Some British Columbians can expect an invitation to book their fall COVID-19 booster shot at the end of this week, as the province rolls out its immunization plan for the new Moderna bivalent vaccine. 

This new booster shot targets both the original SARS-CoV-2 strain and the Omicron BA.1 variant, and was the first bivalent shot to get Health Canada approval last week. 

“We still have a very uncertain trajectory of the pandemic in the next few months,” provincial health officer Dr. Bonnie Henry said Tuesday. “We are not yet at a point where we can let our guard down, both here and globally.”

Though the bivalent vaccine approved for use in Canada targets Omicron’s BA.1 variant, Henry said clinical trials (also cited by the National Advisory Committee on Immunization) have shown the booster to be similarly effective against BA.4 and BA.5—the most prevalent lineages of COVID-19 in Canada at the moment.

People aged 18 or older, and immunocompromised children aged 12 to 17 are eligible to get the bivalent vaccine, based on NACI’s recommendations. 12 to 17 year olds who don’t have other risks can get a regular, unmodified COVID-19 vaccine as their fall booster shot.

As with previous vaccine rollouts, invitations to book a shot will first go out to people in the highest risk categories. This includes people living in long term care and assisted living facilities, shelters and other congregate living arrangements, immunocompromised and people with chronic conditions, First Nations adults, healthcare workers, and people older than 60.

BC is also following NACI’s guidance on the timing of booster shots: they can only be booked six months after the last dose, and are recommended at least three months after prior infection.

The bivalent vaccine rollout will begin in pharmacies first—517 pharmacies across BC are expected to get the first shipment of the vaccines at the end of the week—followed by vaccination centres operated by health authorities. At peak, about 1,100 pharmacies are expected to participate in the rollout.

According to Dr. Penny Ballem, head of the province’s COVID-19 immunization plan, there will be a capacity to vaccinate between 250,000 to 280,000 people per week, for about 10 weeks starting mid-September.

COVID-19 is not the only virus on public health’s radar: the province is also preparing an immunization campaign for influenza shots, in anticipation of a difficult fall and winter season for the impact of respiratory illnesses on the healthcare system.

“Looking at what happened in Australia and New Zealand, we see that influenza [was] a particularly bad season last year for them and it came early,” Henry said. “So what we're planning for…is how [to] best protect people from influenza [and] from COVID at a time where they both might be circulating.”

Starting in October, people will be able to get their influenza shots at the same time as their COVID-19 booster, as a step towards reducing the amount of severe respiratory illnesses in BC in the last two months of the year.

Public health measures unlikely to return

The province’s public health leaders are also expected to share an update next week on how they plan to monitor and report data on COVID-19 and other respiratory illnesses this fall. 

When asked what level of infection or other metric would trigger a resurgence of public health measures, Dr. Henry reiterated her stance on the subject: they are a last resort.

“I don't see us getting there unless we have the emergence of something very different, where we have that susceptibility again,” she said. 

According to her, measures like mask mandates, physical distancing, and business and school closures are no longer needed because of the level of population immunity there now is against the virus, thanks to vaccines. 

As of July 31, about 85% of people aged five and older have had two doses of vaccine, and about 54% have had three shots.

BC’s strategy focuses on vaccinations to reduce the severity of the illness rather than stopping the spread of the virus in the first place, with public health measures that used to be in place. Without these measures, the highly transmissible Omicron variants have caused three waves of hospitalizations and deaths this year. 

At the peak of the most recent wave of Omicron infections across BC this summer, there were about 400 people in the hospital with COVID-19—as of Sept. 1, there are 306 people in the hospital and 25 in ICU.

The number of deaths linked to this most recent wave is still on the rise, according to the most recent data, with about eight people dying each day across the province, as of Aug. 31. 

Studies have also found that BC underreports the number of COVID-19 deaths by about 50%, and has more excess deaths than any other province in the country. 

In the absence of other public health measures, UBC professor, infectious disease modelling expert and member of the independent BC COVID-19 modelling group, Sarah Otto said the key for people hoping to avoid getting infected is to get a booster shot right before the next wave begins, since immunity from booster shots is proven to start waning four months after it’s administered.

“If you have a choice and boosters available to you, then taking that booster does three things: it reduces the chance that you get COVID; it reduces the chance that you have these long COVID risks that we don't even document very well; and it's one [fewer infected] person so that reduces the transmission [risk] from person to person,” Otto told Capital Daily in June. 

“The disadvantages are that it takes some time to go and bother to get a booster.”