COVID-19 Vaccine Program Update

Advisory Alert

December 20, 2022

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To: Local Health System Partners


Updated COVID-19 vaccine booster dose and co-administration guidance

Please be advised that the Ministry of Health’s COVID-19 Vaccine Guidance has recently been updated. It includes new recommendations from the National Advisory Committee on Immunization (NACI) regarding COVID-19 vaccines as well as Health Canada authorization for the use of Novavax Nuvaxovid as a booster dose for individuals 18 years of age and older.

This Advisory Alert provides an overview of the updated Ministry guidelines for COVID-19 booster doses, a new bivalent vaccine for booster doses for children aged 5 to 11, and updated co-administration guidelines for children aged 6 months to 4 years of age.

Staying Up to Date with COVID-19 Vaccines

Staying up to date with COVID-19 vaccines is important. Booster doses are recommended for all eligible populations based on the ongoing risk of infection due to waning immunity, the ongoing risk of severe illness from COVID-19, the societal disruption that results from transmission of infections, and the adverse impacts on health system capacity from the COVID-19 pandemic. Staying up to date means:

The use of a bivalent mRNA COVID-19 vaccine product for the booster dose is recommended over the use of a monovalent vaccine. A monovalent vaccine may be used for those who refuse the bivalent vaccine, with informed consent.

For individuals who have completed their primary COVID-19 vaccine series, the optimal interval for a booster dose after their last COVID-19 vaccine dose (or confirmed SARS-CoV-2 infection) is 6 months. A shortened interval of at least 3 months may be considered in the context of heightened epidemiologic risk and for those with severe COVID-19 outcomes.

COVID-19 Bivalent Booster Doses for Children 5 to 11 Years

Children 5 to 11 years of age are eligible to receive a bivalent Pfizer-BioNTech (10mcg)  booster dose at a recommended 6month interval after completion of their primary series. This is the only authorized bivalent product for this age group. Children with underlying medical conditions that place them at high risk of severe illness due to COVID-19 (including those who are moderately to severely immunocompromised and who received an extended primary series) are strongly recommended to receive a booster dose.

Co-administration of COVID-19 and Other Vaccines for Infants and Children Aged 6 months to 4 Years

NACI has recently recommended that children aged 6 months to 4 years of age may receive a COVID-19 vaccine simultaneously (same day), or at any other time before or after any non-COVID-19 vaccine (live and non-live vaccines), with informed consent. Informed consent should include a discussion of the risks and benefits given the limited data available on administration of COVID-19 vaccines at the same time as or shortly before or after other vaccines. Refer to the full NACI statement here.

Booster Doses of non-mRNA Vaccines

Booster doses of Novavax (protein subunit vaccine) may be offered, with informed consent, to individuals who are 18 years and older without contraindications to the vaccine who are not able or willing to receive an mRNA COVID-19 vaccine.

Booster doses of Janssen (viral vector vaccine) may be offered, with informed consent, to individuals who are 18 years and older, only when all other Health Canada authorized COVID-19 vaccines are contraindicated.

COVID-19 Vaccine Program Support

Your participation in and support for the COVID-19 Vaccine Program is crucial as we continue to respond to SARS-CoV-2 and its impacts on our communities and on our health system and services.

Health care providers are encouraged to visit our COVID-19 Vaccine Clinic Communications in a Box webpage  for information on how to offer COVID-19 vaccine to their patient population, including homebound patients. If you have questions or need support to implement the COVID-19 vaccine program in your office setting, please contact Cynthia Peacock-Rocca, COVID-19, Operations Manager at or by calling 705.522.9200 ext. 279 (toll-free: 1.866.522.9200).

Thank you for your continued support in protecting and promoting health in our communities.


Original Signed By

Dr. Imran Khan
Public Health Physician and Director of Sexual Health, Vaccine Preventable Diseases and COVID-19 Vaccination Division

NOTE: All Advisory Alerts are found on our website.

This item was last modified on December 21, 2022