Frequently Asked Questions

Below you’ll find definitions and answers to the some of the most common questions about COVID-19.

We start with the basics, and answer questions about the virus and the disease itself. Next, we dive into SARS-CoV-2 testing and antibodies and what these mean for our immunity following an infection. We also take some time to breakdown exactly what serosurveillance and other population-based studies are and how their results, when allowed to inform the rollout of vaccines, will be critical to Canada’s response to the COVID-19 pandemic.

If you can’t find the answer to your question, feel free to contact us.

About the Virus and Disease

Figure 1.1. Rapidly spreading variants are being observed globally. Some mutations confer potential selective advantages to the virus, such as increased transmissibility or immune evasion. Photo Credit: Mariana Bego.

The name coronavirus is derived from the Latin corona, meaning “crown.” This refers to the characteristic “crown” shape of the virus’ protein spikes.

This coronavirus family has several members that can infect humans: four are potential causes of the common cold, while the others, SARS-CoV, MERS-CoV and SARS-CoV-2, have triggered dangerous epidemics. SARS-CoV-2 is a close relative to SARS-CoV, which was responsible for the severe acute respiratory syndrome (SARS) epidemic of 2002–2003, which infected over 8,000 people worldwide.

The morphology (shape) of coronavirus is depicted here with spike proteins (red) that form a corona (crown) around the virus. Additional proteins shown include envelope (yellow) and membrane (orange) proteins. Photo Credit: Alissa Eckert, MSMI, Dan Higgins, MAMS

SARS-CoV-2 is the virus that causes the disease known as COVID-19.

Researchers are currently investigating this question. Research suggests prior coronavirus infections may result in the development of antibodies that fight against SARS-CoV-2, but these antibodies may not be strong enough to prevent COVID-19 infection. This is why people should get vaccinated, even if they had a previous SARS-CoV-2 infection.

Like with seasonal coronaviruses that cause the common cold, recovery from an initial infection of SARS-CoV-2 gives a degree of immunity and protection towards re-infection. However, some patients who have recovered from COVID-19 have caught the virus for a second time. The rise of variants increases the likelihood of catching a mutated form of the virus. This is why vaccination is important.

COVID-19 causes diverse degrees of illness, ranging from asymptomatic infection (no symptoms) to mild symptoms, to severe pneumonia, stroke, sepsis, organ failure, and even death. It is suggested that about 1 in 5 infected people will experience no symptoms, although this number is highly variable depending on the population studied.

It is important to differentiate between asymptomatic and pre-symptomatic infections. Someone who is asymptomatic never develops symptoms, from the time they acquire the virus to the time the infection has fully cleared. Pre-symptomatic refers to someone who will eventually develop symptoms (it generally takes 7-13 days after the initial exposure to SARS-CoV-2 to develop symptoms).

It should be noted that even in the absence of symptoms, people can still transmit the virus.

Infection with SARS-CoV-2 can result in a wide range of symptoms such as fever, chills and loss of taste or smell (right panel), or it may go completely unnoticed with no symptoms at all (asymptomatic, left panel). In both cases, infected individuals can go on to transmit the virus to others. Image credit: Kristin Davis

SARS-CoV-2 variants occur when there are changes or “mutations” in the original virus’ genetic code. These changes occur naturally over time as a by-product of replication. The World Health Organization (WHO) tracks variants of SARS-CoV-2 around the globe and designates them as variants of concern (VOCs) when they meet specific criteria demonstrating that they spread much faster, are better adept at infecting people and/or impact the effectiveness of vaccines and therapeutics.

Currently there are five VOCs: Alpha, Beta, Gamma, Delta, and Omicron. The Alpha variant, also known as the B.1.1.7 variant, was first identified in the United Kingdom where a mutation occurred in the receptor binding domain (RBD) of the spike protein. This resulted in a change of the genetic code, specifically, the amino acid asparagine (N) was replaced with tyrosine (Y) at location 501 (N501Y).

The Beta variant, also known as B.1.351 originated in South Africa, the Gamma variant, also known as P.1, originated in Brazil, the Delta variant, also known as B.1.617.2, originated in India and the newest variant entitled Omicron emerged in November 2021. Beta and Gamma variants also have the above N501Y mutation, but they have several others, like E484K. The Delta variant has a more diverse repertoire of mutations than other variants. It lacks the N501 mutation, has a different mutation in position 484 (E484Q), and has several other unique mutations (including P681R and L452R). The Omicron variant has over 30 mutations in the spike protein alone.

The WHO also tracks variants of interest (VOIs), defined as variants with mutations that could affect transmissibility, disease severity, and the effectiveness of immune responses and therapeutics. Currently, there are five VOIs: Eta (B.1.525), Iota (B.1.526), Kappa (B.1.617.1), Lambda (C.37), and Mu (B.1.621).

The name coronavirus is derived from the Latin corona, meaning “crown.” This refers to the characteristic “crown” shape of the virus’ protein spikes.

This coronavirus family has several members that can infect humans: four are potential causes of the common cold, while the others, SARS-CoV, MERS-CoV and SARS-CoV-2, have triggered dangerous epidemics. SARS-CoV-2 is a close relative to SARS-CoV, which was responsible for the severe acute respiratory syndrome (SARS) epidemic of 2002–2003, which infected over 8,000 people worldwide.

The morphology (shape) of coronavirus is depicted here with spike proteins (red) that form a corona (crown) around the virus. Additional proteins shown include envelope (yellow) and membrane (orange) proteins. Photo Credit: Alissa Eckert, MSMI, Dan Higgins, MAMS

SARS-CoV-2 is the virus that causes the disease known as COVID-19.

Researchers are currently investigating this question. Research suggests prior coronavirus infections may result in the development of antibodies that fight against SARS-CoV-2, but these antibodies may not be strong enough to prevent COVID-19 infection. This is why people should get vaccinated, even if they had a previous SARS-CoV-2 infection.

Like with seasonal coronaviruses that cause the common cold, recovery from an initial infection of SARS-CoV-2 gives a degree of immunity and protection towards re-infection. However, some patients who have recovered from COVID-19 have caught the virus for a second time. The rise of variants increases the likelihood of catching a mutated form of the virus. This is why vaccination is important.

COVID-19 causes diverse degrees of illness, ranging from asymptomatic infection (no symptoms) to mild symptoms, to severe pneumonia, stroke, sepsis, organ failure, and even death. It is suggested that about 1 in 5 infected people will experience no symptoms, although this number is highly variable depending on the population studied.

It is important to differentiate between asymptomatic and pre-symptomatic infections. Someone who is asymptomatic never develops symptoms, from the time they acquire the virus to the time the infection has fully cleared. Pre-symptomatic refers to someone who will eventually develop symptoms (it generally takes 7-13 days after the initial exposure to SARS-CoV-2 to develop symptoms).

It should be noted that even in the absence of symptoms, people can still transmit the virus.

Infection with SARS-CoV-2 can result in a wide range of symptoms such as fever, chills and loss of taste or smell (right panel), or it may go completely unnoticed with no symptoms at all (asymptomatic, left panel). In both cases, infected individuals can go on to transmit the virus to others. Image credit: Kristin Davis

SARS-CoV-2 variants occur when there are changes or “mutations” in the original virus’ genetic code. These changes occur naturally over time as a by-product of replication. The World Health Organization (WHO) tracks variants of SARS-CoV-2 around the globe and designates them as variants of concern (VOCs) when they meet specific criteria demonstrating that they spread much faster, are better adept at infecting people and/or impact the effectiveness of vaccines and therapeutics.

