Should Canada offer a booster (third) shot of COVID-19 vaccine to general public?

The Golden Gate Bridge in San Francisco, California. (Dr. Noorali Bharwani)
The Golden Gate Bridge in San Francisco, California. (Dr. Noorali Bharwani)

Majority of the Canadians have had one or two shots of COVID-19 vaccine.

As we know vaccination protects us from getting seriously ill and dying from COVID-19.

For two-dose vaccines, both doses are needed to achieve the highest level of immunity. This high level of protection is achieved two weeks after the second dose.

Common question is – Can we stop taking precautions after receiving two doses of vaccine?

No, you cannot. No vaccine is 100 per cent effective and breakthrough infections are expected.

Evidence shows COVID-19 vaccine will protect you from serious illness and death but there are exceptions to the rule. You cannot lower your guard. Public health officials are calling for more mask-wearing. There is clear evidence that breakthrough COVID-19 infections can occur in people who are fully vaccinated. This is particularly true with various kinds of emerging variants.

COVID-19 booster shots

Recently, U.S. has announced it will offer third shot of COVID-19 vaccine in September to boost up protection against more transmissible variants.

Americans will be eligible to receive a third shot of the Pfizer or Moderna vaccines eight months after receiving their second dose. Why? They noted that COVID-19 vaccines are still highly effective, but their protection against infection appears to be waning as time goes by. According to President Joe Biden, this is the best way to protect ourselves from new variants that could arise.

As of August 15, Israel reported 31 per cent rise in severe or critical COVID-19 cases. Nearly three in five of those patients were fully vaccinated. That country is now offering booster shots to people over age 50. Germany and France recently authorized booster shots for the elderly and vulnerable. Health officials in Canada, meanwhile, have yet to authorize a third dose for the immunocompromised.

A study in Israel has shown third dose of Pfizer’s COVID-19 vaccine has significantly improved protection from infection and serious illness among people aged 60 and older.

One study published in the Centers for Diseases Control and Prevention weekly report (August 27, 2021) found the protection against infection offered by the Pfizer and Moderna vaccines dropped from 74 per cent in the spring to 53 per cent this summer.

A New York study showed people who received the Johnson & Johnson vaccine likewise reported a drop in protection against lab-confirmed infection from 92 per cent in early May to 80 per cent in late July.

Where does Canada stand on booster shots?

Health Canada has not authorized a three-dose regimen for any of the COVID-19 vaccines.

Canada’s National Advisory Committee on Immunization has not yet made a formal recommendation on COVID-19 booster shots.

Ontario is going to offer third dose of vaccine to individuals whose immune systems are compromised and for individuals in high-risk retirement homes.

Many experts feel third dose should be offered to venerable people only. Not to the general public. In Canada, it would be premature to offer third shot to the general population. The aim should be to improve overall vaccine uptake. That would offer greater community protection than giving third booster shots to vaccinated healthy people.

I am sure vaccine experts and people helping governments make vaccine decisions are struggling with this question: Is it ethical for rich countries to offer third dose of vaccine to their citizens while the poor countries are waiting to get vaccines for their people? What do you think?

Take care. Be safe. Besides being fully vaccinated, wearing a mask and washing your hands regularly continues to be important.

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Understanding COVID-19 Vaccination Program

Phoenix, Arizona (Dr. Noorali Bharwani)
Phoenix, Arizona (Dr. Noorali Bharwani)

Finally, COVID-19 vaccines have arrived in Alberta. The lineup has begun and the process will take a few months to complete. This is happening in phases so people most at risk get it first. We just have to be patient and wait our turn.

COVID-19 vaccines are safe, effective and save lives. The vaccine helps prevent you from getting infected and protects you from getting severely sick if you do get it.

There are at least seven different vaccines. The first mass vaccination programme started in some countries in early December 2020 and as of February 15, 2021, 175.3 million vaccine doses have been administered.

Canada has approved three vaccines: Moderna COVID-19 vaccine (efficacy rate 94 per cent – need two doses), Pfizer-BioNTech COVID-19 vaccine (efficacy rate 95 per cent – need two doses) and recently approved AstraZeneca-Oxford University COVID-19 vaccine (efficacy rate of 62 per cent – need two doses).

While AstraZeneca vaccine is less effective than the Pfizer-BioNTech and Moderna vaccines at preventing infection, the shot is 100 per cent effective in preventing the severe outcomes of COVID-19 — including serious illness, hospitalizations and death.

This is better than not having a vaccine. Same principle applies to flu vaccines. They are never 100 per cent effective. Flu vaccines, which differ each year depending on the flu strain in circulation, are typically 54 to 64 per cent effective, yet they are widely used to offer some level of protection to more people.

Other advantage of AstraZeneca vaccine is, unlike the other two vaccines which require freezing facilities, AstraZeneca does not require the same cold storage equipment necessary for the other two. The product can be stored and transported at normal refrigerated temperatures of 2 to 8 C for at least six months. This vaccine also can be easily administered in traditional health care settings, like a doctor’s office or pharmacy.

Government of Canada is expecting more supplies of vaccines and by Canada Day several million people will be vaccinated. That is the plan. The plan is to prevent serious illness, reduce hospitalizations and reduce the number of deaths.

What about the second shot of the vaccine? It will be after four to 12 weeks. Most likely 12 weeks. I don’t think the final decision is out yet but early evidence suggest it’s best to wait the full 12 weeks to deploy the second shot.

How long does the immunity last? It’s too early to know. Research is ongoing to answer this question. You should continue to use face mask and avoid close contact and practice good hygiene.

