Manitoba will begin offering third doses of mRNA vaccines to immunocompromised people and for individuals who may choose to receive a third dose for travel purposes, while also setting out policies to guide medical exemptions to immunization.

Effective immediately, third doses will be available to:

  • people who are moderately to severely immunocompromised due to a medical condition and/or treatment;
  • individuals who wish to receive a third dose for travel purposes; and
  • individuals who have received one or two doses of a vaccine that is not approved by Health Canada.

“We know that people who are immunocompromised may not be able to develop a good defence against COVID-19 with just two doses of the vaccine,” said Dr. Joss Reimer, medical lead of the Vaccine Implementation Task Force. “This initial plan for the third dose recognizes those who are at increased risk of severe illness. It also responds to the individual challenges faced by people travelling outside of Canada.”

Reimer noted a complete list of the medical conditions and/or treatments that would result in a person being considered immunocompromised and recommended to receive a third dose, is available online at manitoba.ca. It includes people who:

  • are receiving active chemotherapy (or immunotherapy) for cancer;
  • have received a solid organ transplant and are currently receiving chemotherapy or other immunosuppressive therapy;
  • were born with moderate or severe dysfunction of their immune system;
  • are living with untreated or advanced HIV-AIDS; or
  • are taking certain medications that severely affect the immune system.

People who are immunocompromised can be immunized by their health-care provider.

Individuals who would like to receive a third dose for travel purposes must be vaccinated by their health-care provider and go through an informed consent process, or present a prescription to a pharmacist.

People who have previously received a vaccine not approved by Health Canada can be immunized at super sites, pop-ups or mobile clinics, or by a health-care provider. Individuals who receive a dose of an mRNA vaccine following one or two doses of a vaccine not approved by Health Canada will be considered fully immunized and can have their immunization record updated by following the process outlined at manitoba.ca.

In all situations, these doses should be given a minimum of 28 days after the person’s most recent dose of any COVID-19 vaccine.

Based on the guidance of the vaccine implementation task force’s medical advisory committee, people in one of three situations may be eligible for a temporary or permanent medical exemption to vaccination. This must be reviewed by a specialist physician and then submitted to the Vaccine Implementation Task Force. It includes people who:

  • had a severe reaction after the first dose of a COVID-19 vaccine (e.g. myocarditis, Guillain-BarrĂ© syndrome);
  • are receiving treatment that affects their ability to mount an immune response, meaning vaccination must be timed carefully with their treatment schedule (e.g. receiving immunocompromising treatment after a transplant, certain types of cancer treatments); or
  • had a severe allergy or anaphylactic reaction to a previous dose of a COVID-19 vaccine or its components that cannot be managed by the Health Sciences Centre Allergy Clinic.

The process to submit medical exemptions will be finalized as soon as possible, along with updated clinical guidance for health-care professionals. The province is also developing a way to ensure individuals with a valid medical exemption are able to access the same benefits as those with an immunization card. This work is expected to be completed in the coming weeks.

Reimer noted the province’s decision to recommend third doses for moderately to severely immunocompromised people was developed in consultation with the Vaccine Implementation Task Force’s medical advisory committee, which includes health-care professionals from a wide range of specialities. It is also informed by guidance on third doses released last week by the National Advisory Committee on Immunization. A complete list of conditions is available at manitoba.ca.