Currently there are five VOCs: Alpha, Beta, Gamma, Delta, and Omicron. The Alpha variant, also known as the B.1.1.7 variant, was first identified in the United Kingdom where a mutation occurred in the receptor binding domain (RBD) of the spike protein. This resulted in a change of the genetic code, specifically, the amino acid asparagine (N) was replaced with tyrosine (Y) at location 501 (N501Y).

The Beta variant, also known as B.1.351 originated in South Africa, the Gamma variant, also known as P.1, originated in Brazil, the Delta variant, also known as B.1.617.2, originated in India and the newest variant entitled Omicron emerged in November 2021. Beta and Gamma variants also have the above N501Y mutation, but they have several others, like E484K. The Delta variant has a more diverse repertoire of mutations than other variants. It lacks the N501 mutation, has a different mutation in position 484 (E484Q), and has several other unique mutations (including P681R and L452R). The Omicron variant has over 30 mutations in the spike protein alone.

The WHO also tracks variants of interest (VOIs), defined as variants with mutations that could affect transmissibility, disease severity, and the effectiveness of immune responses and therapeutics. Currently, there are five VOIs: Eta (B.1.525), Iota (B.1.526), Kappa (B.1.617.1), Lambda (C.37), and Mu (B.1.621).

SARS-CoV-2 Testing and Antibodies

Figure 2.1. The viral test involves a nose or throat swab and it detects the presence of the genetic material of the virus, telling you if you have an active infection. The antibody test involves a blood sample and it detects the antibodies created by your body to fight the virus. This tells you if you were infected in the past. Photo Credit: Mariana Bego

A viral test, also known as diagnostic test, can tell you if you have an active COVID-19 infection, which would require you to take steps to isolate yourself to prevent infecting others.

The test is often performed with samples obtained from a nose or throat swab, as these areas are most likely to have enough virus to be detected. If you test positive, that means you have an active infection. Once the infection is resolved, the test would yield a negative result.

More specifically, the test itself looks for the presence of the virus’ genetic material. In the case of  SARS-CoV-2, the virus that causes COVID-19, this genetic material is RNA.

Obtaining a negative result from a throat or nose swab test (viral test) does not imply that a person has never had COVID-19. It means that the person is not infected with the virus currently, or that the virus is no longer present in the nose or throat mucus, or that there is so little of the virus present that it cannot be detected by the test.

A viral test can tell you if you are currently infected with SARS-CoV-2, while an antibody test can tell you if you have had an infection or vaccination in the past. Antibody testing can be used to differentiate between infection-acquired and vaccine-induced immunity. For example, someone previously infected with SARS-CoV-2 will have antibodies recognizing viral proteins (often tested as antibodies recognizing the viral proteins spike and nucleocapsid), whereas someone that received a COVID-19 vaccine will only have antibodies recognizing spike, but not nucleocapsid. The latter is because COVID-19 vaccines were designed using only the SARS-CoV-2 spike protein.

Serology tests are used to determine if a person has previously been infected with or vaccinated against SARS-CoV-2, the virus that causes COVID-19. Clinicians and researchers refer to them as serology tests, but often commercial laboratories will call them antibody tests. These tests look for the presence of antibodies, which are specific proteins made in response to infections and vaccinations. Antibody tests are particularly helpful in detecting previous infections in those who may have had few or no symptoms.

When our bodies detect the presence of a foreign or ‘never before seen’ protein, like a viral protein, we make antibodies. These antibodies are able to recognize and latch on to (or bind to) this foreign protein (called an antigen) in order to remove it from our bodies. This process is part of a healthy immune response targeting the foreign invader and is the basis for the protective effect of vaccines.

Antibodies can be detected in the blood of people who have been recently infected and vaccinated, in many cases, long after the initial exposure. Another name for antibodies is immunoglobulins, shortened to Ig, and they come in a variety of flavours: IgA, IgM, IgG, IgE, and IgD. Of these, IgM is the first to be made in response to a foreign protein and it can be found in blood for a short time after exposure to the foreign invaders (pathogens). IgG antibodies appear a little later in blood but can be detected for a longer period of time. Vaccines designed against COVID-19 approved and authorized for use in Canada primarily produce IgG antibodies recognizing the spike protein of SARS-CoV-2.

This binding is highly specific, meaning they cannot bind to just any protein – only their target. The strength and specificity of their binding is the basis for many of their important roles:  they can alert several branches of the immune system of an ongoing infection, and they can mark foreign proteins (and consequently the virus attached to them) to be ingested by immune cells and destroyed.

A unique type of antibody called a neutralizing antibody, will recognize proteins of the virus and prevent them from binding to the cell receptor, thereby blocking the virus’ entry into human cells. For SARS-CoV-2, this protein is the spike (S).

Of the many proteins encoded by SARS-CoV-2, the spike (S), which coats the outer layer of the virus, and the nucleocapsid (N), which wraps and protects the virus’ genomic component, are the most abundant. These proteins are often targeted by the immune system and are often recognized by antibodies. COVID-19 vaccines were designed against the S protein. Antibodies recognizing the S protein are dubbed anti-spike IgG or (anti-S IgG, a-S IgG for short). Likewise, antibodies recognizing the N protein are named anti-nucleocapsid IgG (anti-N IgG or a-N IgG for short) and their detection is suggestive of a previous infection with SARS-CoV-2 as vaccination will only produce anti-S IgG.

Spike (S) proteins make up the outer layer of the virus. They are what give the virions (the viral infectious particles) the appearance of having a crown. Spike proteins are responsible for binding to the cellular receptor, an event required for the virus to enter into the human cell. COVID-19 vaccines were designed against the S protein.

Figure 2.2. SARS-CoV-2 has the spike (S) proteins that cover the outer membrane surface. These S proteins bind to a receptor called the angiotensin converting enzyme 2 (ACE2). The nucleocapsid (N) protein forms complexes with the viral RNA and is involved in viral replication. Photo Credit: Mariana Bego

People generally develop antibodies within the first 1-2 weeks after being infected with SARS-CoV-2. These antibodies, found in the bloodstream of recovering (convalescent) individuals, are able to bind to and render the virus incapable of infecting new cells.

Convalescent plasma therapy involves using the plasma (the liquid part of the blood that remains after removing all the cells) of these COVID-19 recovering patients to help treat patients who have been newly infected with SARS-CoV-2. Upon injection of this plasma into the bloodstream of newly infected patients, antibodies pre-existing in the injected plasma can immediately bind to and inactivate the SARS-CoV-2 virus. In doing so, the antibodies help control the virus while allowing the patient’s own immune response to catch-up and fully resolve the infection.

The CITF’s Immune Testing Working Party aims to enable accurate, quality assured, efficient, scalable, and safe immunity testing for SARS-CoV-2 across Canada. Given the novel status of SARS-CoV-2, all immune tests – whether based on blood draws from veins, pin pricks for blood spots, saliva samples, or others – require validation for accuracy. A test’s accuracy depends on its sensitivity and specificity, and the interpretation of a test is also dependent on the timing of testing in relation to an individual’s infection. Defining the duration of antibody responses will guide testing strategies and help understand the technology’s limitations.

