Changes at Healthy Debate

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  • Steven Diamond says:

    This is a plea for many forgotton Canadians. People who are now falling through the cracks of the covid-19 vaccine distribution race. The original criteria, while most regular Canadians waited their turn, was that all medical workers would get it first, for obvious reasons. Also, people in old-age homes, and older-aged outpatients with underlying conditions. And, all of the essential service workers and those at risk because they work with the public. All of this, the absolute right thing to do. Then, we finally got some public vaccine in our anxious Canadian hands. So, as much from need as from curiosity, I read a government news release in early March about the new criteria for the general public. I live with my brother in Ottawa. He is 81-years-old, and I am 66-years-old. The news release, reported through the news media, states that, of course, the oldest of us will get it first; so, my brother would get it right away in March because that’s when 80-year-olds were eligible, and I would get mine in June, because I was only a youngster at 66. Okay, that made sense… if you are only going by age, alone. Problem is, my brother and I both have long-term chronic kidney damage and diabetes; conditions that do not bode well for catching covid-19. My brother, fortunately, just got his first Pfizer vaccine, near Ottawa, yesterday (April 5th). But, I don’t believe that a 66-year-old with chronically severe underlying conditions such as diabetes and kidney damage should have to wait for his first shot in June. I should be able to get my first one right away from the same place my brother got his. He is 81, I am 66, and, in my opinion, we are in the same vaccine category. I say this not only in self-interest, I say this for every Canadian with a potentially deadly underlying condition who is still waiting for his or her first shot simply because they are in a younger age bracket. 

    I have looked for any new information, any sign from the government, about when those in my predicament can get their first shot earlier, too. I can only freefall, along with everyone else – at any age – with a potentially deadly chronic condition who hasn’t had his or her first Covid shot yet. 

    But, that’s only the first crack we are falling through. 

    The second, more recent crack that has opened up, is for the people who have had, or are about to get, their first vaccine. The government is now telling them that their second scheduled shot will be delayed from the recommended twenty-one days, to sixteen weeks. That’s why my brother’s second vaccination appointment is on July 26, rather than April 26.

    Every expert on the planet, besides Canada and the UK, agrees that the time limit for the second dose should be 21 weeks later, or at the very outside, 28 weeks, in order for the vaccine to be completely effective, or even effective at all. Canada is stretching out the delay to allow as many people as possible to get a first dose right away. This comes from the government screwing up the distribution of vaccine in the first place, resulting in there not being enough of it here to allow for two doses within three-to four weeks. So, they stretched it out to 16 weeks for the second dose to make up for the shortfall, claiming – until very recent protestations from the scientific and medical communities – that it is better for more people to get the first shot to immunize more people more quickly. They apparently thought – seemingly in an ad-hoc way – that it would be safe to delay the second dose from three weeks, to four months. But, both the medical and scientific communities in Canada and the US, say there is more evidence showing that if the vaccine is delayed more than the 21 to 28 days originally prescribed, the efficacy of the first shot is completely wasted, and a vaccinee will have to start all over again. Not only that, but without getting the second dose on time – within three to four weeks of the first one – the efficacy of the first shot is only 50%, and any protection it provided fades away quickly, leaving the recipient unprotected once again. All the major news outlets here in Canada now relay updated reports from the medical and scientific experts, pleading with the government that delaying the second dose of the vaccine is not just wrong-headed. It could be deadly.

