An examination of vaccine mandates in Canada

An Examination of vaccine Mandates in Canada

An examination of COVID-19 vaccine mandates in Canada: The scientific and
ethical argument against this ill-conceived move
Reasonable limits can be considered by governing bodies if these limits can be demonstrably jus7fied in a
free and democra7c society. – The Canadian Charter of Rights and Freedoms
Within this framework, a vaccine mandate can be reasonably jus?fied in a pandemic if:
1) The vaccines available to Canadians at this ?me can expect to significantly limit the spread of disease
2) The available vaccines have demonstrated to be reliably effec?ve against the disease
3) The mandate is not overly broad or unreasonable, and is equitable
4) Those subjected to the vaccine mandate can make informed consent, which includes knowing the
long-term safety and efficacy profile of the vaccines
5) There is a reasonable, if not rigorous, risk-benefit analysis performed such that those subjected to
the mandate can expect to know their risk of severe disease from infec?on and the poten?al serious
adverse events of the vaccine of someone of their age, sex, and physical health
Below, the above points are singularly considered with the latest evidence we have for guidance.
1) The mRNA vaccines in use in Canada have not shown the ability to deter the spread of the dominant
delta variant of SARS-CoV-2 in circula?on across Canada. In fact, a study done by scien?sts at Oxford
in the UK found fully vaccinated individuals who experience “breakthrough” infec:ons have viral
loads as high as unvaccinated individuals (reference: hXps://www.bmj.com/content/374/
bmj.n2074). This is among the most relevant arguments against the judicial imposi?on of a vaccine
mandate with the vaccines we currently have available in Canada and much of the developed world.
Not only do these vaccines not fulfill the objec?ves of the mandates according to the science; the
imposi?on of these mandates provide a false sense of security. The delta variant was selected for
and con?nues to spread in regions that are highly vaccinated with the mRNA vaccines (which are
single an?gen target vaccines). A recent study published in the New England Journal of Medicine
describes the resurgence of SARS-CoV-2 infec?ons in highly vaccinated healthcare workers (57% of
those infected were fully vaccinated; reference: hXps://www.nejm.org/doi/full/10.1056/
NEJMc2112981#). Thus, the ra?onal of a vaccine mandate stands on faulty ground on this basis
alone. In the UK, cases are soaring, and the majority of cases in those over 30 years old (as of
October 2021) are in those fully vaccinated, according the Vaccine Surveillance Report (week 41) put
out by Public Health England.
A new preprint (hXps://www.medrxiv.org/content/10.1101/2021.09.28.21264260v1) found that the
likelihood of transmigng the disease increases in fully vaccinated individuals over ?me. As shown in
Figure 1, a person fully vaccinated with the AztraZeneca viral vector vaccine is just as likely to pass on
the infec?on 2 months post-vaccina?on, as an unvaccinated person. An individual fully vaccinated
with the Pfizer-BioNTech mRNA vaccine is 60% likely to pass on the infec?on at 12 weeks post-last
vaccina?on (compared to ~67% likelihood of transmission from an unvaccinated person). As such,
the vaccines in use in Canada currently are quite leaky and the durability of their immune protec?on
is unknown, which ques?ons the ra?onal of the absolu?st mandates – especially in rela?on to those
with infec?on-acquired immunity (now called “natural” immunity). The best study to date assessing
natural immunity to vaccina?on, found those with infec?on-acquired immunity (who are
unvaccinated) are 27 ?mes less likely to experience a re-infec?on and 8 ?mes less likely to be
hospitalized with COVID-19, compared to a fully vaccinated individual (hXps://www.medrxiv.org/
content/10.1101/2021.08.24.21262415v1). More discussion on the lack of recogni?on of natural
immunity in Point 3 below.
Figure 1
In support of the above evidence, of the poor ability of the current vaccines to prevent transmission,
a study found “there appears to be no discernible rela?onship between percentage of popula?on
fully vaccinated and new COVID-19 cases… In fact, the trend line suggests a marginally posi?ve
associa?on such that countries with higher percentage of popula?on fully vaccinated have higher
COVID-19 cases per 1 million people” (hXps://link.springer.com/ar?cle/10.1007/
s10654-021-00808-7). This is reason to abandon the mandates, as many common-sense countries
have. The transparent recogni?on of evidence has earned these countries, which include Singapore,
Sweden, Norway and Denmark, the trust of the public – par?cularly in respect to the competence of
their public health professionals. As such, they have now liped most of their COVID-19 restric?ons
without ever needing to implement heavy-handed mandates.