A viral test, also known as diagnostic test, can tell you if you have an active COVID-19 infection, which would require you to take steps to isolate yourself to prevent infecting others.

The test is often performed with samples obtained from a nose or throat swab, as these areas are most likely to have enough virus to be detected. If you test positive, that means you have an active infection. Once the infection is resolved, the test would yield a negative result.

More specifically, the test itself looks for the presence of the virus’ genetic material. In the case of  SARS-CoV-2, the virus that causes COVID-19, this genetic material is RNA.

Figure 2.1. The viral test involves a nose or throat swab and it detects the presence of the genetic material of the virus, telling you if you have an active infection. The antibody test involves a blood sample and it detects the antibodies created by your body to fight the virus. This tells you if you were infected in the past. Photo Credit: Mariana Bego.

Obtaining a negative result from a throat or nose swab test (viral test) does not imply that a person has never had COVID-19. It means that the person is not infected with the virus currently, or that the virus is no longer present in the nose or throat mucus, or that there is so little of the virus present that it cannot be detected by the test.

A viral test can tell you if you are currently infected with SARS-CoV-2, while an antibody test can tell you if you have had an infection or vaccination in the past. Antibody testing can be used to differentiate between infection-acquired and vaccine-induced immunity. For example, someone previously infected with SARS-CoV-2 will have antibodies recognizing viral proteins (often tested as antibodies recognizing the viral proteins spike and nucleocapsid), whereas someone that received a COVID-19 vaccine will only have antibodies recognizing spike, but not nucleocapsid. The latter is because COVID-19 vaccines were designed using only the SARS-CoV-2 spike protein.

Serology tests are used to determine if a person has previously been infected with or vaccinated against SARS-CoV-2, the virus that causes COVID-19. Clinicians and researchers refer to them as serology tests, but often commercial laboratories will call them antibody tests. These tests look for the presence of antibodies, which are specific proteins made in response to infections and vaccinations. Antibody tests are particularly helpful in detecting previous infections in those who may have had few or no symptoms.

When our bodies detect the presence of a foreign or ‘never before seen’ protein, like a viral protein, we make antibodies. These antibodies are able to recognize and latch on to (or bind to) this foreign protein (called an antigen) in order to remove it from our bodies. This process is part of a healthy immune response targeting the foreign invader and is the basis for the protective effect of vaccines.

Antibodies can be detected in the blood of people who have been recently infected and vaccinated, in many cases, long after the initial exposure. Another name for antibodies is immunoglobulins, shortened to Ig, and they come in a variety of flavours: IgA, IgM, IgG, IgE, and IgD. Of these, IgM is the first to be made in response to a foreign protein and it can be found in blood for a short time after exposure to the foreign invaders (pathogens). IgG antibodies appear a little later in blood but can be detected for a longer period of time. Vaccines designed against COVID-19 approved and authorized for use in Canada primarily produce IgG antibodies recognizing the spike protein of SARS-CoV-2.

This binding is highly specific, meaning they cannot bind to just any protein – only their target. The strength and specificity of their binding is the basis for many of their important roles:  they can alert several branches of the immune system of an ongoing infection, and they can mark foreign proteins (and consequently the virus attached to them) to be ingested by immune cells and destroyed.

A unique type of antibody called a neutralizing antibody, will recognize proteins of the virus and prevent them from binding to the cell receptor, thereby blocking the virus’ entry into human cells. For SARS-CoV-2, this protein is the spike (S).

Of the many proteins encoded by SARS-CoV-2, the spike (S), which coats the outer layer of the virus, and the nucleocapsid (N), which wraps and protects the virus’ genomic component, are the most abundant. These proteins are often targeted by the immune system and are often recognized by antibodies. COVID-19 vaccines were designed against the S protein. Antibodies recognizing the S protein are dubbed anti-spike IgG or (anti-S IgG, a-S IgG for short). Likewise, antibodies recognizing the N protein are named anti-nucleocapsid IgG (anti-N IgG or a-N IgG for short) and their detection is suggestive of a previous infection with SARS-CoV-2 as vaccination will only produce anti-S IgG.

Spike (S) proteins make up the outer layer of the virus. They are what give the virions (the viral infectious particles) the appearance of having a crown. Spike proteins are responsible for binding to the cellular receptor, an event required for the virus to enter into the human cell. COVID-19 vaccines were designed against the S protein.

Figure 2.2. SARS-CoV-2 has the spike (S) proteins that cover the outer membrane surface. These S proteins bind to a receptor called the angiotensin converting enzyme 2 (ACE2). The nucleocapsid (N) protein forms complexes with the viral RNA and is involved in viral replication. Photo Credit: Mariana Bego

People generally develop antibodies within the first 1-2 weeks after being infected with SARS-CoV-2. These antibodies, found in the bloodstream of recovering (convalescent) individuals, are able to bind to and render the virus incapable of infecting new cells.

Convalescent plasma therapy involves using the plasma (the liquid part of the blood that remains after removing all the cells) of these COVID-19 recovering patients to help treat patients who have been newly infected with SARS-CoV-2. Upon injection of this plasma into the bloodstream of newly infected patients, antibodies pre-existing in the injected plasma can immediately bind to and inactivate the SARS-CoV-2 virus. In doing so, the antibodies help control the virus while allowing the patient’s own immune response to catch-up and fully resolve the infection.

The CITF’s Immune Testing Working Party aims to enable accurate, quality assured, efficient, scalable, and safe immunity testing for SARS-CoV-2 across Canada. Given the novel status of SARS-CoV-2, all immune tests – whether based on blood draws from veins, pin pricks for blood spots, saliva samples, or others – require validation for accuracy. A test’s accuracy depends on its sensitivity and specificity, and the interpretation of a test is also dependent on the timing of testing in relation to an individual’s infection. Defining the duration of antibody responses will guide testing strategies and help understand the technology’s limitations.

Immunity

Figure 3.1. When an individual is infected with SARS-CoV-2, the innate immune response is initiated and characterized by dendritic cell (DC) activation. This is followed by an adaptive immune response where T and B cells are activated. T cells can perform many different functions, while B cells differentiate into plasma cells to produce antibodies. Both types of cells establish memory populations to prevent against re-infection. Photo Credit: Mariana Bego.

Immunity – a full defence against a virus or disease – is not offered by one element alone. There are several factors at play within immunity. Cell-mediated immunity (CMI) is the protective immune response generated by immune factors other than antibodies. This includes protection mediated by T lymphocytes (T cells), other white blood cells such as macrophages, and the soluble molecules (cytokines) which are produced by these immune cells. COVID-19 vaccines have been shown to activate cell-mediated immunity to help protect against infection with SARS-CoV-2, the virus that causes COVID-19.

T cells are an important part of the immune response mounted by our body in response to pathogens such as SARS-CoV-2. There are several subtypes of T cells that respond to different types of pathogens, and they play a critical role in shaping the overall immune response. T cells have proteins on their surface that can detect and kill SARS-CoV-2-infected cells. They can also release a wide range of small soluble molecules (cytokines) that can recruit other immune cells to help clear the infection. T cells also influence the antibody response against SARS-CoV-2 by shaping the type of antibodies generated against the virus. Finally, once the infection is cleared, T cells establish themselves as a small memory population that is pre-primed and ready to react to any future re-exposure to SARS-CoV-2, thus protecting against any subsequent infection that may occur.