    So, with another covid-19 surge possibly rearing up, and the federal government saying it will have another update in a couple of weeks or so, I am not willing to hold my breath and wait for politicians to figure it all out – both for my life, and for my brother’s. Therefore, my question is a life-or-death one: Can my brother, 81, who just got his first shot yesterday, April 5th, get his second one on time in 21 days in the US, maybe just across the Ontario-New York border? Or, anywhere else in the US, Canada or the world for that matter? Is that a possibility? I believe that Ontario health coverage has a policy with its OHIP plan that, in the event of not being able to receive a covered medical service or procedure in this province, an Ontario resident can go outside the province for said treatment. And, if an Ontario resident has to pay for that medical service if it is in, for example, the US, then OHIP will reimburse that Ontario resident. Am I still correct on this? Finally, to save my brother from getting covid-19, and most certainly dying from it because the government says he can’t have the second dose until 4 months from now, I will do everything in my power to prevent that from being his fate and allow him to get his second vaccine within the medically recommended time frame of 21 days. I, as yet, have not received my first vaccination. But, I would like to do so as soon as possible, and then I myself would go to the States or anywhere else to get my second shot in the recommended time frame in order to save my life should I get covid-19. Does anyone reading this have any suggestion(s) or knowledge that would help? Or, any ideas who to direct me to, or who I could talk to, to get this information? And, it will not just help my brother and me. It will help everybody else in our situation, and there are a whole lot of people out there who have been told they have to wait 16 weeks to get their second shot. This is unconscionable, given the powerful scientific and medical evidence. So, I am planning to go to the media with my personal query, because this is a life-and-death situation. As the first wave of vaccines is put into people’s arms, we all have to move on this immediately because 21 days is not a lot of time for the government to move. As far as speaking to my family doctor, as I’m sure someone will suggest? I will speak with her tomorrow – but my hopes aren’t high in that direction, I know her. She’s likely to say, “Wait for the government to update the situation”. Plus the fact that my doctor’s office still says, in a recording, that it will not be offering the vaccine. Maybe that has changed – everything is changing quickly these days – but I want to hedge my bets, frankly, when it comes to my brother’s life, and to my own life, as well. I know we all do. This is my particular plea. Let’s do this together, and get moving on this!

    Thank you, 
    Steven Diamond

  • Tamara Mcdonald says:

    I’m really looking forward to read more on this topic.

  • Cathie Hofstetter says:

    Congratulations to you both! Andreas, I hope that our paths will continue to cross in the future as you are one that really gets the impact value of adding the patient’s voice to the discussion. Seema, I wish you all the best and will continue to follow Healthy Debate.

  • Shawn Tracy says:

    Yeah, what Duncan said! LOL
    Seema & Andreas: congrats to you both on your new roles… best wishes and God speed!

  • Duncan G. Sinclair says:

    Thank you, Andreas and colleagues, for initiating Healthy Debate and supervising its informative work since inception. Although not a subscriber, I look forward to what I am sure will be your positive, forward-looking impact on the CMAJ. And Seema, congratulations. You are charged with filling a big pair of shoes. I wish you well and look forward to continued good things from Healthy Debate. As “social media” continues to replace newspapers, journals, and other publications with editors charged with ensuring that the material they publish is backed up with credible evidence and real, as opposed to “alternative” facts it may well be that Healthy Debate (along with others) will become ever more important to inform truthfully public opinion.

    • Peter Walker says:

      As always, Duncan Sinclair has nailed it. Congratulations Andreas and best of luck at the CMAJ. Your legacy at ICES and then Healthy Debate is extraordinary, not to mention all of the other things you have done so well during your career. The CMAJ will benefit enormously from your leadership and insights.

      My best to you Duncan.

    • Ronald Worton says:

      Thanks Duncan for putting my thoughts into words. Andreas continues to shine in each role he takes on and the CMAJ will be the newest beneficiary. Congratulations to Seema, and best of luck in the new role.

  • DonTaylor says:

    Best wishes in your new role, Andreas. And best wishes to Seema in keeping Healthy Debates focussed on cutting through the clutter of healthcare discussions.

  • Michelle Stasiuk says:

    Cngratulations Seema! A huge thank-you Andreas for your time over the last many years. Healthy Debate is a brilliant forum. I appreciate all your time and energy. Best of luck to you!

  • Phil says:

    I hope a change in leadership brings with it a less MD-centric, self-indulgent approach to articles, and amplification of the full breadth of interprofessional voices.

  • Steve Orsini says:



Seema Marwaha


Seema Marwaha is a general internal medicine physician, educator, researcher and journalist in Toronto.

Andreas Laupacis

Editor-in-chief Emeritus

Andreas founded Healthy Debate in 2011. He is currently the editor-in-chief of the Canadian Medical Association Journal (CMAJ)

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