‘I would still receive another rather than no vaccine at all’: Chronically ill people left with little choice

Christopher Leighton, a retired radiation oncologist in Ontario, is among the thousands of chronically ill individuals who would have preferred an alternative to the reformulated mRNA vaccines that will become available across the country this week.

Though the most recent formulation of Nuvaxovid, the brand name for the Novavax vaccine, was approved by Health Canada for those aged 12 years and up, the federal government says it has only purchased Pfizer and Moderna’s mRNA vaccines for the fall vaccination program.

“Because I have an underlying autoimmune condition, I’ve had a pretty intense immune reaction to certain vaccines, so I was interested in exploring Novavax as an option,” Leighton says, adding that that one of the times he received an mRNA vaccine, he got a terrible fever and his arm swelled up “like a baseball” for about a week. He also experienced an exacerbation in his existing neuro-immune symptoms. “It worsened to the point where I needed to take prednisone to dampen it down.”

Though Canada will be receiving up to 19 million doses of mRNA vaccines: “Canada’s current contract with Novavax only provides access to domestically manufactured vaccines, which Novavax has been unable to confirm for the 2024/25 season,” Health Canada spokesperson Nicholas Janveau told CBC.

More than three years after Ottawa announced that it had found a partner to make domestic COVID-19 vaccines, Novavax Inc. has yet to produce any at the Biologics Manufacturing Centre in Montreal. The facility was built with nearly $130 million in federal funds and completed in the summer of 2021. Although it is unclear why the facility has yet to produce a vaccine, some experts speculate it has to do with Novavax’s inability to gain a foothold to compete with the mRNA vaccines in the global market.

When Leighton reached out to the Public Health Agency of Canada (PHAC) in late August to ask about Novavax’s availability, he was told that the government would not be purchasing the vaccine internationally due to low demand, and that “individuals who are unable to receive an mRNA vaccine should speak with their health-care provider about treatment options, including… the use of Paxlovid to reduce the duration and severity of illness.”

“I was looking forward to having a change, but obviously Paxlovid isn’t the equivalent to a vaccine and preventing an infection should be the ultimate goal of a vaccine strategy.” When Leighton shared the response from the PHAC on X, he says the reaction he received from others was “surprising.”

A quick scroll through social media reveals that Leighton is far from the only one to express a preference for the Novavax vaccine. Many people, particularly those with autoimmune conditions and other forms of chronic illness, have anecdotally reported experiencing fewer side effects, among other reasons.

“Some people may feel more comfortable with it because Novavax is similar to other childhood vaccines,” says Leighton, adding that misinformation about the mRNA vaccines have likely also contributed to the hesitation some people are feeling. “There’s just more familiarity with that type of vaccine.”

What is Novavax?

Research indicates that Novavax is as safe as the mRNA vaccines, though they are created using a different vaccine technology.

Novavax is a protein-based vaccine, which means that, like with many traditional vaccines, it contains a small amount of the protein that would be found on or inside the virus or pathogen. “It’s just a piece of the virus training our immune system to fight off the whole virus when we see it,” says Alyson Kelvin, virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan.

The mRNA vaccines on the other hand, contain the genetic code that is found inside of that protein. “Instead of growing the protein in a lab, we give the genetic code to our [bodies through the vaccine], that then use our own cells to produce that protein and train our immune systems.”

Kelvin says that a drawback to protein-based vaccines is that they take much longer to develop than the mRNA vaccines.

The 2024 Novavax vaccine targets the JN.1 variant, the variant that was dominant earlier in the year, but currently makes up less than 3 per cent of new cases. JN.1 was also the “parent” variant to the newer KP.2 and KP.3 sub variants that the mRNA vaccines have been formulated against. The KP.3 variant now makes up nearly 60 per cent of cases.

“I think it’s really important in the current vaccine landscape to give people a choice.”

Despite its decreased prevalence, various posts on X claim that the JN.1-targeted Novavax could actually be more effective than vaccines catered to target newer strains. But according to Kelvin, “it could go either way. It could be more protective because there are cross-reactive antibodies that are elicited with the JN.1 vaccine, or it could be a mismatch,” she says. “That’s something that’s really difficult to assess at this point. We just won’t know until the vaccines have been distributed and we can do efficacy studies.”

So far, a few studies have corroborated what some have shared anecdotally online – that Novavax seems to produce fewer of the already typically mild side effects, such as lower fever, fatigue and pain.

In either case, Kelvin says, people shouldn’t be concerned with taking either as any side effects are generally very mild – so much so that some studies have shown that they can even be difficult to interpret.

Despite the questions that remain about how the two vaccine types will stack up against one another, Kelvin says, “I think it’s really important in the current vaccine landscape to give people a choice.”

Still nothing from domestic manufacturers

When asked why Novavax would not be procured by the federal government this fall, PHAC told Healthy Debate that “only 5,529 doses of Novavax were administered” in Canada last year.

PHAC added that “Novavax indicated that any new procurement of internationally produced doses for the JN.1 strain by the Government of Canada would require a minimum order which far exceeds previous or projected demand.”

Leighton says that he suspects the low demand is likely in-part due to a lack of awareness. “I don’t believe my public health unit was providing [Novavax] last year, and if they were, they didn’t advertise it,” he says. “The comment I’ve heard from a lot of people is that they didn’t know where they could get it.”

PHAC also told Healthy Debate that the “provinces and territories may choose to procure the vaccine directly from Novavax from supply produced in India for their fall vaccination campaigns.”

But Leighton adds that “there’s some irony in that there’s supposedly a contract to produce Novavax in Canada that Health Canada is funding. But as far as we know, they have yet to ever produce a vaccine.”

Although there may be select stock of Novavax available in Canada despite the federal government’s decision, as of now it seems unlikely. As of Oct. 1, several provinces – including Alberta, Saskatchewan, Ontario, Nova Scotia, P.E.I. and Newfoundland and Labrador – confirmed to The Canadian Press that they will not place orders for the Novavax vaccine.

Leighton says it’s important that everyone make their own decisions based on consultations with their health-care provider.  “I feel for me it’s an educated guess and there’s no assurance my reaction would be milder [with Novavax]. It’s more of a hope,” he adds, “I’ve had around six [mRNA vaccines] at this point, and even with my history of dreadful immune responses to those, I would still receive another rather than no vaccine at all.”