In addition to cell-mediated immunity, antibody-mediated immunity is also a critical arm of the protective immune response. Antibody-mediated immunity is also referred to as humoral immunity and involves macromolecules found in fluids including antibodies produced by B cells and other blood proteins that are involved in fighting off pathogens. Antibodies have several functions, one of which is blocking a virus from entering and infecting a cell. This is known as “neutralization”. COVID-19 vaccines have been shown to activate antibody-mediated immunity to help protect against infection with SARS-CoV-2.

Once an individual has received a vaccine against COVID-19 or has recovered from SARS-CoV-2 infection, their immune system remains primed for exposure or re-exposure to the virus. This is enabled by immune cells that have recognized and resolved the initial SARS-CoV-2 infection, or in the case of a vaccine, recognized the parts of the SARS-CoV-2 virus included in the vaccine formula. These immune cells, specifically developed for SARS-CoV-2, establish long-living memory populations which are ready to respond to exposure or re-exposure to the same virus.

While early studies have indicated that antibody levels themselves may drop after the initial exposure to SARS-CoV-2 through infection or vaccination, both B cells (cells that produce antibodies) and T cells (cells that enable cell-mediated immunity) establish memory populations and form a protective response to prevent against infection or re-infection. Currently, it is unknown exactly how long the protective response following infection and/or vaccination can remain, but the CITF is funding several studies looking into this.

CITF-funded researchers are involved in characterizing SARS-CoV-2 humoral and cell-mediated responses resulting from infection and vaccination. These include antibody titers, neutralization, T cell exhaustion, immune senescence, longevity and durability of the immune response to SARS-CoV-2. Researchers are also involved in studying conditions and immune factors that are associated with re-infections, breakthrough infections and the correlates of protection.

Herd immunity, alternatively known as community immunity, is when a large proportion of the population is immune to a specific disease such as COVID-19, reducing the spread of the disease from person to person. Although not every individual is immune to the virus or bacteria, the majority of those immune protect the rest of the individuals (including newborns or immunocompromised individuals who may not be able to get vaccinated) from getting infected.

Herd immunity can be achieved by having enough individuals infected with the virus or it can be achieved with vaccinations. Vaccinations are the ideal approach for achieving herd immunity and it was reported by some studies that at least 70-85% of the population would need to be immune to achieve herd immunity. Herd immunity depends on the reproduction number or R0, which tells us the average number of people that a single person with the virus can infect. A higher R0 indicates more people need to be immune to reach herd immunity.

Figure 3.2. Herd immunity is achieved when there is a large proportion of individuals that are immune to SARS-CoV-2 that would reduce the risk of the remaining individuals from getting infected. Photo Credit: Mariana Bego.

Correlates of protection to a virus or an infectious pathogen are measurable signs that a person (or other potential host) is immune, in the sense of being protected against becoming infected and/or developing disease. For many viruses, antibodies serve as a correlate of immunity, but they are not the only element to consider when determining whether a person is completely immune. Unfortunately, the correlates of protection against SARS-CoV-2 are still not completely understood.

CITF-funded researchers are interested in defining the markers that are associated with protective immunity against SARS-CoV-2 infection. Factors under consideration include presence and minimum thresholds of binding antibodies and neutralizing antibodies against the SARS-CoV-2 spike and nucleocapsid proteins. T and B cells are also being studied to determine their role in protection as they are shown to last longer than antibodies. Researchers would like to determine if 1) If these are good markers and 2) how much of these markers are needed to confer protection.

Immunity – a full defence against a virus or disease – is not offered by one element alone. There are several factors at play within immunity. Cell-mediated immunity (CMI) is the protective immune response generated by immune factors other than antibodies. This includes protection mediated by T lymphocytes (T cells), other white blood cells such as macrophages, and the soluble molecules (cytokines) which are produced by these immune cells. COVID-19 vaccines have been shown to activate cell-mediated immunity to help protect against infection with SARS-CoV-2, the virus that causes COVID-19.

Figure 3.1. When an individual is infected with SARS-CoV-2, the innate immune response is initiated and characterized by dendritic cell (DC) activation. This is followed by an adaptive immune response where T and B cells are activated. T cells can perform many different functions, while B cells differentiate into plasma cells to produce antibodies. Both types of cells establish memory populations to prevent against re-infection. Photo Credit: Mariana Bego.

T cells are an important part of the immune response mounted by our body in response to pathogens such as SARS-CoV-2. There are several subtypes of T cells that respond to different types of pathogens, and they play a critical role in shaping the overall immune response. T cells have proteins on their surface that can detect and kill SARS-CoV-2-infected cells. They can also release a wide range of small soluble molecules (cytokines) that can recruit other immune cells to help clear the infection. T cells also influence the antibody response against SARS-CoV-2 by shaping the type of antibodies generated against the virus. Finally, once the infection is cleared, T cells establish themselves as a small memory population that is pre-primed and ready to react to any future re-exposure to SARS-CoV-2, thus protecting against any subsequent infection that may occur.

In addition to cell-mediated immunity, antibody-mediated immunity is also a critical arm of the protective immune response. Antibody-mediated immunity is also referred to as humoral immunity and involves macromolecules found in fluids including antibodies produced by B cells and other blood proteins that are involved in fighting off pathogens. Antibodies have several functions, one of which is blocking a virus from entering and infecting a cell. This is known as “neutralization”. COVID-19 vaccines have been shown to activate antibody-mediated immunity to help protect against infection with SARS-CoV-2.

Once an individual has received a vaccine against COVID-19 or has recovered from SARS-CoV-2 infection, their immune system remains primed for exposure or re-exposure to the virus. This is enabled by immune cells that have recognized and resolved the initial SARS-CoV-2 infection, or in the case of a vaccine, recognized the parts of the SARS-CoV-2 virus included in the vaccine formula. These immune cells, specifically developed for SARS-CoV-2, establish long-living memory populations which are ready to respond to exposure or re-exposure to the same virus.

While early studies have indicated that antibody levels themselves may drop after the initial exposure to SARS-CoV-2 through infection or vaccination, both B cells (cells that produce antibodies) and T cells (cells that enable cell-mediated immunity) establish memory populations and form a protective response to prevent against infection or re-infection. Currently, it is unknown exactly how long the protective response following infection and/or vaccination can remain, but the CITF is funding several studies looking into this.

CITF-funded researchers are involved in characterizing SARS-CoV-2 humoral and cell-mediated responses resulting from infection and vaccination. These include antibody titers, neutralization, T cell exhaustion, immune senescence, longevity and durability of the immune response to SARS-CoV-2. Researchers are also involved in studying conditions and immune factors that are associated with re-infections, breakthrough infections and the correlates of protection.

Herd immunity, alternatively known as community immunity, is when a large proportion of the population is immune to a specific disease such as COVID-19, reducing the spread of the disease from person to person. Although not every individual is immune to the virus or bacteria, the majority of those immune protect the rest of the individuals (including newborns or immunocompromised individuals who may not be able to get vaccinated) from getting infected.

