Ministry of Health

COVID-19 Guidance for Individuals

Vaccinated outside of Ontario/Canada
V. 2.0 September 14, 2021

Highlights of changes
• Updated scenario 2 (page 3) to align with the Public Health Agency of
Canada’s (PHAC) COVID-19: Recommendations for those vaccinated with
vaccines not authorized by Health Canada for those staying in Canada to
live, work or study.
• New Appendix A: Characteristics of COVID-19 Vaccine Platforms and
Recommendations for Additional Doses for Individuals Vaccinated Outside
of Ontario/Canada
This guidance provides basic information only. This document is not intended to
provide or take the place of medical advice, diagnosis or treatment, or legal advice.
In the event of any conflict between this guidance document and any applicable
emergency orders, or directives issued by the Minister of Health, Minister of Long-
Term Care, or the Chief Medical Officer of Health (CMOH), the order or directive
prevails.
• Please check the Ministry of Health (MOH) COVID-19 website regularly for
updates to this document, list of symptoms, other guidance documents,
Directives and other information.

Background
This document is intended to provide health care providers and Public Health Units
(PHUs) with approaches for individuals who have received COVID-19 vaccination
outside of Ontario or Canada.

This guidance is being updated to align with PHAC’s COVID-19: Recommendations

for those vaccinated with vaccines not authorized by Health Canada for those
staying in Canada to live, work or study, published on August 17, 2021. This
approach is aimed at providing optimal protection on an individual basis and the

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guidance will be updated as needed based on new data that will become available
on international vaccines.

In Canada, as of September 13, 2021, the following four COVID-19 vaccines are
authorized for use by Health Canada: Pfizer-BioNTech (mRNA), Moderna (mRNA),
AstraZeneca/COVISHIELD (viral vector) and Janssen/Johnson & Johnson (viral
vector). A number of vaccines are available in other countries that are not authorized
for use in Canada. Some of the vaccines authorized in other countries have been
reviewed by the World Health Organization (WHO) and added to their Emergency
Use List (i.e., CoronaVac/Sinovac and Sinopharm/BBIBP), some are under review by
the WHO and others have not been submitted for review. The vaccine
immunogenicity, vaccine efficacy and effectiveness of COVID-19 vaccines vary.
While many of these vaccines appear to be performing well based on available
data, others have lower vaccine effectiveness and/or vaccine efficacy.

This guidance aims to balance optimal protection against COVID-19, limiting

reactogenicity by minimizing the number of additional doses provided and providing
a straightforward approach that is easy to implement. Limited data for the whole
inactivated virus vaccine platform suggests that this platform is less efficacious than
the mRNA and viral vector vaccines; hence, there are strong potential benefits of
offering one additional mRNA dose to individuals who received a vaccine that uses
a whole inactivated virus vaccine platform (regardless whether or not the vaccine is
authorized under the World Health Organization Emergency Use List). There is
currently limited data available on the safety or efficacy of receiving a Health
Canada authorized COVID-19 vaccine after receipt of a non-Health Canada
authorized COVID-19 vaccine, however the below guidance is based on
immunological principles and expert opinion from PHAC and is similar to the
approaches of other jurisdictions (i.e. United Kingdom). Appendix A outlines a list of
international COVID-19 vaccines, their characteristics and the recommendations for
additional doses, this list is evolving and non-comprehensive.

Individuals Vaccinated outside of Canada/Ontario

• Individuals who have received a partial or complete COVID-19 vaccine series
outside of Ontario or Canada should contact their local public health unit to
have their COVID-19 immunization record documented in COVaxON prior to
receiving any additional doses and for their vaccination receipts..

