Ep. 51: COVID-19 Vaccine Q&A with Dr. Peter Nord
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Soon, all adults will have the opportunity to get the COVID-19 vaccine. The Medical Advisory Services Team at Medcan compiled the top questions they’ve been hearing from corporations and clients. Here, host and CEO Shaun Francis takes them up with chief medical officer Dr. Peter Nord (pictured above). The result is a timely, fast-paced and informative episode featuring easy-to-understand answers to your most pressing vaccine-related questions.
Note: The information contained in this podcast episode reflects the medical consensus at the time of posting. New studies and research are likely to change recommendations as well as the medical consensus over time as more information becomes available. The links provided are intended to assist the reader. Third-party links are not endorsed by Medcan.
Links, references and highlights:
The Medical Advisory Services Team at Medcan has put together a vaccine primer answering the questions that their clients have asked. Here is that primer.
Dr. Peter Nord referenced the Vaccine Queue Calculators designed to inform citizens when they’ll become eligible for the vaccine. Here’s the one Canadians should use. Those in the U.S. should use this one.
Canada’s National Advisory Committee on Immunization (NACI) provides a comprehensive guide packed with vaccine-related information.
Understanding How Vaccines Work is a guide created by the U.S. Centers for Disease Control and Prevention (CDC).
If you’re looking for higher-level information geared to physicians, the Centre for Effective Practice has a wonderful vaccine resource that delves deep into the vaccines’ research history. Access that here.
For further vaccine details, including the ingredient lists, see the following links:
For live updates on the frequency of side effects for COVID-19 vaccines in Canada, click here.
Learn more about Medcan’s medical advisory services for employers for guidance on keeping employers and customers safe and healthy.
Your COVID-19 Vaccine Questions Answered with Dr. Peter Nord final web transcript
Christopher Shulgan: This is episode 51 of Eat Move Think, the podcast from Medcan that empowers people of all ages and cultures to live well for life. I'm the show's executive producer, Christopher Shulgan. Today, we're talking about the vaccine. We've explored it previously in episode 43, and we're revisiting it today because at some point very soon it'll become real to all of us in a very physical way—because we'll actually roll up our sleeves and get it.
Christopher Shulgan: So in this show, we're exploring the reality of the vaccine in nitty-gritty detail. Here's how it came together. Medcan has a team group of expert physicians called the Medical Advisory Services Team who advise corporations on how to keep employees and customers safe. Through their work, the MAST docs receive all kinds of vaccine-related questions: Do you have to do anything to prepare for the vaccine? Can you stop wearing your mask once you get it? Does it protect against the variants? And if so, how long does that protection last?
Christopher Shulgan: Today, we've compiled the MAST physicians' answers in one easy to understand, quick listening podcast episode. Here asking the questions is Eat Move Think host and Medcan chief executive officer Shaun Francis with Medcan chief medical officer Dr. Peter Nord providing the answers. Let's get to it.
Shaun Francis: Hi, Peter. We last spoke about the vaccine in Episode 43, right after the news came out they were approved. From where you're standing, how have things changed since then?
Peter Nord: Well, vaccines have become a reality. Back then we were talking about they're coming, it's kind of exciting. And now they're here. We're now up against the challenge of how do we get them into arms as most effectively and broadly as we possibly can?
Shaun Francis: Lots of issues with distribution. Did you predict that?
Peter Nord: I'm a bit surprised, actually, because we knew for six months that vaccines were coming. It's a bit of a head scratcher as to why the whole distribution channel wasn't fixed early and ready to go. You'd think there would be a plan on the shelf, just dust it off and implement. And so it's sort of seems like everyone's just sort of been caught on the back of their heels.
Shaun Francis: Yeah, and it appears as though while we have purchase orders, we don't have priority commitments from these suppliers.
Peter Nord: Yeah, it's been interesting. But the one good thing is, Canada leads the globe in terms of the number of orders that they have out per capita. So we actually have 500 percent of the population covered with orders for vaccine. In the US, it's 200 percent. So Canada leads globally, in actually the number of vaccines. We have five shots set for every Canadian, we just have to get it on our soil.
Shaun Francis: And Trudeau has promised everyone being vaccinated by September. Does it still look like that is on track?
Peter Nord: Yeah, I think that's a very conservative and a very realistic and doable goal. But again, the Pfizer shortage was a bit of a surprise. So as long as there's no surprises in terms of production, I think the distribution is going to be there. We're going to get our act together and get a broad distribution plan. But that's all predicated on production.
Shaun Francis: So let's get things out of the way with this series of short, fast-paced questions and answers. These are questions that we've heard from our patients at Medcan. Can COVID-19 vaccines give you COVID-19?