Herd immunity can be achieved by having enough individuals infected with the virus or it can be achieved with vaccinations. Vaccinations are the ideal approach for achieving herd immunity and it was reported by some studies that at least 70-85% of the population would need to be immune to achieve herd immunity. Herd immunity depends on the reproduction number or R0, which tells us the average number of people that a single person with the virus can infect. A higher R0 indicates more people need to be immune to reach herd immunity.

Figure 3.2. Herd immunity is achieved when there is a large proportion of individuals that are immune to SARS-CoV-2 that would reduce the risk of the remaining individuals from getting infected. Photo Credit: Mariana Bego.

Correlates of protection to a virus or an infectious pathogen are measurable signs that a person (or other potential host) is immune, in the sense of being protected against becoming infected and/or developing disease. For many viruses, antibodies serve as a correlate of immunity, but they are not the only element to consider when determining whether a person is completely immune. Unfortunately, the correlates of protection against SARS-CoV-2 are still not completely understood.

CITF-funded researchers are interested in defining the markers that are associated with protective immunity against SARS-CoV-2 infection. Factors under consideration include presence and minimum thresholds of binding antibodies and neutralizing antibodies against the SARS-CoV-2 spike and nucleocapsid proteins. T and B cells are also being studied to determine their role in protection as they are shown to last longer than antibodies. Researchers would like to determine if 1) If these are good markers and 2) how much of these markers are needed to confer protection.

Serosurveillance and other population-based studies

Figure 4.1. Using a spring-loaded lancet provided in the test kit, drops of blood from a fingerprick are placed onto the DBS filter paper card. The DBS is then sealed, packaged, labelled and shipped to an analytical lab, where it is processed and analyzed for the presence of SARS-CoV-2 antibodies. A positive result would be indicative of a past infection. Photo Credit: Kristin Davis.

Seroprevalence is the number (or percentage) of people in a population who test positive for specific antibodies against a virus or infectious agent, based on blood tests. If the seroprevalence is 1%, for example, this suggests that 1% of the population studied has antibodies to the virus or infectious agent and therefore could have some form of resistance to it. Seroprevalence could refer to people with antibodies due to infection and/or antibodies due to vaccination.

Health surveillance is common in public health. It is a way of observing and monitoring the health and wellness of large groups of people. Serosurveillance monitors and estimates antibody levels in blood samples from certain groups of people against infectious agents, such as SARS-CoV-2, the virus that causes COVID-19. The goal is to measure how many people have been exposed to SARS-CoV-2 and have subsequently developed antibodies, which are an essential part of developing immunity. This will help researchers estimate population immunity resulting from a past infection or vaccination. When it’s known how many people have antibodies to ward off potential infection, or at least serious forms of infection, public health officials can more confidently inform and protect people.

To understand population immunity to the SARS-CoV-2 virus, blood samples from thousands of Canadians are currently being tested to check levels of antibodies directed against SARS-CoV-2 proteins.

As vaccines become available, serosurveillance can help us determine priority groups for vaccination by identifying populations that remain vulnerable to infection. Seroprevalence studies can also help us monitor the effectiveness of the existing vaccination programs.

SARS-CoV-2 is a relatively new virus so there are many questions that still need to be answered. For example, at this stage in the pandemic, we still don’t know for certain how long antibodies (from a COVID-19 infection or a vaccine) remain in the body. By continuing to gather as much information as possible about the virus, we improve our ability to mount a comprehensive and well-informed response against it.

Immune testing is not testing for an active virus (when you go get a nasal or mouth swab to see if you have SARS-CoV-2). Rather, it means testing individuals for the presence of antibodies made in response to SARS-CoV-2 (the virus that causes COVID-19). It is usually done with a blood sample, but other methods have been developed as well, including using saliva. Immune testing on a large scale can approximate the total number of individuals who have been infected and their socio-demographic distribution. Special techniques can be used to detect variants of concern in the samples. This information can be used to better understand SARS-CoV-2’s patterns of infection and inform measures to prevent transmission.

Vaccine surveillance studies look at vaccine effectiveness (How good are vaccines at preventing severe disease, new infections, and transmission?) and vaccine safety (identifying and quantifying the vaccine’s adverse effects). An adverse effect is an undesired harmful effect resulting from a medication or other intervention.

Vaccine surveillance also looks more precisely at the immune response generated by the vaccine (how successful is the vaccine at developing a protective immune response? What are the details of the vaccine-induced immune response? How long can these “markers of protection” be detected? How long will the vaccine work?).

Vaccine surveillance covers vaccine confidence which explores the driving factors behind any concerns people may have about getting vaccinated (aka. vaccine hesitancy).

Natural immunity is better termed “infection-acquired immunity”. It means the person has some form of defence against the virus due to an infection or exposure – not thanks to a vaccine. Vaccine-induced immunity refers to the body’s defence mechanism against a virus created in response to a vaccine.

Currently, there is no consensus on how long either type of immunity lasts.

Sometimes referred to as field studies, population-based studies aim to answer research questions for defined populations, based on a sample of that population. These populations of interest can be large, like the entire population of a city, or they can be defined by a single characteristic shared by a number of people, like children between the ages of 3 and 5.

These studies are traditionally described as studies that involve a defined “general population,” as opposed to a hospital-based or occupation-based population.

To extrapolate statistics from population-based studies, several minimum requirements need to be met:

  1. The sample of individuals needs to be big enough, randomly selected, and representative of the general population;
  2. The measurements need to be standardized;
  3. The tests used need to have adequate sensitivity and specificity.

Population-based seroprevalence surveys of COVID-19 help us to do things like estimate how infectious the virus is and its fatality rate. They can tell us, for example, how much transmission is due to asymptomatic and mild infections. They can also help us identify exposed and susceptible populations.

These types of studies are well suited to inform evidence-based policy decisions.

CITF-funded researchers are involved in large-scale projects estimating seroprevalence by region and province or territory. They are also involved in estimating infection-acquired and vaccine-induced seroprevalence among populations of interest such as school-aged children, long-term care facilities, healthcare workers, geographical hotspots, and people at higher risk due to pre-existing health conditions, among others. You can see a complete list of our funded studies here.

Core data elements are a standardized list of questions developed by CITF experts that must be integrated into surveys done by CITF-funded groups studying immunity. These core data elements aim to encourage the many CITF-funded research groups to acquire and record survey data in a standardized manner. The goal is for the CITF to be able to directly compare results from different COVID-19 studies and initiatives across Canada.

Specifically, the core data elements include questions and responses related to COVID-19 status, COVID-19 symptoms, quality of housing, risk factors, risk acquisitions, vaccines and health behaviour changes related to the virus.

A DBS, or dried blood spot kit, is an easy-to-use way to take a blood sample that people can do at home. It’s a great alternative to having blood drawn in a clinic, as people don’t have to leave home to do it. The participant is asked to follow a step-by-step process which involves them pricking their finger and depositing several blood drops onto a card which is then mailed back to a laboratory for analysis. Please see a video made by one of our funded studies here.

Currently, these kits are being used by a number of seroprevalence studies supported by the CITF in order to collect blood for antibody testing. Scientists use the collected blood spots to determine the presence of SARS-CoV-2 antibodies in a surveyed population.