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 • Proof of immunization (e.g., an immunization record, proof of vaccination
certificate (PVC) 1 is required to verify the COVID-19 vaccine product received. 2
• All vaccine doses administered out of province (regardless of the vaccine
product) should be reported, verified and documented by public health units
into COVaxON. 3

Scenario 1: COVID-19 vaccines authorized by Health Canada administered

outside of Ontario/Canada

• This scenario applies to all vaccine products that are authorized by Health
Canada, even if they are authorized under a different trade name in a different
country (e.g. Comirnaty, Spikevax).
• Individuals who have proof of immunization and have received all
recommended doses of a Health Canada authorized COVID-19 vaccine or a
combination of Health Canada authorized vaccines with at least the minimum
recommended interval between doses 4 outside of Ontario or Canada are
considered to have a complete vaccine series and no additional doses are
needed.
• Individuals who received the first dose of a two-dose Health Canada
authorized COVID-19 vaccine series outside of Ontario or Canada do not need
to restart the vaccine series, but should receive the second dose as close to
the interval recommended by Ontario as possible. 5

1
See Canadian Immunization Guide to Immunization records.
2
The Canadian Immunization Guide outlines that vaccination should only be considered valid if there
is written documentation of administration.
3
COVaxON is the provincial data base where COVID-19 immunization records are stored and provides
the information that is used for vaccination receipts.
4
See NACI’s immunization schedule, by COVID-19 vaccine: Table 3 for the minimum intervals.
5
NACI recommends that the vaccine series be completed with the same COVID-19 vaccine product
if readily available. See NACI’s recommendations on interchangeability.
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Scenario 2: COVID-19 vaccines not authorized by Health Canada

• Individuals who have proof of immunization and have received a complete

one or two-dose series of a COVID-19 vaccine that is not authorized for use
by Health Canada will be offered one additional dose of an mRNA vaccine. 6
o The minimum interval between the preceding dose and the additional
dose should be 28 days.
o If the individual has already received three doses of a non-Health
Canada authorized COVID-19 vaccine at the appropriate interval, no
additional doses should be offered at this time.
• Individuals who have proof of immunization and have received an
incomplete series of a non-Health Canada authorized vaccine, should
receive one additional dose of an mRNA vaccine.6
o The minimum interval between the preceding dose and the additional
dose should be 28 days.

Scenario 3: Unknown COVID-19 Vaccine Product

• If the individual indicates that they have received a previous dose(s) of a

COVID-19 vaccine, but have no proof of immunization, consider whether
further investigation can be done to obtain proof of immunization (e.g.,
contacting clinic location/health care provider or immunizer, etc.).
• If the COVID-19 vaccine product used for a previous dose(s) remains
unknown, or if written proof of immunization is provided for a vaccine whose
generic or trade name is not recognized (see Appendix A), a new vaccine
series should be started with a Health Canada authorized COVID-19 vaccine.
o Per NACI recommendations, if the previous date of immunization was
known, it would be prudent to wait for a period of at least 28 days after
the administration of any other COVID-19 vaccine dose(s) before
initiating a new Health Canada authorized COVID-19 vaccine series.

6
Per the Public Health Agency of Canada, for individuals that have received a complete
course/series of a non-Health Canada authorized vaccine, the mRNA vaccine is expected to
optimize protection.
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Individuals leaving Canada before Completion of
COVID-19 Vaccine Series
• If an individual needs to leave Ontario or Canada before completion of their
COVID-19 vaccination series, they should bring proof of immunization from
their first dose and follow public health guidance from the jurisdiction they
are entering. If the individual is going to another province they should contact
the health authority in the jurisdiction they arrive in to complete their COVID-
19 vaccine series.

