As Jim Mulcahy sits and receives a four-hour IV drip as part of his cancer treatment every Thursday at St. Martha's Regional Hospital in Antigonish, N.S., he wonders if he's adequately protected against COVID-19.
He's concerned that two doses of the vaccine isn't enough to protect him and other people with damaged immune systems against the virus.
Mulcahy, 73, wants to know if Nova Scotia will follow the United States and Ontario in offering a third dose of vaccine to severely immunocompromised people.
"It's a very human, at times very poignant circumstance, when I look at those individuals and think that their lives might be made easier, their vulnerability reduced, and perhaps the safety of those people with whom they are in loving relationships protected, if they received this dose," said Mulcahy.
Mulcahy said he recently learned that, despite being double-vaccinated, evidence suggests that cancer and chemotherapy have left him significantly more vulnerable to COVID-19 than a healthy person who has had the same vaccines.
This is Mulcahy's third cancer diagnosis. He has already faced two blood cancers and now, after more than a decade in remission, he has been hit with the toughest one yet — multiple myeloma.
It is not considered curable, Mulcahy said, so he is being treated with a combination of self-administered needles and chemo drugs, plus the I.V. treatments, "until the drugs fail."
If he were to contract the virus, it would likely be life-threatening, he said.
"It's been an emotional and a physical challenge to deal with this latest diagnosis," he said. "The fact that that diagnosis might be significantly complicated by a second serious illness increases that physical-emotional stress for me."
3rd doses offered elsewhere
Earlier this month, the U.S. Food and Drug Administration and Centres for Disease Control and Prevention announced that they are now recommending people who are moderately to severely immunocompromised receive an additional dose of mRNA COVID-19 vaccine after the initial two doses to ensure better protection against the virus.
Ontario announced last week that it is making third doses of vaccine available to specific groups of "severely immunocompromised" people and the "vulnerable elderly in high-risk congregate settings."
Nova Scotia's Chief Medical Officer of Health Dr. Robert Strang said during Monday's COVID-19 briefing that the National Advisory Committee on Immunization is looking at the issue and will make a recommendation in September.
"They are the experts and we will wait to hear from them," Strang said.
Research promising, but not conclusive
Dr. Lisa Barrett, an infectious disease researcher and clinician at Dalhousie University in Halifax, said there is new information coming out about immunocompromised people and vaccines, both from formal studies and what she calls "real world data."
"It does appear that there are certain groups of people who seem to be less protected even if they've had two doses of vaccine," she said.
Barrett said the so-called real world data is more difficult to interpret because of variations in vaccine type and the intervals at which they're given, and it's complicated further by the emergence of the delta variant.
But Barrett pointed to a study done in Toronto with transplant recipients. While it does appear that their levels of antibodies were low after two doses of vaccine, they increased after a third shot.
The antibody levels measured in this study include a specific antibody called a neutralizing antibody that seems to correlate with protection from serious COVID-19 infection.
What we do not yet know, Barrett said, is if those increased antibody levels actually translate into real world protection in the immunosuppressed, or how much it improves efficacy.
Barrett said the National Advisory Committee on Immunization will be assessing both the studies and the real world data, looking into both the safety and the efficacy of third doses, before they make recommendations.
"We also want to be mindful of the best use of vaccine globally and make sure that we're not using up doses when we don't need to," she said.
Barrett doesn't want people to fear that they have no protection if they're immunocompromised, but she advises they exercise additional caution.
"If you're immunocompromised and you've had two of your vaccines, you're still far better protected than someone who hasn't had their vaccines," Barrett advises.
"Just consider wearing a mask for now."
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