Time frame: 2020-2022

Overview:
Not long after the World Health Organization declared COVID-19 a pandemic, Dr Natalie Prystajecky and Dr Melissa Glier, who had already been studying viruses in wastewater since 2018, were able to quickly leverage an existing collaboration, methods, and equipment for testing enteric viruses in wastewater to be able to test for SARS-CoV-2, the virus that causes COVID-19. Recently adopting an alternative sampling method that allows to test wastewater from an entire community, their team is also working on a method to test wastewater as it exits a building, thus providing key information on how COVID-19 is being spread throughout and among BC communities.

Results:
Funding for their work allowed Drs Prystajecky and Glier’s team to optimize their methods and test for SARS-CoV-2 in five wastewater treatment plants in Metro Vancouver, covering nearly 50% of BC’s population, along two regional health authorities. Weekly reports are shared with medical health officers and epidemiologists within regional health authorities, BC Centre for Disease Control staff, and Metro Vancouver.

Their collaborations have extended to the development of a three-day rapid sequencing method to effectively track COVID-19 variants of concern within a region, and key findings from their studies have been published in the Journal of Environmental Sciences and the American Society for Microbiology, with more to come. With the Omicron variant, wastewater testing has become a critical and necessary component of SARS-CoV-2 monitoring and surveillance.

Rapid SARS-CoV-2 Vaccine Research Initiative in BC

Time frame: 2021-2022

Overview:
In a new and unique partnership with Genome BC and Michael Smith Health Research BC (formerly the Michael Smith Foundation for Health Research), we funded nine new rapid-response vaccine research projects addressing COVID-19 vaccine research priorities and knowledge gaps. This funding program was developed and implemented in real-time, enabling us to get funding to critical research projects rapidly in order to have high-impact on vaccination roll-out for BC. Collective funding of around $1.3M is allowing for vaccine research that ultimately focuses on public health response and ensuring access to, and confidence in, vaccination programs for everyone in BC.

More specifically, the projects funded address areas such as:

• vaccine breakthrough infections;
• vaccine effectiveness in the context of Variants of Concern and in immune response;
• viral transmission;
• equitable distribution;
• vaccine acceptance and attitudes towards vaccines; and
• vaccine literacy and hesitancy among people who are pregnant or breastfeeding, people who are incarcerated, people who work in long-term care homes and a variety of multicultural communities in the Lower Mainland.

For a summary of the projects, go here.

Results:
We’ll continue to share outcomes of this research as these projects progress. You can stay connected on project updates by visiting this page and subscribing to our newsletter.

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The introduction of vaccination for COVID-19 was a game-changing moment in our pandemic, and equally important was the immediate launch of research to study the new vaccine technologies, and to monitor the effectiveness of SARS-CoV-2 vaccines in the real world and in real time.

Through one of the most critical COVID-19 projects we are funding, Dr Danuta Skowronski, Epidemiology Lead, Influenza & Emerging Respiratory Pathogens at the BC Centre for Disease Control (BCCDC), is leading this novel and real-time vaccine effectiveness research. Vaccine effectiveness (VE) looks at strength, durability, and interchangeability (protection offered when mixing vaccines), among other factors, and allows researchers and public health experts to learn about vaccines in real-world populations (this is different from efficacy, which is based on clinical trial data).

VE monitoring is critical in guiding vaccine policies and programs (e.g., target populations, intervals between doses, number of booster doses), and it is this monitoring that informs changes to vaccine programming and evidence-based decision-making, especially in relation to variations in pandemic waves and variants of concern (VOC).

Early work included reporting of the strength and duration of SARS-CoV-2 vaccine protection against infection, including emerging VOC and serious outcomes. This included:

• Single-dose effectiveness in healthcare workers and long-term care facility residents;
• Comparing mRNA vaccines versus AstraZeneca effectiveness in younger adults;
• The strength, durability, and interchangeability of two-dose VE including mixing different types of vaccines and extended intervals between doses.

Early findings demonstrated:

• The mRNA formulations gave higher protection against infection compared to AstraZeneca, but both provided excellent protection against severe outcomes.
• An AstraZeneca dose, plus a single dose of an mRNA vaccine in a mixed two-dose schedule, is as effective as two mRNA doses.
• Protection was better with a longer interval between first and second doses, and that the decision to extend the interval between first and second doses in BC not only brought first dose protection to more people more rapidly, but it also may have resulted in better responses to one’s second dose.