COVaxON Documentation
• PHUs are responsible for documenting immunization information for
individuals who have received a partial or complete COVID-19 vaccine series
outside of Ontario into COVaxON. The information stated on the client’s
immunization record or proof of immunization will need to be entered.
• See the COVaxON job aid and functionality change communications for more
information.
• Functionality has been developed within COVaxON under ‘historical dose
administration’ with two options for recording:
A. Out of Province (OOP): A client may have received one/both doses outside
of Ontario and therefore this information would not be recorded in COVaxON.
The historical OOP dose(s) must be recorded in COVaxON.
o For a client that had Dose 1 OOP: The client must contact their PHU to
enter the dose 1 (i.e., historical dose) prior to booking their appointment
for dose 2.
o For a client that had both doses or only Dose 2 OOP: The client should
contact their PHU to enter those historical doses prior to booking an
appointment for dose 3 (if needed).
B. Non-Ontario Stock (NOS): A client may have received one/both doses from
non-Ontario vaccine stock (i.e., Federal Stock used for correctional facilities,
military groups, embassies, etc.). The historical NOS dose(s) can be recorded in
COVaxON. The location that conducted the vaccination will provide

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a list of data to be entered in COVaxON by the PHU/approved group. If the
client received their first dose via NOS, the historical entry of dose 1 needs to
be made prior to booking their second dose appointment.

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Appendix A: Characteristics of COVID-19 Vaccine Platforms and Recommendations
for Additional Doses for Individuals Vaccinated Outside of Ontario/Canada
*This is an evolving and non-comprehensive list, the WHO’s list of vaccines for emergency use and the CDC’s list can be
referenced if needed on a case by case basis for other non-Health Canada vaccines that are not listed below.

mRNA vaccines
Vaccine Vaccine Authorization Interval Schedule Scenario Ontario Guidance
Manufacturer
Pfizer- Pfizer-BioNTech WHO EUL 21 days 2 doses 2 doses No further doses
BioNTech COVID-19 (valid (complete)
Vaccine/Comirnaty/ dose if
BNT162B2 / 19 days
Tozinameran or more) 1 dose Administer 1 dose
(incomplete) of mRNA vaccine

Moderna Moderna COVID-19 WHO EUL 28 days 2 doses 2 doses No further doses
vaccine /Spikevax / (valid (complete)
mRNA-1273 / TAK- dose if
919 21 days 1 dose Administer 1 dose
or more) (incomplete) of mRNA vaccine

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Whole inactivated virus vaccines
Vaccine Vaccine Authorization Interval Schedule Scenario Ontario Guidance
Manufacturer

Sinovac Sinovac- WHO EUL 14-28 2 doses 2 doses Administer 1 dose

CoronaVac/ days (complete) or 1 of an mRNA
Ad5-nCoV dose (incomplete) vaccine

Sinopharm/Beijing COVID-19 WHO EUL 21-28 2 or 3 3 doses No further doses

Institute of vaccine BIBP days doses (complete)
Biological Products /BBIBP-CorV
2 doses Administer 1 dose
/ Covilo
(complete) or 1 of an mRNA
dose (incomplete) vaccine
Sinopharm/Wuhan COVID-19 China 21 days 2 doses 2 doses Administer 1 dose
Institute of vaccine WIBP, (complete) or 1 of an mRNA
Biological Products Inactivated dose (incomplete) vaccine
SARS-CoV-2
Vaccine (Vero
cell)
Bharat Biotech Covaxin India and 8 28 days 2 doses 2 doses Administer 1 dose
/BBV152 other (complete) or 1 of an mRNA
countries dose (incomplete) vaccine

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Whole inactivated virus vaccines continued.
Vaccine Vaccine Authorization Interval Schedule Scenario Ontario Guidance
Manufacturer

Minhai SARS-CoV-2 China 14 days 2 doses 2 doses Administer 1 dose

Biotechnology Co. Vaccine (Vero (complete) or 1 of an mRNA
Cells) dose (incomplete) vaccine
Chumakov Center KoviVac Russia 14 days 2 doses 2 doses Administer 1 dose
(complete) or 1 of an mRNA
dose (incomplete) vaccine
Kazakhstan RIBSP QazCovid-in / Kazakhstan 21 days 2 doses 2 doses Administer 1 dose
QazVac (complete) or 1 of an mRNA
dose (incomplete) vaccine
Shifa Pharmed COVIran- Iran 28 days 2 doses 2 doses Administer 1 dose
Industrial Group Barekat (complete) or 1 of an mRNA
dose (incomplete) vaccine