COVID-19 vaccine and other vaccines: Spacing recommendations from the National Advisory Committee on Immunization (NACI) has published the following recommendations:

  • COVID-19 vaccines should not be given simultaneously with any other vaccines.
  • Wait for a period of at least 28 days between the administration of the complete two-dose schedule of COVID-19 vaccine and the administration of another vaccine (except in the case where another vaccine is required for post-exposure prophylaxis). This includes refraining from administering other vaccines between the first and second dose of COVID-19 vaccine.
  • Wait for a period of at least 14 days after the administration of another vaccine before administering a COVID-19 vaccine.

Take care and be safe.

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Parotid Gland Abscess

Abscess over the left parotid gland area. (Dr. Noorali Bharwani)
Abscess over the left parotid gland area. (Dr. Noorali Bharwani)

46 year-old female presented with a two-week history of an abscess over the left parotid area. The patient reports an abscess in the same location 18 months prior which she had aspirated. She has a medical history of Sjögren’s syndrome.

The patient had finished a course of amoxicillin-clavulanic acid and then was started on a course of a cephalosporin. Incision and drainage was done under local anesthetic and a large amount of pus was drained. The patient healed well.

Culture: Streptococcus anginosus

Streptococcus anginosus is part of the human bacteria flora, but can cause diseases including brain and liver abscesses under certain circumstances.” (Wikipedia)

Pathology: Showed no parotid tissue. There was acute-on-chronic inflammation of subcutaneous tissues.

Salivary Gland

Infection: parotitis, sialandenitis

Symptoms – One-sided salivary gland swelling. Fever and pain will accompany the swelling.

Pathogens – Typically normal bacteria found in the mouth. Viral infections such as mumps often affect the salivary glands. Mumps most often involves parotid salivary gland. Mumps is a rare problem today because of the MMR vaccine.

Dehydration and malnutrition raise the risk of getting a bacterial infection.

Sjögren’s syndrome

This is a chronic autoimmune disease in which cells of a person’s immune system attack the salivary and other moisture-producing glands, leading to dry mouth and eyes. About half of people with Sjögren’s syndrome also have enlargement of the salivary glands on both sides of the mouth, which is usually painless.


In some cases, no treatment is needed.

Antibiotics for fever or pus drainage, or if the infection is caused by bacteria. Antibiotics are not useful against viral infections.

Surgery or aspiration to drain abscess.

Self-care steps that can be done at home to help with recovery:

  • Practice good oral hygiene. Brush teeth and floss well at least twice a day. This may help with healing and prevent infection from spreading.
  • Rinse mouth with warm salt-water rinses (1/2 teaspoon of salt in 1 cup of water) to ease pain keep the mouth moist.
  • Stop smoking.
  • Drink lots of water and use sugar-free lemon drops to increase the flow of saliva and reduce swelling.


Most salivary gland infections go away on or are cured with treatment. Some infections will return. Complications are uncommon.


  • Abscess of salivary gland
  • Infection returns
  • Spread of infection (cellulitis, Ludwig’s angina)


In many cases, salivary gland infections cannot be prevented. Good oral hygiene may prevent some cases of bacterial infection.

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Measles is a Highly Contagious Viral Infection of the Respiratory Tract

Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)
Cacti on a golf course in Scottsdale, Arizona. (Dr. Noorali Bharwani)

Measles is making bad news. It seems to have started in Disneyland. A place where kids go for fun. How ironic and sad. And it has spread to several states in the U.S.

According to Centers for Disease Control and Prevention (CDC) website, 50 people from six states were reported to have had measles in the first two weeks of this month. Most of these cases are part of a large, ongoing outbreak linked to Disneyland in California.

According to CBS news (January 22, 2015), at least 75 people have now been infected with measles virus. The California public health officials are urging those who haven’t been vaccinated against the disease, including children too young to be immunized, to avoid Disney theme parks.

Age of people infected ranges from seven months to 70 years old, including five Disneyland workers.

Measles spreads through the air through coughing and sneezing. It starts with a fever, runny nose, cough, red eyes, and sore throat, and is followed by a rash that spreads all over the body. About three out of 10 people who get measles will develop one or more complications including pneumonia, ear infections, or diarrhea. Complications are more common in adults and young children.

Alberta had a measles outbreak last year. On April 29, 2014, Alberta Health Services declared a measles outbreak in the Calgary, Central and Edmonton Zones of Alberta Health Services (AHS). By July, AHS declared the outbreak to be over.

The best way to prevent measles is to have Measles-Mumps-Rubella (MMR) Vaccine. All health care workers should be vaccinated with two doses of the vaccine. Health care workers are at greater risk of measles infection than the general population because they provide care for ill individuals. A recent review concluded that health care workers were 13 to 19 times more likely to develop measles than other adults.

MMR vaccine is highly effective at preventing measles. One dose is 85-95 per cent effective and the effectiveness of two doses approaches 100 per cent. Two doses provide long-lasting immunity. The vaccines are very safe.

Measles was eradicated by year 2000 because of vaccination. But the virus has made a comeback in recent years, in part because of people obtaining “personal belief exemptions” from rules that say children must get their shots to enroll in school. Others still believe in now-discredited research linking the measles vaccine to autism.

Who started the current outbreak? Should we blame people who refuse to get vaccinated because they believe it is harmful to their children? Apparently, a small number of those stricken had been fully vaccinated. It is also reported the outbreak was triggered by a measles-stricken visitor to one of the Disney parks who brought the virus from abroad last month.

Coughing and sneezing spreads the highly contagious virus. Deaths are caused by complications associated with the disease. Complications are more common in children under the age of five or adults over the age of 20.

There is no specific antiviral treatment. Mostly symptomatic treatment is provided for symptoms and complications. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive. It costs approximately one U.S. dollar to immunize a child against measles. And it saves lives.

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