Recent findings are demonstrating that:

• Two-doses of vaccine provided protection against the Delta variant in both teens and adults.
• As we transitioned from Delta to Omicron, VE against infection decreased, but against hospitalization it remained comparable.
• With the rise of Omicron in December 2021, two-dose protection against severe outcomes was also well-maintained in adults.
• A third vaccine dose boosted protection from Omicron for adults, but less so than for Delta, and offered comparative protection against hospitalization.
• The incremental value of booster doses during times of low incidence (not in a ‘wave’) needs further study.

Perhaps you’ve learned about some of these findings in Dr Henry’s modelling updates, demonstrating why research like this is vital to the progression of the COVID-19 pandemic, to our understanding of vaccination, for decision-making around vaccine programming, and to care for our population as we experience differing waves or periods of high incidence versus low incidence.

Both early and recent findings, as well as continued findings as this work progresses, have been, and will continue to be, used to guide decisions for vaccination in BC. With the loosening of public health restrictions, and the transition to weighing one’s own personal risk and self-management (going at your own pace), vaccination will continue to be critical in our ability to protect ourselves and others from COVID-19.

For vaccination to continue to offer this protection, we have to understand how the evolution of SARS-CoV-2 impacts vaccines and how well they work—across all age groups, in all settings, and against new VOC. Ongoing monitoring of VE is critical to assess: potential waning of vaccine protection; impact of booster doses; protection in children; and with continued evolution of VOC, evaluating the strength, durability, and interchangeability of vaccines is an ongoing need for all target groups.

For this reason, we are partnering with the BC Ministry of Health, the BCCDC, and private donors to ensure this research can continue to provide critical evidence, for as long as our pandemic continues to impact BC, and the world. It is research like this that has been shaping our pandemic response in BC, and saving lives; and it is research like this that will ensure we keep everyone protected as we look ahead and learn to live with COVID-19 as safely as we can.

Vaccination remains our strongest tool in our toolkit, and we need to understand vaccine effectiveness in real-time and continue monitoring and providing evidence for decision-making. Findings from this research have already had substantial impacts on public policy provincially, nationally, and internationally. If you’d like to support this work, you can donate via our Emergency Response Fund.

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“Now, more than ever before, British Columbians recognize and value public health leadership, and the need for us all to share responsibility for protecting the health of our population. By partnering with MSFHR and Genome BC, we can share the responsibility of funding vaccine research and ensure we’re keeping our population safe and well.”

Kristy Kerr, Executive Director, BCCDC Foundation for Public Health

The main goal of this provincial initiative is to fund BC-based research solutions in priority areas that will have significant potential for fast impact on the COVID-19 pandemic in BC.

The objective is to address questions such as:

• What is the long-term effectiveness of vaccination in preventing illness and infection and reducing transmission?
• What can we learn about the immune response to vaccination using real world data?
• What concerns do people or communities in British Columbia have and how can we counter misinformation?
• How can we overcome barriers to equitable distribution?
• How could new considerations, such as Variants of Concern, affect implementation strategies?

To guarantee real and immediate impact, we also partnered with the Academic Science Health Network to ensure engagement with public and patient populations was embedded within the research, and Population Data BC to support key access to data needs in a timely fashion. These two key pieces will help researchers to ensure that their results can have the intended impact—real-time results to provide solutions to vaccine questions that will advance COVID-19 vaccination in BC.

The projects represent a range of studies, all with an emphasis on addressing urgent issues; at their core they all focus on our public health response and ensuring access to and confidence in vaccination programs for everyone in BC. It’s critical research such as this that has, and will continue, to address COVID-19, and help us get closer to putting an end to our pandemic in BC.

With a collective funding allocation of around $1.3M, this initiative is able to support 9 research projects that will address areas such as:

• vaccine breakthrough infections;
• vaccine effectiveness in the context of Variants of Concern and in immune response;
• viral transmission;
• equitable distribution;
• vaccine acceptance and attitudes towards vaccines; and
• vaccine literacy and hesitancy among people who are pregnant or breastfeeding, people who are incarcerated, people who work in long-term care homes and a variety of multicultural communities in the Lower Mainland.

This is collaboration at its best—when we authentically work together with a shared goal and vision the impact is clear—Genome BC and MSFHR are essential research funding organizations in BC, and by joining forces we will move the dial on vaccine research much faster.

We’d like to thank Genome BC and MSFHR for their commitment to supporting critical research in BC, and for their willingness to work together to help combat the COVID-19 pandemic.