Seroprevalence is the number (or percentage) of people in a population who test positive for specific antibodies against a virus or infectious agent, based on blood tests. If the seroprevalence is 1%, for example, this suggests that 1% of the population studied has antibodies to the virus or infectious agent and therefore could have some form of resistance to it. Seroprevalence could refer to people with antibodies due to infection and/or antibodies due to vaccination.

Health surveillance is common in public health. It is a way of observing and monitoring the health and wellness of large groups of people. Serosurveillance monitors and estimates antibody levels in blood samples from certain groups of people against infectious agents, such as SARS-CoV-2, the virus that causes COVID-19. The goal is to measure how many people have been exposed to SARS-CoV-2 and have subsequently developed antibodies, which are an essential part of developing immunity. This will help researchers estimate population immunity resulting from a past infection or vaccination. When it’s known how many people have antibodies to ward off potential infection, or at least serious forms of infection, public health officials can more confidently inform and protect people.

To understand population immunity to the SARS-CoV-2 virus, blood samples from thousands of Canadians are currently being tested to check levels of antibodies directed against SARS-CoV-2 proteins.

As vaccines become available, serosurveillance can help us determine priority groups for vaccination by identifying populations that remain vulnerable to infection. Seroprevalence studies can also help us monitor the effectiveness of the existing vaccination programs.

SARS-CoV-2 is a relatively new virus so there are many questions that still need to be answered. For example, at this stage in the pandemic, we still don’t know for certain how long antibodies (from a COVID-19 infection or a vaccine) remain in the body. By continuing to gather as much information as possible about the virus, we improve our ability to mount a comprehensive and well-informed response against it.

Immune testing is not testing for an active virus (when you go get a nasal or mouth swab to see if you have SARS-CoV-2). Rather, it means testing individuals for the presence of antibodies made in response to SARS-CoV-2 (the virus that causes COVID-19). It is usually done with a blood sample, but other methods have been developed as well, including using saliva. Immune testing on a large scale can approximate the total number of individuals who have been infected and their socio-demographic distribution. Special techniques can be used to detect variants of concern in the samples. This information can be used to better understand SARS-CoV-2’s patterns of infection and inform measures to prevent transmission.

Vaccine surveillance studies look at vaccine effectiveness (How good are vaccines at preventing severe disease, new infections, and transmission?) and vaccine safety (identifying and quantifying the vaccine’s adverse effects). An adverse effect is an undesired harmful effect resulting from a medication or other intervention.

Vaccine surveillance also looks more precisely at the immune response generated by the vaccine (how successful is the vaccine at developing a protective immune response? What are the details of the vaccine-induced immune response? How long can these “markers of protection” be detected? How long will the vaccine work?).

Vaccine surveillance covers vaccine confidence which explores the driving factors behind any concerns people may have about getting vaccinated (aka. vaccine hesitancy).

Natural immunity is better termed “infection-acquired immunity”. It means the person has some form of defence against the virus due to an infection or exposure – not thanks to a vaccine. Vaccine-induced immunity refers to the body’s defence mechanism against a virus created in response to a vaccine.

Currently, there is no consensus on how long either type of immunity lasts.

Sometimes referred to as field studies, population-based studies aim to answer research questions for defined populations, based on a sample of that population. These populations of interest can be large, like the entire population of a city, or they can be defined by a single characteristic shared by a number of people, like children between the ages of 3 and 5.

These studies are traditionally described as studies that involve a defined “general population,” as opposed to a hospital-based or occupation-based population.

To extrapolate statistics from population-based studies, several minimum requirements need to be met:

  1. The sample of individuals needs to be big enough, randomly selected, and representative of the general population;
  2. The measurements need to be standardized;
  3. The tests used need to have adequate sensitivity and specificity.

Population-based seroprevalence surveys of COVID-19 help us to do things like estimate how infectious the virus is and its fatality rate. They can tell us, for example, how much transmission is due to asymptomatic and mild infections. They can also help us identify exposed and susceptible populations.

These types of studies are well suited to inform evidence-based policy decisions.

CITF-funded researchers are involved in large-scale projects estimating seroprevalence by region and province or territory. They are also involved in estimating infection-acquired and vaccine-induced seroprevalence among populations of interest such as school-aged children, long-term care facilities, healthcare workers, geographical hotspots, and people at higher risk due to pre-existing health conditions, among others. You can see a complete list of our funded studies here.

Core data elements are a standardized list of questions developed by CITF experts that must be integrated into surveys done by CITF-funded groups studying immunity. These core data elements aim to encourage the many CITF-funded research groups to acquire and record survey data in a standardized manner. The goal is for the CITF to be able to directly compare results from different COVID-19 studies and initiatives across Canada.

Specifically, the core data elements include questions and responses related to COVID-19 status, COVID-19 symptoms, quality of housing, risk factors, risk acquisitions, vaccines and health behaviour changes related to the virus.

A DBS, or dried blood spot kit, is an easy-to-use way to take a blood sample that people can do at home. It’s a great alternative to having blood drawn in a clinic, as people don’t have to leave home to do it. The participant is asked to follow a step-by-step process which involves them pricking their finger and depositing several blood drops onto a card which is then mailed back to a laboratory for analysis. Please see a video made by one of our funded studies here.

Currently, these kits are being used by a number of seroprevalence studies supported by the CITF in order to collect blood for antibody testing. Scientists use the collected blood spots to determine the presence of SARS-CoV-2 antibodies in a surveyed population.

Figure 4.1. Using a spring-loaded lancet provided in the test kit, drops of blood from a fingerprick are placed onto the DBS filter paper card. The DBS is then sealed, packaged, labelled and shipped to an analytical lab, where it is processed and analyzed for the presence of SARS-CoV-2 antibodies. A positive result would be indicative of a past infection. Photo Credit: Kristin Davis.

Vaccines

Figure 5.1. The COVID-19 mRNA vaccine contains instructions (mRNA) to make a lot of SARS-CoV-2 Spike proteins. The release of this Spike protein outside of the host cell triggers an immune response and the host makes antibodies, B cells, and T cells against the virus, similar to what happens in natural infection. Photo Credit: Mariana Bego.

COVID-19 vaccines trigger our bodies to develop immunity against SARS-CoV-2 without us having to get the disease first. There are currently four main types of COVID-19 vaccines: messenger RNA (mRNA) vaccines (such as Pfizer-BioNTech’s Comirnaty and Moderna’s Spikevax), protein subunit vaccines (such as Novavax’s COVID-19 vaccine), viral vector vaccines (such as Johnson & Johnson and Oxford-AstraZeneca’s Vaxzevria), and inactivated virus vaccines (such as the Sinovac COVID-19 vaccine).

The mRNA vaccine teaches our cells to make a copy of a protein unique to SARS-CoV-2 called the spike protein. Our body recognizes these proteins as foreign and generates antibodies and build B cells and T cells to remember the virus so we can defeat it if we are infected in the future.

The protein subunit vaccines consist of harmless proteins of the SARS-CoV-2 virus, while vector vaccines contain a different harmless virus that enters our cells to produce the SARS-CoV-2 spike protein. Lastly, the inactivated SARS-CoV-2 vaccine consists of the killed virus that no longer replicates.

All types of vaccines have the same end goal: generate a supply of memory B and T cells to remember how to the fight the virus in the future. The levels and duration of immunity offered by these different vaccines, however, may vary.

