After two injections, Otahbachi's symptoms have improved considerably but haven't disappeared entirely. He fears as soon as the free doses run out, the painful rash that has tortured him for well over a year will return.
His faith in Canadian health care shattered, Otahbachi has begun exploring treatment options in Morocco and Turkey.
"Here, actually I feel like … I'm wasting my time, I'm wasting my health, I'm wasting my body. It's [a] hopeless case," he said.
Outaleb, still the family's sole breadwinner, said it's been heartbreaking to watch her husband's suffering.
"I really feel sorry for that because he does not deserve it. He's a great dad, he's a great husband," she said. "As a family we're a victim of what happened. It's not really fair for a family who are just starting their life to live this."