OTTAWA—Confused yet?

This week, as Canada continues to wade through a third wave of COVID-19 infections, an arcane government advisory panel muddied the waters about when — and with which shot — people should get vaccinated.

Here’s what you need to know about NACI and the confusing kerfuffle over its latest COVID-19 vaccine guidance.

What’s NACI?

It’s the National Advisory Committee on Immunization, an arms-length panel of experts that reports to officials at the federal health department. And it’s not just a pandemic thing. The committee has been around since 1964 and has issued guidance on vaccines for a range of diseases, from hepatitis to rabies to tetanus and more.

It is comprised of 14 members, all doctors from various institutions who are experts in fields like infectious diseases, public health, pediatrics, preventive medicine and immunology.

It is not to be confused with Health Canada, the federal department that reviews and approves vaccines, and the Public Health Agency of Canada, another federal body that works on preventing diseases and responding to public health threats for the government.

What is NACI’s role in the pandemic?

The committee does not set government policy on vaccines. As its name implies, it gives advice about how to use vaccines that Health Canada has approved for humans.

It falls to the provinces and territories — masters of health policy in their respective domains — to decide how to take that advice.

OK. So what did NACI say?

On Monday, NACI broke with the mantra repeated by politicians and some health experts that Canadians should take the first COVID-19 shot they are offered. Instead, NACI declared mRNA vaccines made by Pfizer-BioNTech and Moderna are “preferred” to viral vector shots made by AstraZeneca and Johnson & Johnson, which have been linked to very rare blood clots.

The committee said some people might want to wait until they can get the mRNA shots to avoid the small risk of clots.

What’s wrong with that?

Kate Mulligan is an assistant professor of social and behavioural health sciences at the University of Toronto’s Dalla Lana School of Public Health. She called the committee’s advice “unnecessary fear-mongering” and said there are two big problems with it.

The first is that NACI is using a “very individual risk approach,” Mulligan said. This downplays the importance of “population health,” which relies on as many people getting the protection of a vaccine as soon as possible to curb the spread of COVID-19, she said.

The second problem is that people who can afford to wait for “preferred” vaccines are those who don’t have to expose themselves to the virus by leaving the house for work, Mulligan said. That makes NACI’s advice “very much geared toward people who are already living with the great privilege of not being at high risk,” she said.

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Why are officials saying different things about vaccines?

It’s a result of Canada’s layered system of governance, with health officials and politicians guiding the pandemic response at the local, provincial and federal levels. Mulligan said there are good reasons for this, like how local officials will have the best understanding of the nearby pandemic situation. The problem is when there are multiple different messages coming from the same level of government — which happened this week when NACI contradicted Prime Minister Justin Trudeau and others who are calling for everyone to get the first vaccine that is offered to them.

“I don’t blame people for feeling confused,” she said. “My advice to people is to pick the most local voice for you, because they’re going to know your context… Unless that person is at great odds with some of the other levels of government, then that’s probably the right strategy for the vast majority of us.”

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