Project summaries:

Daniel Ting, UBC
Vaccine Effectiveness of Variants in British Columbia
The Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) has harmonized data collection for COVID-19 tested patients across 50 emergency departments in 8 provinces, including BC. This new project will leverage CCEDRRN’s existing and growing registry infrastructure to determine the real-world effectiveness of vaccines in BC in reducing severe COVID-19, as documented by emergency admission. Research efforts will specifically focus on vaccine effectiveness against the P.1 Variant of Concern circulating in BC, and on effectiveness of a single dose to assess outcomes of Canada’s dose delay. This study will provide critical real-world data about vaccine performance and support key study sites in the Lower Mainland.

Zabrina Brumme, Simon Fraser University (SFU)
COVID-19 vaccine immune response with HIV
This project will evaluate the magnitude and duration of COVID-19 vaccine immune response over time in persons with and without HIV (control). Laboratory analysis investigating both antibody and cellular immune responses will also consider recognition of emerging Variants of Concern. This study also includes looking at socio-demographic and other correlates of immunity differences to try to help direct public health response around handling vaccination for individuals living with HIV and, potentially, other immunocompromised individuals.

Agatha Jassem, UBC, BC Centre for Disease Control
COVID-19 SMILES – the study of vaccine escape mutants
Vaccine escape mutants have the potential to undermine the effectiveness of the global vaccination campaign against SARS-CoV-2. The team will develop a surveillance program to detect and sequence viral variants emerging from vaccine breakthrough infections. These mutants will be tested experimentally to understand their responsiveness to vaccine-induced immunity, and modeling will be incorporated to project the impacts of vaccine escape mutants on transmission and pandemic progression in BC.

Catherine Hogan, UBC, BC Centre for Disease Control
VITAL: Vaccine Investigation of Transmission Analysis Longitudinally and Effectiveness
This project will integrate data sources to investigate (1) the impact of SARS CoV-2 vaccination on viral load and subsequent infection transmission at a population level and (2) the characteristics of individuals who have post-vaccine breakthrough infections with and without Variants of Concern. The outcome of this work will be to understand the vaccination scenarios most likely to effectively halt transmission in BC, and to help plan and prioritize public health interventions.

Sofia Bartlett, UBC, BC Centre for Disease Control
Advancing COVID‐19 vaccines in BC Prisons
A previous COVID-19 study in BC Provincial Correctional Centres in January 2021 identified that COVID-19 vaccine acceptance among people who are incarcerated (PWAI) was low, with only 59% (181/308) of PWAI surveyed indicating they would accept a COVID-19 vaccine if offered. To increase COVID-19 vaccine confidence among PWAI, the team will undertake a community-based study including PWAI in the research design process and as peer educators. Quantitative surveys will be developed with PWAI, then deployed to determine current vaccine literacy levels and concerns about COVID-19 vaccines among PWAI. Using this data, educational resources will be co-developed with PWAI, and peer-educator training provided to PWAI.

Julie Bettinger, UBC, BC Children’s Hospital Institute
COVID-19 South Asian Community Response Study
Statistics Canada estimates South Asians are 50-60% less likely to get a COVID-19 vaccine due to misinformation and fear of adverse events. Our study will identify the information needs, values, beliefs, and experiences related to COVID-19 vaccination among ethnically South Asian communities in the lower mainland of British Columbia and develop culturally appropriate communication interventions to promote COVID-19 vaccination.   

Marie Tarrant, UBC Okanagan
COVID-19 vaccine hesitancy in pregnancy, breastfeeding, and parenthood
Limited data on COVID-19 vaccine developments for pregnant and breastfeeding persons as well as for children may increase vaccine hesitancy in Canada. To counter misinformation and promote vaccine uptake, this project will examine vaccine hesitancies and concerns among people who are (or planning to be) pregnant or breastfeeding and parents with young children in BC. Quantitative and qualitative data will be collected to examine COVID-19 vaccine knowledge, concerns, and vaccine hesitancy to assist in developing knowledge mobilization materials for these groups. A deeper understanding of these communities’ hesitancies will allow us to create tailored resources for these priority populations to promote vaccine acceptance.

Katelin Albert, University of Victoria
What British Columbians Know and Think about COVID-19 and Vaccinations
This research investigates Southern British Columbians’ concerns, opinions, and attitudes towards COVID-19 vaccinations and public health initiatives, and what contributes to these beliefs. In order to combat misinformation and vaccine hesitancy, this project will uncover what information people have, what they do with that information, and how it influences their attitudes towards vaccination. From those insights, these efforts will contribute to revealing the relationships between people’s views of personal and public safety, their attitudes towards vaccination, their behaviours during this pandemic, and the daily stressors and mental health needs that might lead them to draw on misinformation or adopt risky behaviours.

