A man gets a vaccination
Photo: Steven Cornfield

With a vaccine now available for children under five, boosters soon available for those five to 11, and students preparing to return to schools and universities in the midst of an ongoing pandemic, Fatima Tokhmafshan and her team want to answer all of your vaccine-related questions.

Tokhmafshan is a Montréal-based geneticist, medical doctor candidate, and director of community and patient engagement and outreach for the Coronavirus Variants Rapid Response Network (CoVaRR-Net).

The network of researchers from institutions across Canada assist the federal government in assessing how COVID-19 variants will affect Canadians and people around the world. They also find ways to detect and stop variants from spreading.

In May, CoVaRR-Net launched Motivational Interviewing to Increase COVID-19 Vaccine Acceptance (MIICOVAC). The national research pilot project and outreach program was created to increase COVID-19 vaccine knowledge and to “explore and solve” vaccine hesitancy across Canada.

People can book one-on-one virtual meetings with experts who provide reliable, up-to-date, science-based information to their vaccine-related questions.

“They (immunization counsellors) will not make the decision for you. They will not push you to make any decisions. That’s your autonomous decision to make,” Tokhmafshan said in an interview. “But they will provide a non-judgmental environment for you to just come and voice your concerns.”

A smiling woman with short dark hair and her hands in the pockets of a white lab coat and stethoscope around her neck smiles at the camera. She's standing in front of an off white wall.
Fatima Tokhmafshan Photo: Contributed

The Halifax Examiner spoke at length with Tokhmafshan about the MIICOVAC pilot project, vaccines, vaccine hesitancy, what we might expect in terms of variants this fall, how long to wait for a booster if you’ve been infected, and other related questions.

Here is our conversation, edited for brevity and clarity.

HE: Why did you believe this initiative was needed?

Fatima Tokhmafshan (FT): People think vaccine hesitancy is a new phenomenon. It’s not. Even when the first variolation (obsolete method for immunizing against smallpox) started, there were people who were printing pamphlets and then going on their soapbox and saying, ‘Oh, it’s evil,’ or ‘It’s the devil’s work,’ so vaccine hesitancy has long been there.

We knew that there would be some resistance. We knew that there would be questions, there would be anxieties. With all the information at hand, it’s people’s right to make informed decisions. Above all it’s about giving people information so that they can make the best decisions for their health autonomously. It’s not about twisting arms.

HE: Do you have any sense yet about what we can expect this fall in terms of variants?

FT: One challenge we are facing is that because testing has been reduced, we are mostly reliant on wastewater and what is circulating in wastewater.

We are keeping an eye on a number of different lineages. I want to say this to reassure Canadians that we aren’t sitting waiting for things to happen. Our team of over 90 scientists at CoVaRR-Net, this is our mission.

We are constantly monitoring what is happening in Canada and around the world so if we see something interesting pop up somewhere else, we look for it, we search for it here in terms of whether something new is going to pop out.

So far, it doesn’t look like it (anything new), but at the same time we have been surprised before. Again, it goes back to the vaccinations.

We do have our own Canadian variants, and each region and territory has their own little local lineages that are circulating. Vaccination reduces and hampers the virus’s ability to replicate, to copy itself. It’s through those copies that you get new variants.

HE: Some folks will say, ‘Why bother with vaccines? People are still getting sick. People are still transmitting it to others.’ Why should people ‘bother’ getting these vaccines?

FT: Having a vaccine that is sterilizing — meaning that 100% of the time it’ll stop infection — is a very tall order.

What the vaccine is doing, basically, is the virus particle enters your body, it enters your nostrils, or wherever. Because the person is vaccinated, their immune cells recognize it (virus) right away because they’ve seen it. It’s like preparing for an exam. They’ve studied it, they know what’s coming. They mobilize and they stop it before it gets too many copies of itself produced.

For a person who is vaccinated, they could get infected and they could transmit, but they are basically transmitting lower viral loads.

HE: Does it matter how many vaccines you’ve had? 

FT: You definitely need two doses. There’s data that shows that two doses of the vaccine gives you good protection against disease, gives you good long term memory to protect you against the disease.

But this whole thing is a little over two years, so we don’t have really long-term data for me to be able to tell you (definitively). Unlike measles or mumps, where I can tell you how many years those things are. Polio is life long. You get four shots, four doses, you’re set for life.

So that’s why it is important that while we are gathering data and understanding how long that long-term memory lasts, people should keep up to date with their vaccines.

HE: Can you talk about why we need boosters?

FT: This was a two-series vaccination and now it’s more. However, your immune system is a 1,000-piece beautiful orchestra. It’s highly complex but highly coordinated. All the pieces work together and recognize each other.