There is clear evidence that the risk of COVID-19 mortality and serious morbidity has been reduced
(to date) in at-risk individuals with the vaccines we are using. This evidence should be used to
recommend vaccina?on, par?cularly for those at moderate-to-high risk of serious morbidity/
mortality, as has been done in those high trust countries, without absolu?st mandates. It does not
jus?fy manda?ng vaccines to everyone for access to services, being employed or being able to have
mobility. The irra?onal implementa?on of these mandates (e.g. different rules for Quebec federal
government employees vs. those in the rest of the Canada) underscores the poli?cal – and worse
coercive – nature of these mandates that have nothing to do with evidence-based healthcare and
equity.
2) In direct rela?on to the above, there has been a recogni?on of a precipitous drop of vaccine efficacy
with the mRNA vaccines over a rela?vely brief period (possibly within 4-6 months). Although certain
jurisdic?ons, like Israel, have decided to keep plunging on with a 3rd booster shot in less than a year
due to increasing COVID cases, no trials have shown the long-term safety and efficacy of giving
mul:ple booster shots of these mRNA vaccines because we have never used mRNA delivery
plaAorm vaccines outside of emergency use authoriza:on. This has made making informed
decisions about their use during this pandemic exceedingly difficult. Given this technology is
rela?vely new in its clinical use, it poses a valid ethical issue in manda?ng their use without providing
other op?ons. There is the addi?onal issue of imperfect vaccina?on of a large popula?on selec?ng
for more virulent pathogens (hXps://journals.plos.org/plosbiology/ar?cle?id=10.1371/
journal.pbio.1002198). Experimentally it has been shown that “an?-disease vaccines that do not
prevent transmission can create condi?ons that promote the emergence of pathogen strains that
cause more severe disease in unvaccinated hosts.”
3) If the mandate was really based on ensuring immune protec?on, then there exists a glaring
oversight in not including equal access rights to those who have been previously infected and
recovered from COVID-19. Although it has long been recognized that natural infec?on typically
provides more durable and comprehensive immunity than vaccines, there has been resistance in
acknowledging this fact by our public health officials. A new UK study now confirms, that those who
have been infected with SARS-CoV-2 once have beNer immunity than someone who has had 2
doses of the mRNA vaccine (reference: hXps://www.science.org/content/ar?cle/having-sars-cov-2-
once-confers-much-greater-immunity-vaccine-vaccina?on-remains-vital). Furthermore, past
infec?on appears to provide beXer protec?on against the delta variant than the mRNA vaccine
(reference: hXps://www.medpagetoday.com/infec?ousdisease/covid19/94258). Given this, why
would these individuals who have natural immunity to COVID-19 (which would include at least 1.7
million Canadians) not be given at least the same access to public life, as the vaccinated group under
this mandate? This omission speaks to a profound lack of logic and equity in the rollout of this plan.
European countries who had put in place “immunity passes” included previous infec?on as evidence
of immunity. Ignoring this basic inclusion does nothing to inspire faith in the management of
pandemic policies and can even be perceived as a means of coercing people into unnecessary
procedures; thus incurring all of the poten?al risks (touched upon below) and none of the benefits.
An American professor launched a lawsuit on this very ground against his ins?tu?on, George Mason
University (GMU), that had blindly implemented mandatory vaccina?on and ini?ally chose not to
recognize his natural immunity through previous infec?on. GMU relented before the trial went to
court (hXps://thebfd.co.nz/2021/09/04/university-caves-on-vaccine-lawsuit-but-ques?ons-remain/).
4) As noted before, we have rela?vely limited experience using the mRNA vaccines, and for some
reason these are the only types of vaccines available to Canadians at this ?me. These mRNA vaccines
were pre-emp?vely authorized by Health Canada, a decision that has been ques?oned by one of the
top medical journals, BMJ (hXps://blogs.bmj.com/bmj/2021/08/23/does-the-fda-think-these-datajus
?fy-the-first-full-approval-of-a-covid-19-vaccine/). We need to acknowledge that we are s?ll
poorly informed about many aspects of this technology, as promising as it is. For starters, there is no
publicly available biodistribu:on data (i.e. where the drug product goes in the body aper injec?on
and where their encoded an?gens are expressed and presented to the immune system); the
durability of their immune protec:on is at this :me uncertain; and there are non-trivial safety
signals, which include (but are not limited to) myocardi:s/pericardi:s (reference: hXps://
jamanetwork.com/journals/jama/fullar?cle/2782900#), a number of hyperglycemic disorders
including the onset of type2 diabetes, and func:onal neurological disorders (reference: hXps://
jnnp.bmj.com/content/early/2021/08/17/jnnp-2021-327000). Furthermore, other than the
pancrea?c issues associated with hyperglycemia, most of these serious adverse events are observed
to occur more frequently in those least likely to experience serious COVID-19. Given these issues,
informed consent is challenging for a mandated drug for which the science is s?ll evolving. To put in
place such a policy seems ethically ques?onable given the poor scien?fic ra?onal for its
implementa?on (as outlined in points 1 & 2).
