Why Canada's booster shot guidance is all over the map

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Canada's vaccine advisory committee has given advice that's repeatedly been proven right throughout the pandemic — in the face of limited data and vocal criticism — and saved lives.

But multiple medical experts say the failure to do so quickly and transparently threatens to undermine public confidence on key vaccine issues and forces provinces to make crucial decisions on their own.

The National Advisory Committee on Immunization (NACI) released new guidelines on booster shots Friday — after weeks of deliberation — strongly recommending them for those over 80 and leaving the door open to others at risk of lowered vaccine protection.

But the NACI recommendations came after a handful of provinces and territories across Canada already announced their own plans for booster shots, calling into question the speed in which the committee can react to emerging evidence and issue national advice.

"It's fair to say that NACI has come up with some excellent recommendations," said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario's COVID-19 vaccine task force.

"But it would be very helpful to have these recommendations faster." 

B.C. pre-empted NACI on Tuesday, rather than wait any longer for the committee's highly anticipated guidance to be released, announcing its own plan to roll out boosters for everyone in the province by May 2022 that goes far beyond the committee's approach.

Provincial Health Officer Dr. Bonnie Henry said in a phone interview the reason B.C.'s booster guidance came days earlier than NACI's is because she wanted the province to have a "simple, longer term strategy that people will understand." 

"What we're seeing now on the ground here is breakthrough [infections] in the older people who went first," she said. "So that's why we needed to be more proactive to try to get out booster doses to those people right away."

WATCH | Breakthrough COVID-19 infections cause confusion, concern:

The Northwest Territories offered boosters to everyone over the age of 18 on Thursday, and the Yukon will soon make them available to those over 50. Saskatchewan expanded boosters to Indigenous people over 50 and anyone over 65 and Alberta did the same for Indigenous people over 65 and anyone 75 or older earlier this month.

But this isn't the first time NACI has been beaten to the punch. 

NACI previously recommended third doses for severely immunocompromised people who don't generate strong initial responses to the vaccine — a different matter than booster shots that top up declining antibody levels — but even that guidance was pre-empted by some provinces.