One aspect of the need to get an additional dosage is that because the virus is circulating still quite rampantly, you want to make sure that your antibody levels are high enough. That’s the arm of your immune system that reduces your chance of infection.

It’s very normal for them (antibodies) to go down, because it takes a lot of energy out of your body. You burn a lot of energy. It’s quite exhausting for you to keep pumping out antibodies long term, and it’s actually a disease state. If you have antibodies for the long term, there are a lot of immune diseases that are caused because of that. So it’s totally normal that the antibody levels go down.

But because the virus is everywhere, we want to make sure you’re reducing your chance of infection, so it’s good to be up to date with your vaccine.

HE: So based on what we know at this moment in time, what is the best timing for adults to get their boosters if they’re eligible?

FT: I would say get it yesterday, because the fact of the matter is that unfortunately, access to clinical tests have been reduced. It’s very scarce that people can go get tested.

We don’t have a very clear and vivid picture of transmission across the country right now. Some provinces are doing better than others, but for the most part, we can say it’s still quite rampant.

First and foremost, to protect yourself against the potential risks of getting sick, you should get vaccinated. Schools are starting or have started. A lot of people are back from vacation. People have travelled.

We fully expect new variants to be circulating because people have gone to different places and might have been exposed to different lineages that have been floating at other places and you’re bringing them back.

I 100% recommend people to be up to date with their vaccination depending on what is offered in your region. Even if you might be a very strong person, a very healthy person, in fairness, nobody’s invincible. I’ve seen 20-something year olds, 30-something year olds in hospital in pretty bad shape because of COVID.

Do it for yourself, first of all, for your own well-being, and then do it for the people around you.

HE: What would your advice be those who might be worried because they’ve only had one booster, they’re not yet eligible or able to get that second one, and have concerns about what that means with a possible fall wave on the horizon?

FT: I wish that our vaccination strategy overall was a little more harmonized nationally.

For most of this pandemic, really in most provinces, people are left with the biggest share of responsibility. And again, kudos to them, to most Canadians. They’ve done a fantastic job of protecting themselves and protecting their loved ones and their communities.

I would just say I understand the fatigue that might have set in as you’ve been hearing about this for over two years, but the risks are just not worth taking at this moment.

As a clinician, I don’t want to see you walk into my clinic. I care about you and I want you to be happy and healthy and living your life out there. The risks are currently not worth taking for anybody.

So if you have access to be up to date with your vaccines, please do. And if not yet, then do what you can, masking and reducing your contact when possible to remain protected.

HE: One question that comes up a lot is from people who may have recently been infected. That includes many Nova Scotians over the summer months. How long should people wait to get vaccinated after being infected with COVID-19?

FT: There are NACI recommendations so I would recommend people follow the guidelines. Generally speaking, we have over 200 years of knowledge and we know that spacing out exposures to the antigen, to the immunogen, helps with the maturation of the immune response.

You don’t want it to get too close. But because also there’s a lot of transmission happening, you don’t want to get it too far apart so that the antibodies have waned too much.

*Note: Current NACI recommendation for a booster dose after a COVID-19 infection is “6 months since previous infection unless a shorter interval of 3 to <6 months is warranted in the context of heightened epidemiological risk”

HE: What about those who question whether they even need to be vaccinated after being infected?

FT: The analogy I try to use is to imagine you’re part of a class and your teacher is helping you prepare. They hand out study material, but they hand out different study materials to different people. So a group of kids in your class get stacks of paper to study, another group gets maybe five or six pages to study, a third group gets one sheet, and a fourth group gets nothing.

That’s sort of like how infection-generated immunity works. You never know how much training your body or immune system is going to get to prepare for the test, which is the impending infection with the virus.

But the beauty of the vaccine is that we have standardized it. We are exposing everybody to the same amount of learning and teaching material. All the students in the class are getting the same amount of paper to study.

Now, it’s true that some of them will do better on the test than others, just because that’s how the human body works. There are genetic factors, your risk factors are different. Some students, despite getting the same amount of study material, might fail — those are the people who still get infected or might get a little sick.

But because we’ve standardized your immune system’s learning material, the chances of more people doing well is higher. That’s why vaccine generated immunity is better.

That’s why even if you were infected, you should still go get your third shot, fourth shot. Be up to date with your vaccine because you never know how much study material your body got.

HE: What about long-COVID concerns?

FT: We’re just scratching the surface about what are the long-term consequences. We know that, for instance, a child who gets measles if they’re not vaccinated and they end up with an infection down the road, their rashes are resolved and whatnot, but they can end up with encephalitis/inflammation of the brain and end up with a lot of long-term sort of consequences. And the same thing is true with this disease.

