It’s perfectly normal to have questions about the COVID-19 vaccines. While we're inching closer to the light at the end of the tunnel as the rollout finally picks up speed in Canada, there are some lingering concerns that we must overcome to contain the spread of the virus and stamp out the COVID-19 pandemic once and for all.

Is the AstraZeneca vaccine safe? Should older adults be worried about blood clots? Are the Vaccine Hunters legit? Why have a four-month waiting period between the first and the second dose? Dozens of Canadians have been submitting questions via VAX BECAUSE, our platform designed to help you find reliable information about COVID-19 vaccines from expert sources.

As part of this project, we spoke to Dr. Kimberley Gauthier, a cell biologist, postdoctoral researcher, and protein trafficking expert from Toronto. 

To say that Dr. Gauthier is familiar with these issues is an understatement. On top of her day job, she regularly devotes some of her free time to answer vaccine-related questions from the public within the bounds of COVID-19 Resources Canada. Alongside her peer Dr. Krishana Sankar and many more, she’s helped Canadians from all over the country get the information they need.

Here are her answers to some of the biggest questions Canadians have asked about the COVID-19 vaccine.

1. Are we able to “vaccine shop” in Canada? Why? 

Dr. Kimberley Gauthier: So, right now, you kind of have a choice. If you have a medical reason to not get one of the particular vaccines — for example, an allergy to one of [their] components — certainly you will have ... the option to pick one that you don't have an allergic reaction to. You can also choose where you want to get the vaccine. Some vaccines might be offered in pharmacies or doctor's offices just based on their storage requirements. 

The general advice, though, is to take the first vaccine that's offered to you [and] approved for use. The faster you can get protection, the better for you, the better for your community, the better for your family. So although you can vaccine shop, it’s generally advised not to. 

2. Is it safe to get the AstraZeneca vaccine if there's a personal history of blood clots in my family? 

Yes. We recently had some updated guidance on that in Canada. Health Canada, the regulatory body that approves the vaccine, has approved [its] use for anyone over 18. Then we have a separate organization called the National Advisory Committee on Immunization (NACI), [which] provides recommendations on how to use the vaccine and how to optimize their benefit for public health and minimize the harm. Their recommendation is to only offer the AstraZeneca vaccine for people over the age of 30. 

As for the family history of blood clots, if there's a history of cerebral venous sinus thrombosis (CVST), then that's a good time to have a conversation with your primary health care provider about if that vaccine is right for you. But there aren't any risk factors specifically identified right now or formally recognized for these blood clots with the AstraZeneca vaccine. They are very rare: it's somewhere in the range of 1 in 100,000 cases …  

It's important to know the symptoms, to look out for yourself so that you can monitor [them]. Any symptoms of blood clots or stroke, bleeding or red spots on the skin that are unidentified, a very severe headache, dizziness, fatigue or extreme fatigue — these kinds of things are important to look out for if you have any new or unexpected symptoms a month after your vaccine. 

3. Do the risks of a blood clot outweigh the risk of catching COVID-19?

I think that if there's a lot of COVID-19 [cases] in your community, then your risk of catching COVID-19, your risk of getting severe outcomes — especially with the variants that were circulating that seem to have a higher risk of hospitalization — outweigh the risk of getting a vaccine. 

You want to think about your risk factor. Was your risk of getting [the vaccine] so that you don't get all the other complications that come along with COVID-19? And if you decide you don't want one particular vaccine, [and] you want to wait for a different vaccine that can be offered, then you have to think about ... your risk of [dying from COVID-19] in that waiting time. 

It's also important to keep in mind that there are detectable symptoms for blood clots. Right now, Health Canada advises to look out for and symptoms including shortness of breath, chest pain, leg swelling or pain in your legs, persistent abdominal pain, a sudden or severe or worsening headache, blurred vision, confusion, any unusual skin bruising, or bleeding. If this occurs, it will be between four and 20 days after the vaccine. So it's not a lifelong risk; it's just in a short period after your vaccine. If you experience symptoms, it's important to get medical care right away and let your provider know which vaccine you receive just in case there's a variation. 

And of course, it's also important to know that there are treatments available for these blood clots: People who have experienced these conditions after vaccination have been successfully treated and are living their lives. So these are all things you want to factor in if you happen to be offered the AstraZeneca vaccine … The symptoms are pretty severe, so it's something that would definitely warrant medical visits. But in general, your risk of getting a blood clot after the AstraZeneca seems to be in the range of about 1 in one 100,000, so [it] is very low. 

Overall, you want the benefits to outweigh [the risks] by a lot, and that's why the current recommendation is to offer the vaccine for anyone over the age of 30.  

4. Have you personally been vaccinated against COVID-19? Why or why not?

Yes, I have my first dose, and I'm waiting four months like the rest of Canada for my second dose. It was offered to me for my work, and I took it right away — no hesitation for me. I had done a lot of research, and I looked into it, of course; I wanted to ... make the best choice.