There are currently four COVID-19 vaccines that are approved and authorized for use in Canada (see table below). On September 16, 2021, three of these vaccines were authorized under the Food and Drug Regulations Act, prompting the transition to using brand names instead of company names, notably, Comirnaty, Spikevax, and Vaxzevria.

Brand name Manufacturer(s) Research name Vaccine type Number of doses administered
Comirnaty Pfizer, Inc. and BioNTech BNT162b2 mRNA 2
Spikevax ModernaTX, Inc. mRNA-1273 mRNA 2
Vaxzevria AstraZeneca Canada Inc. and Verity/SII (COVISHIELD) ChAdOx1 Viral-vector 2
(Johnson & Johnson) Janssen Pharmaceutical Companies of Johnson & Johnson JNJ-78436735 Viral-vector 1

For more information on these vaccines, please the Government of Canada’s website.

Vaccines against SARS-CoV-2 have been developed to prime your body’s immune response to ensure that it fights against the virus, reducing the risk of you getting COVID-19. These vaccines are especially good at reducing the risk of severe COVID-19 symptoms, hospitalization, and death.

That said, the risk of a vaccinated person catching SARS-CoV-2 and developing COVID cannot be completely eliminated. Early data suggest fully vaccinated people can get the Delta variant and perhaps other variants. However, when compared to unvaccinated individuals, fully vaccinated people are less likely to acquire SARS-CoV-2, and when they do, they get less severe COVID-19 symptoms.

Studies suggest that vaccinated individuals have reduced numbers of virus in the blood and this could mean there is less virus to transmit, meaning reduced transmission. That said, vaccinated individuals can still transmit the virus for a period of time after infection. Therefore, it is extremely important that vaccinated people continue to follow public health guidelines including frequent hand washing, maintaining a safe distance from others, wearing a mask, and staying home if feeling unwell.

If you had COVID-19 previously, you should still get vaccinated because the level of immunity from infection and its duration is not entirely clear. The vaccine will also provide longer-term protection as it has been optimally designed to generate an effective immune response. There is no harm in getting a vaccine to boost your immune response to SARS-CoV-2.

Vaccine effectiveness is measured by the impact of vaccination on COVID-19-related hospitalizations, mortality, effects of COVID-19 vaccination on asymptomatic infection and transmission, and how groups of different ages, and overall health status respond to the vaccine. Some of the studies the CITF supports include assessing effectiveness with different combinations of vaccines, vaccinations in pregnant women and children, vaccinations in people at higher risk due to other health conditions, and vaccine effectiveness for prevention of serious outcomes among hospitalized adults.

The CITF is involved in supporting research studies which evaluate vaccine safety. Vaccine safety is evaluated by tracking adverse events following immunization (AEFIs) including an association with anaphylaxis and other allergic events, Guillain-Barré syndrome, Bell’s palsy, and vaccine-associated enhanced disease, among others. Some of the studies we fund are documenting health events including temporary local injection site reactions, systemic symptoms (fever, fatigue, myalgia), respiratory symptoms suggestive of the cold or flu, and gastrointestinal symptoms (nausea, vomiting, diarrhea, or stomach pain), among others. The populations studied overlap with studies measuring vaccine effectiveness and include pregnant women, children, people at higher risk due to other health conditions, and hospitalized adults.

The current vaccines approved for use were tested in clinical trials before the new variants emerged. Evidence to determine how effectively the vaccines will work against them has been coming out in bits as studies follow this issue closely.

Preliminary studies show that individuals vaccinated with the Pfizer-BioNTech Comirnaty mRNA vaccine can neutralize the variants of concern Alpha and Beta, originating from the UK and South Africa, respectively. Another study has shown that there was a reduction in the capability of Moderna’s Spikevax mRNA-1273 to ward off the Beta variant. Lastly, Novavax announced that their vaccine had a vaccine efficacy of 89.3% in a UK population where there was high prevalence of the Alpha variant, suggesting that it is effective against this variant. Altogether, these studies suggest the importance of continuous monitoring of the variants as this could indicate a need for a vaccine strain change.

Real-world data show that vaccines remain highly effective at reducing COVID-19-related hospitalizations and emergency department (ED) visits, even in the presence of the circulating Delta variant. Unvaccinated individuals who contracted the Delta variant are 5 to 7 times more likely to need ED care or hospitalization when compared to vaccinated individuals. Moderna’s Spikevax and Pfizer-BioNTech’s Comirnaty were both highly effective at preventing hospitalizations among adults ages 18 and older (95% and 80%, respectively). But vaccine effectiveness was lower for those aged 75 years and above. Vaccination is therefore highly important to ease the burden on the healthcare system.

Based on clinical trials, the manufacturers of the SARS-CoV-2 vaccines recommend two doses at specific intervals to achieve optimal efficacy. Due to vaccine supply shortages, countries were faced with the difficult decision to delay the second dose to maximize the number of people receiving their first dose. However, it has now been shown that a longer interval between the vaccine doses could actually improve immunity.

Canada’s National Advisory Committee on Immunization (NACI) has recommended that individuals can receive their second dose up to four months after receiving their first dose. Modelling by the Public Health Agency of Canada also suggested intervals could be extended up to six months between doses. However, ongoing long-term follow-up in clinical trials and in the real world will be imperative to understand the actual duration of protection.

Most vaccines are given as two doses to offer the maximum benefit of protection against SARS-CoV-2. Pfizer-BioNTech’s Comirnaty, Moderna’s Spikevax, and AstraZeneca’s Vaxzevria COVID-19 vaccines are all given as a two-dose series, while the Johnson & Johnson vaccine is a single-dose shot. All four vaccines have been shown to be effective at preventing symptomatic COVID-19 disease beginning two weeks after the first dose in clinical trials.

In two-dose series, the first dose acts to prime immunological memory, while the second dose acts as a ‘boost’ to extend protection over the longer term. This essentially means that more exposure time allows the body a chance to produce more antibodies and memory cells to fight off the virus. Protection offered by the first dose is lower than the efficacy achieved after the second dose. Peak levels of humoral and cellular responses are observed after this second dose.

A breakthrough infection occurs when individuals who are fully vaccinated against a disease, such as COVID-19, are subsequently infected. The term ‘breakthrough’ signifies the virus broke through the protective barrier that vaccines provide. The effectiveness of COVID-19 vaccines is not 100% and as such, breakthrough infections can occur, although they are predominantly asymptomatic or mildly symptomatic. COVID-19 vaccines remain the best way to be protected against severe disease, hospitalization, and death resulting from SARS-CoV-2 infection.

COVID-19 vaccines trigger our bodies to develop immunity against SARS-CoV-2 without us having to get the disease first. There are currently four main types of COVID-19 vaccines: messenger RNA (mRNA) vaccines (such as Pfizer-BioNTech’s Comirnaty and Moderna’s Spikevax), protein subunit vaccines (such as Novavax’s COVID-19 vaccine), viral vector vaccines (such as Johnson & Johnson and Oxford-AstraZeneca’s Vaxzevria), and inactivated virus vaccines (such as the Sinovac COVID-19 vaccine).

The mRNA vaccine teaches our cells to make a copy of a protein unique to SARS-CoV-2 called the spike protein. Our body recognizes these proteins as foreign and generates antibodies and build B cells and T cells to remember the virus so we can defeat it if we are infected in the future.