There’s still a lot we’re learning. But as a clinician, I look at just the molecular pathways — the thing that gets the virus out to the cells — and it scares me. And that’s one of the things the vaccine helps.

The vaccine does not fully protect you against infection. It does reduce your risk of infection, but it also prevents that severe damage that we see. It prevents severe disease, it prevents that severe damage that the virus can do.

That’s because basically your immune system has been trained. It has learned what the virus looks like, what needs to happen, and before the virus has a chance to colonize your liver and your kidneys and all those other organs, your immune system springs into action and protects you.

So that’s a very good reason, an encouraging reason, to get vaccinated to protect yourself from all those debilitating side effects.

HE: Do we yet have any idea whether vaccination actually helps reduce the risk of long-COVID?

FT: The jury’s still out, but based on everything we know about immunology and over 200 years of knowledge about how vaccination works, it’s fair to assume that vaccination will indeed reduce, can indeed reduce, the risk of severe side effects.

The whole point is that your body’s not going to be colonized as severely as if you weren’t vaccinated because your immune system is going to spring into action. That’s the whole point of it.

A graphic from a website showing colourful cartoon people online seeking information about COVID-19 vaccines.
Source: MIICOVAC project website

HE: Are there any overarching concerns people have when it comes to hesitancy?

FT: I’ve been doing vaccine hesitancy work for about a decade now and a lot of time, two things have become apparent for me.

One is that a majority of times people don’t know what exactly it is about the vaccine that they’re apprehensive about. Motivational interviewing is good in that it helps you peel layer by layer and then you get to the actual root of the problem and it usually has nothing to do with the compound. It has something to do with some peripheral experience, which is why it is very important that we understand people’s context, culture and identity to be able to help them.

The second thing I’ve figured out in all years of my vaccine advocacy is that a lot of times people just want to be heard. They just want to say out loud to somebody who has some sort of professional authority, ‘these are my worries’ and feel heard and acknowledged. Then they will be able to go and make that decision and take that step.

It’s like this for almost every other aspect of life. We shouldn’t be surprised that vaccine decision making is also like that.

HE: It’s definitely not a one-size-fits-all approach.

FT: Certainly not. The other reason this was very important for me personally to do as a racialized woman is that racialized populations and marginalized and underserved populations have borne the brunt of this pandemic. Immigrants, refugees, people that have low-paying minimum wage jobs, frontline jobs. Those are the people that we have left behind when it comes to access to health information.

Health literacy in Canada generally is low and it’s lower again if you are a racialized person, if you’re an immigrant. And it has nothing to do with education. We are a highly educated country, but health literacy, which is access to information, understanding health information, all of that is quite low in Canada.

HE: How does the MIICOVAC initiative help address that?

FT: Our immunization counsellors are diverse.The point of having a personalized approach is that you want to understand people’s context. We’re trying to be as inclusive, as diverse as possible and really meet people where they are.

HE: We’re on the cusp in many jurisdictions of having children return to school. I assume you’d like to hear from parents whose kids aren’t vaccinated yet?

FT: Absolutely. And now that the boosters have been authorized for children five to 11 years old, I would like parents who have questions to sign up and show up and talk to us about that. Ask us questions, help us clarify information, or let us just hear you out about your experience.

If you have needle phobia, if you have anything related to vaccination or even if you had a good experience and you want to share it, that you made a decision and want to share what helped you make that decision, we would be happy to hear that as well.

HE: Uptake in children still is pretty low. I assume this is a concern?

FT: It’s quite abysmal in certain provinces, certain regions, and it’s even worse if you are in remote and rural regions. There is a lot of room for improvement.

We want to make sure that kids in Canada have the best chance and the safest chance to grow up happy and healthy. And immunization, this immunization and other immunizations, help.

HE: How does it work if someone wants to have a one-on-one conversation about their own vaccinations or about vaccinating their children?

FT: It’s very straightforward and open to everybody. We try to make it as easy as possible. Basically if you’re an adult resident of Canada, regardless of your immigration status, you can go to the website, fill out a short survey so that we understand where you’re coming from and what your worries and anxieties are.

Then you’re guided to a calendar system where you book a session with a trained immunization counsellor. The sessions can last anywhere between 15 to 30 to 45 minutes, depending on what the person’s needs are. If there is a need, you might rebook a second session.

It’s a health care-related decision and I want people to feel comfortable about having a meeting with our immunization counsellors. I trained them. I know they’re highly empathetic people, and we provide them with the most up to date science. They’re great listeners and they will help you make informed decisions.

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Yvette d'Entremont

Yvette d’Entremont is a bilingual (English/French) journalist and editor, covering the COVID-19 pandemic and health issues. Twitter @ydentremont

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