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Quebec offers 3rd dose of mRNA COVID vaccine to AstraZeneca recipients who need to travel

The Quebec government says fully vaccinated residents who have received the Oxford-AstraZeneca COVID-19 vaccine can receive a third dose of an mRNA vaccine before travelling.

Quebec is offering the extra shot because some countries don’t recognize the version of the AstraZeneca vaccine made at the Serum Institute of India — known as COVISHIELD — and Canadians who have received it could find themselves barred from entry.

Many European countries, for instance, don’t recognize that vaccine. The European Union’s new vaccine passport only counts those approved by the European Medicines Agency, which doesn’t list COVISHIELD. 

There are also reports of various cruise lines only accepting certain vaccines or combinations of shots, including Princess Cruise Lines, which does not consider guests who’ve had any version of the AstraZeneca shot followed by an mRNA vaccine to be “fully vaccinated.” However, the company does allow two different doses of the same type of vaccine even if they’re made by different brands.

On Monday, Quebec officials noted in a press release that third doses will be available only to people who need to travel imminently and for an essential reason.

The province has said it will also press Ottawa to try to convince other jurisdictions to accept COVISHIELD and AstraZeneca vaccinations. 

Quebec health officials are warning that it’s up to the recipient to seek advice and weigh the risks before getting a third dose of the Pfizer-BioNTech or Moderna mRNA-based vaccines.

A spokesperson for the province’s health department said a third dose doesn’t necessarily provide more protection compared with two doses, and that the safety of receiving two shots of AstraZeneca mixed with an mRNA vaccine is unclear.

WATCH | What we know about mixing COVID-19 vaccines:

Infectious diseases specialist Dr. Isaac Bogoch explains comments from the World Health Organization about COVID-19 vaccines taken out of context and what health experts know about mixing vaccines. 2:25

No studies assessing impact

Robert Maranda, of the health department, says there are no studies assessing the impact of receiving three doses of two separate vaccines.

“The person should be properly counselled to be informed of the potential risks associated with this added dose compared to the benefits of the planned trip,” he said in an email.

“It is up to everyone to weigh the balance of risks and benefits.”

Those comments are in contrast with advice from World Health Organization (WHO) officials who recently stressed that individual citizens shouldn’t be the ones making the call about whether to get extra shots.

“Individuals should not decide for themselves, public health agencies can, based on available data,” Dr. Soumya Swaminathan, WHO’s chief scientist, recently tweeted to clarify broader comments she had made on mixing vaccines during a briefing.

WATCH | NACI recommends provinces stop administering AstraZeneca in most cases:

The National Advisory Committee on Immunization (NACI) is recommending the provinces stop administering the AstraZeneca vaccine in most cases — even as booster shots for people who’ve already received first doses of the product. The committee is citing better immune responses by mRNA vaccines and greater supply as reasons for the new guidelines. 1:59

No evidence of need for third dose, NACI says 

Currently in Canada, the guiding recommendations from the country’s National Advisory Committee on Immunization (NACI) state that there is “currently no evidence on the need for booster doses of COVID-19 vaccine after the vaccine series is complete.”

NACI does, however, recommend swapping in different vaccines for different doses in certain situations. 

The advisory body calls for the same mRNA vaccines to be used for a second dose if possible, but that another mRNA shot “can be considered interchangable” if the first type is unavailable.

NACI also recommends that either an AstraZeneca or COVISHIELD vaccine, or an mRNA one, can be offered as a second dose for people who had a first shot of AstraZeneca or COVISHIELD. It notes that mRNA options are actually preferred as a second dose, thanks to emerging safety evidence and the possibility of a better immune response.

Currently, the vaccines approved for use in Canada include both versions of the AstraZeneca shot, and those made by Pfizer, Moderna and Johnson & Johnson.

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