5) Taking the collec?ve points outlined above – which speak to the unknown immune protec?on
durability, uncertain efficacy in preven?ng spread of the delta variant, insufficient data on long-term
safety and efficacy with mul?ple boosters (of note, risk of experiencing vaccine-induced myocardi?s
is increased with the 2nd shot – does this mean greater risk of heart injury in young vaccinated men
infected with SARS-CoV-2?) – a proper risk-benefit analysis cannot be performed for those with
different risk profiles for serious disease. This makes grounds for manda?ng vaccina?on in certain
groups a poor judgement given the gaps in our knowledge at this ?me.
Where do we go from here?
We should not poli?cize health. It is highly disappoin?ng to see this is the path that has been forged with
the current Trudeau Administra?on. It is divisive and at worst dangerous because it turns away from
logic and reduces us to dogma. Original modelling had put forth a target of having 70% of the popula?on
vaccinated to come close to herd immunity for SARS-CoV-2, and we have well surpassed this target – yet
we have not succeeded in hal?ng the number of growing cases. It seems disingenuous to blame this all
on the unvaccinated, as the spread of the delta variant, across the globe, seems agnos?c to mRNA
vaccina?on status as noted previously. If going by the evidence, we ought to be re-evalua?ng our
strategy at this ?me, instead of just moving the goalpost and pugng in mandates not supported by any
credible evidence – that unnecessarily restricts and ostracizes members of our society.
One immediate move would be to make available different types of vaccines to de-risk our response to
the pandemic. Specifically – Canadians should have access to those old tried-and-true vaccines to
protect, specifically those at high risk of morbidity, that we have had decades if not centuries of
experience using (whole inac?vated and adjuvanted subunit vaccines; e.g. Covaxin and Novavax,
respec?vely). Submissions for these have already been received by Health Canada. These would serve as
beXer booster shots (if required or desired) for those who have already had COVID-19 and recovered, as
it would s?mulate a memory response to a larger repertoire of an?gens (instead of the one under high
selec?ve pressure). A good segment of the “vaccine hesitant” are wai?ng for access to these vaccines.
Despite the picture painted that the vaccine hesitant are an?-science, an?-vaxx rednecks, a study by
Carnegie Mellon University and the University of PiXsburgh found that those with a PhD are the most
“vaccine hesitant” of all (reference: hXps://unherd.com/thepost/the-most-vaccine-hesitant-educa?ongroup-
of-all-phds/); perhaps this is an aXribute of their ability to more fully grasp what cons?tutes an
effec?ve vaccine, assess their risk/benefit profile, and thus they are less suscep?ble to groupthink.
We also need to make sure we now give due aXen?on to the overall health of Canadians as it is clear
that serious COVID-19 morbidity and mortality is significantly amplified by co-morbid condi?ons. As our
popula?on ages, sustainable health care needs to include a strong component that focuses on disease
preven?on which goes beyond just vaccines. The benefit of vaccines is tempered in those with poor
nutri?on, with chronic metabolic and cardiovascular disease, and even in those who are under chronic
stressors (be they infec?ous or non-infec?ous in nature). It is thus very unfortunate that our response to
the pandemic resulted in an unprecedented increase in obesity in children in the U.S. (hXps://
www.bmj.com/content/374/bmj.n2332). This is the an?thesis of sound public health.
I hope some of the above can be used to put forth a reasoned science-based response to the pandemic
and heal the divisions it has wrought.
I would be happy to discuss/advise further if required.
Shirin Kalyan, PhD
Bio: Shirin Kalyan has a PhD in Experimental Medicine and Immunology. She is currently an Adjunct
Professor in Medicine at UBC and the Vice President of Scien?fic Innova?on at a biotech firm (Qu
Biologics – Immunotherapeu?cs & Transla?onal Research). She has over 60 published works in
Immunology, Transla?onal Medicine, Biotechnology, etc.
Background:
Educa?on
• Doctorate, Experimental Medicine (UBC)
o Doctoral Scholarships from the Canadian Ins?tutes of Health Research and the
Michael Smith Founda?on of Health Research
• Alexander von Humboldt Post-Doctoral Fellowship Awardee – Ins?tute of Immunology (CAU,
Germany)
Current Employment
• Adjunct Professor, Medicine (UBC)
• Vice President, Scien?fic Innova?on – Immunotherapeu?cs and Transla?onal Research (Qu
Biologics)
Publica?ons: hXps://www.researchgate.net/profile/Shirin-Kalyan/research