Peter Nord: No.
Shaun Francis: Do mRNA vaccines change your DNA?
Peter Nord: No.
Shaun Francis: Is the vaccine safe?
Peter Nord: Yes, absolutely safe.
Shaun Francis: Should you get the vaccine?
Peter Nord: Yes, everyone should get the vaccine.
Shaun Francis: Now let's put ourselves in the place of a listener who's leading up to getting the vaccine. Should you be angling for one versus another? How do you choose which one you want?
Peter Nord: Really, whatever is being offered. They're all passing Health Canada criteria, which again, starts with safety and then moves to efficacy. And it's got to reach that bar for both of those areas. And if it reaches that bar, it's safe. So whatever is being offered, you can be confident in taking that that particular vaccine.
Shaun Francis: So would you be concerned about the differences between the mRNA vaccines and my understanding is Astra Zeneca is the adenovirus vaccine. Is that right?
Peter Nord: Yeah, that's right. Yeah, there's different buckets of vaccines based on how they work. And they're different, but again, as long as the output, the outcome is the same in terms of safety and efficacy, it really doesn't matter how they work, the details of the biochemistry, it's just that they work. That's the takeaway message.
Shaun Francis: Who shouldn't get the vaccine?
Peter Nord: Yeah, really everybody should get the vaccine. So that's the headline. But the Moderna and Pfizer biotech clinical trials really didn't include children, pregnant and breastfeeding women, and they really didn't look at folks that were significantly immunocompromised. So we don't know, we don't have that data. Probably okay. There's no reason to think that it wouldn't be as effective and safe in in these populations of people than anybody else, but we have to be clear that we just don't have that data. And of course, probably okay, but if in doubt, ask your physician.
Shaun Francis: Should I get vaccinated if I've already had COVID-19?
Peter Nord: Yeah, there's really no evidence about how long the antibodies from a COVID-19 infection will last. And actually, this applies even to the vaccines. We really don't have a good sense of how long our immune system is charged up. So as a result of that, the National Advisory Committee on Immunization or NACI, and the Centres of Disease Control in the States—CDC—they recommend getting the vaccine to protect yourself, your loved ones and your community, even if you have been found to be positive for COVID-19 infection.
Shaun Francis: So if I'm in a relatively high priority group and I've had COVID, are they prioritizing? In other words, would I be lower priority if I've had COVID, or are they agnostic on that?
Peter Nord: Yeah, they're agnostic on that. It's interesting, but vaccines are vaccines. And if you're in that high-risk category, you should assume that the only way to truly get the protection that we can count on is through a vaccine.
Shaun Francis: Are there any special measures that a person should take to prepare?
Peter Nord: Well, not really. I think we are seeing the most common side effect is a sore arm and just feeling a little under the weather for a day or two. So maybe Tylenol. No harm in taking a Tylenol at the time of the shot just to make yourself feel a little better. Most people have no issues with the shot, but there's no harm in taking a Tylenol. That would be probably the extent of how to prepare.
Shaun Francis: How do I know I'm eligible for the vaccine? When and where will I actually get it?
Peter Nord: Yeah, so the province or the state in which you reside is really responsible for the prioritization and distribution of COVID-19 vaccines. So basically, just visit your local government's website for the latest updates. If you live in Canada, you can use Vaccine Queue—and that's Q-U-E-U-E—Calculator to estimate when you'll be eligible. If you live in the US, you can use a similar vaccine queue calculator to estimate how many people require vaccination before it's your turn.
Shaun Francis: Got it. Folks, we'll put the vaccine queue calculators in the links on our Eat Move Think podcast site. Can I go to my family doctor for this?
Peter Nord: Yeah, absolutely. In Canada, there's phases. So there's the phase one that we're in right now. When we get to phase two, that's going to be more of a distribution through family doctors' offices, through pharmacies, and a broader distribution channel system than we're seeing right now, which is mostly through hospitals, and special sites that have been set up. So it'll be a little different in phase two, and it's looking like that's probably starting the first week of April.
Shaun Francis: What can I expect from the actual experience and aftermath? And will I have any side effects for a few days?
Peter Nord: Yeah, most people have a bit of a sore arm. They might feel a bit fatigued, and with mild headaches. Those are the most common sort of side effects. These symptoms can worsen though after the second dose. What we are seeing is, as now we're getting more experience with people having their second dose, so either 21 days later or 28 days later, they are having a little bit more symptoms after the second dose. Which makes sense, because your immune system is already charged up and it's reacting a little bit more strongly to the second dose. And even one in 10 people will experience more, so more muscle aches, maybe chills or a mild fever. This is pretty much consistent with what you experience after a normal flu shot. While the rate of severe allergic reactions to these vaccines has been slightly higher than what you might see with a normal flu shot, they remain super rare at about one in 100,000. That's the one that we know very well with the Pfizer vaccine. Although it's important to note that if you're allergic to this one substrate that's part of the vaccine, which is called polyethylene glycol or P-E-G, peg for short, or any of these derivatives, you should speak with your healthcare provider prior to taking the vaccine.