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Non-replicating, recombinant viral vector-based vaccines
Vaccine Vaccine Authorization Type Interval Schedule Scenario Ontario
Manufacturer Guidance
AstraZeneca/ AstraZeneca WHO EUL Recombinant 4-12 2 doses 2 doses No further doses
Oxford COVID-19 ChAdOx1-S weeks (complete)
University Vaccine / adenoviral (valid dose
1 dose Administer 1
Vaxzevria / vector if 28 days
(incomplete) dose of an
ChAdOx1-S / or more)
mRNA vaccine 7
AZD1222
Serum COVISHIELD/ WHO EUL Recombinant 4-12 2 doses 2 doses No further doses
Institute of ChAdOx1- ChAdOx1-S weeks (complete)
India (SII) S.nCoV-19 adenoviral (valid dose
vector if 28 days
1 dose Administer 1
or more)
(incomplete) dose of an
mRNA vaccine7
Janssen COVID-19 WHO EUL Recombinant Not 1 dose 1 dose No further doses
(Johnson & Janssen / adenoviral applicable (complete)
Johnson) JNJ- vector
78436735 / (Ad26)
Ad26.COV2.S

7
NACI preferentially recommends an mRNA vaccine following AstraZeneca/COVISHIELD, but individuals may receive a second dose of
AstraZeneca/COVISHIELD in Ontario.
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Non-replicating, recombinant viral vector-based vaccines continued
Vaccine Vaccine Authorization Type Interval Schedule Scenario Ontario
Manufacturer Guidance
Gamaleya Sputnik V/ Russia and Recombinant 21 days 2 doses 2 doses Administer 1
National Gam- 69 other adenoviral vector (complete) dose of an
Centre of COVID-Vac countries (Ad26 (prime), mRNA
Epidemiology Ad5 (-boost) vaccine
and expressing full
Microbiology length spike
glycoprotein
Gamaleya Sputnik Russia and 11 Recombinant Not 1 dose 1 dose Administer 1
National Light other adenoviral vector applicable (complete) dose of an
Centre of countries (Ad26 (prime), mRNA
Epidemiology Ad5 (-boost) vaccine
and expressing full
Microbiology length spike
glycoprotein
CanSino Ad5-nCoV / China and 7 Recombinant Not 1 dose 1 dose Administer 1
Biologics Convidecia other adenoviral vector applicable (complete) dose of an
countries (Ad5) mRNA
vaccine

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Protein subunit vaccines
Vaccine Vaccine Authorization Interval Schedule Scenario Ontario Guidance
Manufacturer

Novavax NVX-CoV2373 / Pending 21 days 2 dose 2 dose (complete) Administer 1 dose

CoVovax authorization or 1 dose of an mRNA
in Canada (incomplete) vaccine

Anhui Zhifei RBD-Dimer / China 30 days 2 or 3 3 doses (complete) No further doses

Longcom ZF2001 / Uzbekistan doses
ZIFIVAX 2 doses (complete) Administer 1 dose
or 1 dose of an mRNA
(incomplete) vaccine
Vektor State Epi VacCorona Russia 21 days 2 doses 2 doses (complete) Administer 1 dose
Research Center Turkmenistan or 1 dose of an mRNA
of Virology and (incomplete) vaccine
Biotechnology

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Protein subunit vaccines continued.
Vaccine Vaccine Authorization Interval Schedule Scenario Ontario
Manufacturer Guidance

Center for Abdala / CIGB-66 Cuba 14 days 3 doses 3 doses No further

Genetic (complete) doses
Engineering and
Biotechnology
2 doses Administer 1
(CIGB), The
(incomplete) or dose of an
Havana
1 dose mRNA vaccine
(incomplete)
Medigen MVC-COV1901 Taiwan 28 days 2 doses 2 doses Administer 1
(complete) or 1 dose of an
dose mRNA vaccine
(incomplete)

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