And I feel very confident that it was a good, safe choice to make for myself [and] my health. I am not interested in taking my chances [with COVID-19 and] I do not want this virus for my family. I know that I will reduce my risk of being a vector [that could] infect the people around me, which is really important. I want to make sure that I'm protecting the health of those around me and the people I work with because I am in the lab every day. And for my community in general, I know that it's a great idea for as many people as possible to get vaccinated because it increases the chances of getting herd immunity and protecting each other. 

5. Why do we have to wait four months between the first and the second vaccine dose? 

So this was, again, a recommendation that came from NACI. Some places were already using extended doses, so Quebec, for example, had decided to extend their second dose before it had made the recommendation. This is based on real evidence that we're seeing from the UK in particular, where they added a three-month delay for the second dose, and it's had phenomenal results. Using just that first dose in combination with their public health measures, they've been able to reduce their daily cases and deaths and the overall impact that it has had on their public health, which is phenomenal. 

The bigger picture is to protect as many people as we can in a [shorter] time. We know that we're racing against time with COVID-19, especially as our third wave is picking up … and we have limited doses. But we see that just one dose alone offers substantial protection against disease [and] hospitalization, which is really important. 

6. There have been outbreaks in long-term care homes that had been almost fully vaccinated, and people have taken that as a sign that vaccines are ineffective. What would you say to them? 

We know that even when fully vaccinated, some people … will still get the virus. We saw this in the clinical trials. This isn't unexpected, but it's going to be a far lower number or percentage of people than those unvaccinated. So the risk has been reduced, but it isn't zero, and the goal is to keep it as low as possible. 

A thing to look for is the severity of the illness. Evidence from Scotland has shown that even [after] just one dose, vaccines reduced the risk of hospitalization by 85% to 95%.

7. What are the biggest obstacles in terms of getting vaccines to everyone in Canada? 

I can't speak for all of Canada, but I can speak for Ontario, where I live. And I've seen it firsthand. There have been a lot of challenges with reaching some communities, and that comes down to just the way the vaccine [rollout] has taken place. It's been a bit decentralized. There’s a provincial website to … identify where you can get the vaccine. Then you also have to go to your public health unit individually — and if you've never really interacted with the public health unit before, like me, it's really confusing and hard to figure out. Beyond your public health unit, you can also contact the hospitals or the pharmacies themselves, and it's a lot of guesswork. 

When I had to book an appointment for my parents, I had to call many pharmacies; [many] of them didn't have any vaccines, and I had to put them on the waitlist at many different places. I had the time to do that, but for someone without that kind of time — someone without books, computer literacy skills, someone without the motivation to do it — it seems not worth it. 

There are also barriers in [accessing] vaccines where they're located. A lot of vaccines are offered in community pharmacies, but we've seen that some communities with higher caseloads have fewer and fewer pharmacies offering [them]. So just getting the vaccines to where they need to be has been a huge challenge. And it's the same communities who have the highest impact from COVID-19 who are left behind in the vaccine rollout. That’s [inequitable].

8. What do you think about certain groups like Vaccine Hunters as a viable alternative to the existing booking system?

I wish we had a centralized provincial booking system. I think that that's what the Vax Hunters have accomplished: They've become more of a central source for people, which was impossible to navigate in a lot of other settings. So I see the need and I think they're filling a very important need. I think it's phenomenal that this group of people took that time and effort to fill the void of information. 

9. What do you want all Canadians to know when it comes to COVID-19 vaccines?

The vaccines are safe. I want people to feel comfortable asking questions about the vaccines and knowing where to get information, and to ask people to talk to someone who knows your health history. [This could be] your own family doctor or your local pharmacist, someone familiar with you, your health, and who can really answer more specific questions for you. 

Then there are a lot of resources online. For example, the Society of Obstetricians and Gynecologists of Canada is a great resource for those who are pregnant or breastfeeding and have questions about vaccines or COVID-19 in general. The Health Canada website is also a great place to get information. 

These are really hard to synthesize and hard to put together sometimes, and it creates a lot of challenges. I think that social media becomes a very appealing place to get information, too. I've definitely gotten a lot of information there, and it's really important to be critical about our sources. Do they provide references? Do we know who runs the account? Is there transparency on who these people are? The biggest takeaway for me is [that] there's a lot of misinformation, and a lot of it is really intentional. It's put out there specifically to confuse us, so it's really important that we're careful about the kind of information that we consume.

10. If my parents are a bit hesitant and they're not 100% sure about getting vaccinated, but I'm worried about their safety, what can I do? 

It’s something I've dealt with myself with my family and friends. I think it's important to always approach with empathy and just listen with compassion and be open-minded to what they have to say. Try to really get to the root of their concerns. Some people might ask you, "Are the vaccines safe?” but what they're really asking is, “Is it safe for me?” Try to understand why they would think that it's not safe for them, what are their beliefs, what is the heart of their concern? And then …  provide resources. People don't change their mind on the spot; it usually takes them a bit of time, so I think being patient as well as choosing the right time and place for those kinds of conversations is important.

This interview has been edited for length and clarity.