The protein subunit vaccines consist of harmless proteins of the SARS-CoV-2 virus, while vector vaccines contain a different harmless virus that enters our cells to produce the SARS-CoV-2 spike protein. Lastly, the inactivated SARS-CoV-2 vaccine consists of the killed virus that no longer replicates.

All types of vaccines have the same end goal: generate a supply of memory B and T cells to remember how to the fight the virus in the future. The levels and duration of immunity offered by these different vaccines, however, may vary.

Figure 5.1. The COVID-19 mRNA vaccine contains instructions (mRNA) to make a lot of SARS-CoV-2 Spike proteins. The release of this Spike protein outside of the host cell triggers an immune response and the host makes antibodies, B cells, and T cells against the virus, similar to what happens in natural infection. Photo Credit: Mariana Bego.

There are currently four COVID-19 vaccines that are approved and authorized for use in Canada (see table below). On September 16, 2021, three of these vaccines were authorized under the Food and Drug Regulations Act, prompting the transition to using brand names instead of company names, notably, Comirnaty, Spikevax, and Vaxzevria.

Brand name Manufacturer(s) Research name Vaccine type Number of doses administered
Comirnaty Pfizer, Inc. and BioNTech BNT162b2 mRNA 2
Spikevax ModernaTX, Inc. mRNA-1273 mRNA 2
Vaxzevria AstraZeneca Canada Inc. and Verity/SII (COVISHIELD) ChAdOx1 Viral-vector 2
(Johnson & Johnson) Janssen Pharmaceutical Companies of Johnson & Johnson JNJ-78436735 Viral-vector 1

For more information on these vaccines, please the Government of Canada’s website.

Vaccines against SARS-CoV-2 have been developed to prime your body’s immune response to ensure that it fights against the virus, reducing the risk of you getting COVID-19. These vaccines are especially good at reducing the risk of severe COVID-19 symptoms, hospitalization, and death.

That said, the risk of a vaccinated person catching SARS-CoV-2 and developing COVID cannot be completely eliminated. Early data suggest fully vaccinated people can get the Delta variant and perhaps other variants. However, when compared to unvaccinated individuals, fully vaccinated people are less likely to acquire SARS-CoV-2, and when they do, they get less severe COVID-19 symptoms.

Studies suggest that vaccinated individuals have reduced numbers of virus in the blood and this could mean there is less virus to transmit, meaning reduced transmission. That said, vaccinated individuals can still transmit the virus for a period of time after infection. Therefore, it is extremely important that vaccinated people continue to follow public health guidelines including frequent hand washing, maintaining a safe distance from others, wearing a mask, and staying home if feeling unwell.

If you had COVID-19 previously, you should still get vaccinated because the level of immunity from infection and its duration is not entirely clear. The vaccine will also provide longer-term protection as it has been optimally designed to generate an effective immune response. There is no harm in getting a vaccine to boost your immune response to SARS-CoV-2.

Vaccine effectiveness is measured by the impact of vaccination on COVID-19-related hospitalizations, mortality, effects of COVID-19 vaccination on asymptomatic infection and transmission, and how groups of different ages, and overall health status respond to the vaccine. Some of the studies the CITF supports include assessing effectiveness with different combinations of vaccines, vaccinations in pregnant women and children, vaccinations in people at higher risk due to other health conditions, and vaccine effectiveness for prevention of serious outcomes among hospitalized adults.

The CITF is involved in supporting research studies which evaluate vaccine safety. Vaccine safety is evaluated by tracking adverse events following immunization (AEFIs) including an association with anaphylaxis and other allergic events, Guillain-Barré syndrome, Bell’s palsy, and vaccine-associated enhanced disease, among others. Some of the studies we fund are documenting health events including temporary local injection site reactions, systemic symptoms (fever, fatigue, myalgia), respiratory symptoms suggestive of the cold or flu, and gastrointestinal symptoms (nausea, vomiting, diarrhea, or stomach pain), among others. The populations studied overlap with studies measuring vaccine effectiveness and include pregnant women, children, people at higher risk due to other health conditions, and hospitalized adults.

The current vaccines approved for use were tested in clinical trials before the new variants emerged. Evidence to determine how effectively the vaccines will work against them has been coming out in bits as studies follow this issue closely.

Preliminary studies show that individuals vaccinated with the Pfizer-BioNTech Comirnaty mRNA vaccine can neutralize the variants of concern Alpha and Beta, originating from the UK and South Africa, respectively. Another study has shown that there was a reduction in the capability of Moderna’s Spikevax mRNA-1273 to ward off the Beta variant. Lastly, Novavax announced that their vaccine had a vaccine efficacy of 89.3% in a UK population where there was high prevalence of the Alpha variant, suggesting that it is effective against this variant. Altogether, these studies suggest the importance of continuous monitoring of the variants as this could indicate a need for a vaccine strain change.

Real-world data show that vaccines remain highly effective at reducing COVID-19-related hospitalizations and emergency department (ED) visits, even in the presence of the circulating Delta variant. Unvaccinated individuals who contracted the Delta variant are 5 to 7 times more likely to need ED care or hospitalization when compared to vaccinated individuals. Moderna’s Spikevax and Pfizer-BioNTech’s Comirnaty were both highly effective at preventing hospitalizations among adults ages 18 and older (95% and 80%, respectively). But vaccine effectiveness was lower for those aged 75 years and above. Vaccination is therefore highly important to ease the burden on the healthcare system.

Based on clinical trials, the manufacturers of the SARS-CoV-2 vaccines recommend two doses at specific intervals to achieve optimal efficacy. Due to vaccine supply shortages, countries were faced with the difficult decision to delay the second dose to maximize the number of people receiving their first dose. However, it has now been shown that a longer interval between the vaccine doses could actually improve immunity.

Canada’s National Advisory Committee on Immunization (NACI) has recommended that individuals can receive their second dose up to four months after receiving their first dose. Modelling by the Public Health Agency of Canada also suggested intervals could be extended up to six months between doses. However, ongoing long-term follow-up in clinical trials and in the real world will be imperative to understand the actual duration of protection.

Most vaccines are given as two doses to offer the maximum benefit of protection against SARS-CoV-2. Pfizer-BioNTech’s Comirnaty, Moderna’s Spikevax, and AstraZeneca’s Vaxzevria COVID-19 vaccines are all given as a two-dose series, while the Johnson & Johnson vaccine is a single-dose shot. All four vaccines have been shown to be effective at preventing symptomatic COVID-19 disease beginning two weeks after the first dose in clinical trials.

In two-dose series, the first dose acts to prime immunological memory, while the second dose acts as a ‘boost’ to extend protection over the longer term. This essentially means that more exposure time allows the body a chance to produce more antibodies and memory cells to fight off the virus. Protection offered by the first dose is lower than the efficacy achieved after the second dose. Peak levels of humoral and cellular responses are observed after this second dose.

A breakthrough infection occurs when individuals who are fully vaccinated against a disease, such as COVID-19, are subsequently infected. The term ‘breakthrough’ signifies the virus broke through the protective barrier that vaccines provide. The effectiveness of COVID-19 vaccines is not 100% and as such, breakthrough infections can occur, although they are predominantly asymptomatic or mildly symptomatic. COVID-19 vaccines remain the best way to be protected against severe disease, hospitalization, and death resulting from SARS-CoV-2 infection.