Shaun Francis: What's our guidance from Medcan on what you can and cannot do after getting it? You know, do you have to still mask? Do you still need to be physically distant?
Peter Nord: Yeah, that's a really good question. So there's sort of this concept that if you get the vaccine, you're good to go. And that's the immunity passports that we're seeing. But really, if you've had that shot, you might still have in your nasopharyngeal area, in your nose and your mouth, you actually might be harbouring the virus. And it's not going to make you sick, so the vaccine really was to protect people from getting sick and having to go into the hospital and ultimately from dying. But you still might be transmitting the virus, we just don't know at this stage how that's all working. And so we have to assume that the transmissions are still going to happen. And that means that we've got to keep doing all those practices that have been keeping us safe so far and are really working well. And that's distancing and the use of PPE, like masks and face coverings and hand hygiene and not touching our face. So really, one of the big takeaways that we really want to get out to the listeners is that the vaccines are there to protect the person, and then ultimately to protect our healthcare system so that we can allow it to do what it's supposed to do is look after sick people.
Shaun Francis: If nothing changes from what you can and can't do post-vaccine, and I'm in a low-risk category, so say I'm 30 years old, low risk, the side effects, in fact, could be more consequential than COVID to me. What's the incentive for those people to get vaccinated?
Peter Nord: Really, it's the community benefit. It's that herd immunity that we've talked about in the past.
Shaun Francis: So you're saying that if I get vaccinated, I continue to take all the safety measures, at what point do the safety measures get, let's say disarmed, for example, the masking and the social distancing?
Peter Nord: You know, it probably won't be a black and white, it won't be sort of a one-day thing. But I think the takeaway message is, we're turning the corner right now in Canada, and certainly in Ontario, and the case counts are coming down. And other than the potential for maybe a blip of a small third wave in the spring, the spring is going to be better than the winter, the summer is going to be better than the spring, and the fall is going to be better than the summer. And we're going to be releasing a lot of the lockdown stringent measures that are in place right now, gradually over time. And month by month by month, season by season, it's going to get better and better.
Shaun Francis: How long do you think the vaccine protection will last?
Peter Nord: Well, that's a really good question. That's kind of the $64,000 question. So two things: we don't really know because the studies around safety and efficacy didn't look at that. So there's one aspect of that is the bell curve. And even if we could say that we have, on average, six months' protection, now we think it's probably three to six to eight months probably, if we look at other models and look at the benefit from influenza shots. But we just don't know. Again, there's studies going on looking at that. But even if we could say, you know what? On average, it's six months, just to pick a number. Well, there's a bell curve around that. There's probably people where their immune system starts to wane after a few weeks. Maybe their immune system is not really solid, is not as strong as somebody else's. And then the average, and then the other side of that bell curve, you might have people that have, you know, one shot, and they're good for 12 months.
Peter Nord: And the problem is that we don't know, on an individual level, where people are going to fall on that bell curve. So most people we could say would be, let's say, six months. That's sort of our working hypothesis right now. But on an individual basis, we just don't know. Like, I might be the person who only gets two months of benefit. And so that's a question mark. We're looking forward to getting more information on that, but even if we have the population studies to show what the average is, the only way to know for sure if you're still protected or not, is to have a COVID antibody test, where you go in, you have a blood sample, and determine whether your immunity is still strong or whether it's starting to peter out a little bit.
Shaun Francis: So do you imagine a world where we're getting our COVID vaccination annually?
Peter Nord: In a word, yes. I have a feeling I think where we're going to end up—and this is just, you know, a life according to Nord in the future—I think we're going to see something like measles. Where it's pretty much eradicated, but we still have measles outbreaks around the world, and they can be really devastating. And so I have a feeling, especially if we—again, back to our hypothesis, if we only get, let's say, six months' benefit, and even with that, with herd immunity, we still might not be able to stamp this out completely. And if that's the case, we might have to deal with it in a seasonal way, just like we deal with influenza A and B. So our flu shot in years hence might be influenza A, B and C for COVID.
Shaun Francis: Leading on to this thought of having to be vaccinated annually is the discussion of the UK and South African COVID-19 variants. Are the vaccines effective against them?