Valorie Crooks, SFU
The INFORM Study
The COVID-19 pandemic has created a crisis in long-term care. In Fraser Health, there have been 105 outbreaks and 426 deaths across its 85 long-term care facilities. Even with the arrival of vaccines, challenges still exist for this sector and this project will address the emerging challenge of concerningly low rates of vaccination among long-term care staff in Fraser Health. This team of researchers and integrated end-users will tackle this problem by developing and disseminating tailored informational tools through a two-pronged qualitative approach. The tools will also be more widely distributed throughout British Columbia using engaged end-user networks.

The post A New Partnership to Fund Priority Research on COVID-19 Vaccination in BC appeared first on Pacific Public Health Foundation.

COVID-19 Vaccine Roll-out

COVID-19 vaccine development has been unprecedented, with researchers working day and night to develop, test, seek approval for, manufacture, and now distribute vaccines across Canada. The timeline of this work has been incredible and has shifted the tide of the pandemic towards a brighter future.

While we all must continue to use all our layers of protection (handwashing, mask-wearing, physical distancing, etc.), the introduction of novel vaccines and roll-out plans, have offered us all hope in a dark time. However, this will take some time; it will be many months before everyone in BC is vaccinated.

We can, and must, learn during this time, and moving forward. It is imperative we gather evidence that will help us through the rest of this pandemic and vaccination program, and importantly to prepare for any future threats.

In other words, now is the time to invest in and learn more about this new phase of the global pandemic.

Why do we Need Vaccine Research?

The work that has been undertaken to bring vaccines to the people is not a question; however, understanding the effectiveness (how well a vaccine works in real-world conditions) and immunogenicity (the ability of an antigen (i.e., vaccine) to provoke an immune response in an individual) of the vaccines remains.

In addition, logistical challenges and vaccine hesitancy require research, and we must assure equitable distribution to priority populations, which requires new knowledge.

We have a lot to learn to keep people safe into the future, and it is critical, as we roll out the vaccine program that we undertake this work immediately and in real-time. Researchers and public health experts will gather invaluable information during this time, information that will be lost if we don’t act now.

This is not about questioning whether the COVID-19 vaccines are safe. Rigorous approvals are required before a vaccine is put into use and the available vaccines are safe and effective in phase 3 trials. However, they are of novel design and must be evaluated in real settings and populations, and this means asking key questions, such as:

1. What is the effectiveness of the vaccine in preventing illness and infection?
2. What is the effectiveness of the vaccine in reducing transmission? 
3. What is the immunogenicity of the vaccine?
4. What concerns do British Columbians have about the vaccine?
5. How do we deliver equitable access to vaccination?

Our Role

As a public health foundation, it was our responsibility in early 2020 to rapidly pivot our work to support COVID-19 response, and to ensure that evidence-based information is being shared.

It is now our duty to support the COVID-19 vaccine roll-out—a critical part of our efforts to address the pandemic.

While we remain committed to BC’s public health pandemic response, our partners have informed us that we’re facing an urgent need for vaccine-related research. This requires rapid-response funding that can allow us to learn from the vaccine roll-out, in real-time. 

What does this mean for the Foundation?

It means that for the near future, we’ll be incorporating vaccine research into our Emergency Response Fund.

Plus, we’re reaching out to our partners to combine our efforts, because by collaborating, we can leverage our collective strengths to support research better, and faster. When we work together, we accomplish so much more.

In other words, bringing philanthropy together with government and other partners means we are working collectively to leverage all our efforts and strengths to achieve an even greater impact. As our government and health authority partners are implementing the vaccination roll-out, it is our responsibility to support research.

However, supporting research in an ever-changing landscape is not easy. Working in real-time, with new information constantly coming at us, is not easy. But, during this pandemic it has remained critical to stay on top of the priorities, and it’s our call-to-action to go where we’re most needed—we’re facing a new landscape that we’re ready to tackle to help keep all British Columbians safe.

How You Can Help

As British Columbians, we have a unique opportunity to learn in real-time in a way like no other, and we have a responsibility to undertake this work. However, in order to move quickly, we need your help to support our public health leaders, experts, and researchers, now.

We’re with you—we’re all ready to celebrate the end of this pandemic. And with vaccines now being administered, we’re one colossal step closer.

We’re calling on you to come alongside us in this final push—please help us to ensure we don’t lose this opportunity to gain valuable evidence that will protect us now and long into the future.

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