Peter Nord: Yeah. So the good news is, as of today, the vaccines are effective against all the predominant variants that we're seeing: the UK variant, the South African variant, the Brazil variant. And we're going to see more. One of the good news stories around this virus is that it's actually mutating relatively slowly compared to some other ones. And that's great news. It means that we can get these vaccines out and know that they're going to be effective. Now at some point, the variants might become so variant that the bandwidth of coverage for the vaccines doesn't cover it. And so we're saying today we're good, we got great coverage for all these strains with the vaccines that we have out there. But that's not to say in the future—and even later this year, if there was a strain that was significantly different, then it's possible that the vaccines would not be effective.
Peter Nord: The good news there is, in speaking with the manufacturers—and this is just a modern miracle, not just that we got these things out the door in six to nine months, but the fact that they can re-engineer the vaccine to the new strain in about six weeks and start pushing out and manufacturing millions of doses within weeks after that. So rest assured, even if we have a strain that goes beyond the bandwidth of our current vaccines, very quickly, the manufacturers can retool that that new vaccine to make it effective.
Shaun Francis: Peter, part of the work we're doing to support our corporate partners is providing advisory services through our Medical Advisory Services Teams. We're providing guidance on corporations on how they can prepare for vaccine rollout. What are your recommendations for employers? Should they be mandating employees be vaccinated before they can come back to work?
Peter Nord: Yeah, that's a great question. And it's a bit of a tough one, because some of it bumps up against empiricism and ethics and who are you going to dispute and in civil liberties, frankly. But ideally, a Provincial Medical Officer of health or a local public health authority could implement a vaccine mandate. And it's sort of what we've got now for masks in many jurisdictions. That takes the responsibility away from every individual employer for having to fight this out with their employees, and puts the responsibility for public health measures where it belongs, which is on public health. The authorities would then mandate accommodations for people for whatever reason, can't take the shot, or for those that refuse vaccination on religious or moral grounds. So those people would have to be accommodated because there's an absolute right of accommodation under the Human Rights Code. For example, in Ontario, the Occupational Health and Safety Act stipulates that employers have an obligation, a mandatory obligation, to get rid of known hazards in the workplace and protect employees from work related illness or injury.
Peter Nord: And to that end, employers must take precautions to limit the risk of infectious diseases in the workplace. And that's mandated, that's under the Act. So a vaccine requirement for workers is probably coming. We're seeing it probably first would be in the health care setting. We're starting to see that now. However, it hasn't been tested in a Canadian court. So that's a big takeaway. You know, some of the litigators are starting to look at Ontario's Immunization of School Pupils Act, which is similar to many jurisdictions around North America as a bit of a template. In this case, in all of these jurisdictions, we require students to be vaccinated against certain diseases, so that there is safety in coming to school. And there's really very few exceptions that are permitted under those kind of regulations. So we are looking at opportunities that work in other jurisdictions and other areas as a way to get to this. But it's fraught with challenges from a human rights, from an accommodation perspective, and from an occupational health and safety perspective. So more to follow on that. But right now, the verdict is still a bit out.
Shaun Francis: Should employers act to hasten vaccine uptake among employees? And if so how should they do that?
Peter Nord: Yeah, that's really important. As we get to the distribution phase where the general population is being vaccinated, employers are going to play a key role in that. And there's a bunch of things that employers can do. And I look at them as three areas: number one, offering incentives to get vaccinated. So that's reward recognition or stipends. The second area is to help employees to navigate the system. So where can they go to get vaccinated, reducing the financial barriers to getting vaccinated. You know, a lot of our clients are offering four hours of paid time to get that shot. And then the third big bucket is playing an active role. So facilitating appointments, like making the appointments on behalf of the employee or holding on-site clinics. And then maybe most importantly, and in some ways the easiest, is just to communicate over and over again to your employee base, about the safety and the efficacy of these vaccines.
Shaun Francis: Well thanks, Peter, for the vaccine update. I know all of our clients are looking forward to receiving theirs at Medcan.
Peter Nord: My pleasure.
Christopher Shulgan: That's it for this episode of Eat Move Think. That was our host, Shaun Francis, in conversation with Medcan chief medical officer Dr. Peter Nord.
Christopher Shulgan: We post highlights and the episode transcript at eatmovethinkpodcast.com.
Christopher Shulgan: Eat Move Think is produced by Ghost Bureau. Senior producer is Russell Gragg. Editorial and social media support from Emily Mannella, Tiffany Lewis and Chantel Guertin.
Christopher Shulgan: Remember to rate and subscribe to Eat Move Think on your favourite podcast platform. Follow Shaun on Twitter and Instagram @shauncfrancis—that's Shaun with a U—and Medcan @medcanlivewell. We'll be back soon with a new episode examining the latest in health and wellness.
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