As major pharmaceutical companies near the finish line on a COVID-19 vaccine, the Canadian government is figuring out who to immunize first and how to do it as quickly as possible.
Moderna, Inc. announced Monday its vaccine tested 94.5 per cent effective in a study of 30,000 people in the United States. That came days after Pfizer Inc. announced its own vaccine contender was more than 90 per cent effective in a study with 43,000 participants.
The news is welcome as COVID cases surge in Canada, surpassing 300,000, with healthcare professionals worried about hospital capacity and many cities looking at reinstating lockdowns.
Vaccines are expected to roll out at some point next year, but details are only starting to emerge on what that rollout will look like.
How many doses are we getting?
Canada has already committed to buying 56 million doses of the Moderna vaccine and 76 million of Pfizer’s version, as long as both companies finish testing and get Health Canada’s approval.
Canada pre-bought 358 million doses of developing vaccines. That would be enough to cover Canada’s entire population nearly 10 times over, though there is still uncertainty around how long the effectiveness of each vaccine will last.
Canada has also invested $440 million in COVAX, a partnership between the Global Alliance for Vaccines and Immunization, the World Health Organization, and the Coalition for Epidemic Preparedness Innovations that uses pooled purchasing agreements to ensure low-income countries get access to vaccines but will also secure additional doses for Canada.
“Although it sounds kind of greedy, I think it was probably more strategic and it doesn’t rule out the possibility of helping other places,” said Lynora Saxinger, a professor with the University of Alberta’s department of medical microbiology and immunology.
The United States, the European Union, India, and the United Kingdom have all pre-bought more doses than Canada. Globally, 9.5 billion doses are already reserved, so Canada will get a fraction of whatever comes out in the first round of availability.
When will the COVID-19 vaccine arrive in Canada?
Last week, Prime Minister Justin Trudeau said Canadians could access a COVID-19 vaccine within the first three months of 2021 if the Pfizer vaccine could continue down its promising trajectory. “We see the light at the end of the tunnel," Trudeau said.
Jeff Kwong, interim director of the Centre for Vaccine Preventable Diseases at the University of Toronto, said it’s unlikely anyone will be immunized before March at the earliest. He said the Pfizer and Moderna vaccines will both require two doses, which complicates the rollout.
“There’s a lot of planning going on right now, but not a lot of certainty about anything at this point,” Kwong said.
“Be patient, because it’s not going to happen overnight. It’s going to be months, if not years, to vaccinate everyone who wants to get a vaccine.”
Saxinger said it’s likely Canada will end up using a “menu of vaccines,” with some that might work better for different populations for different reasons. Dozens of vaccines are in development around the world, including several by Canadian companies, and at least 10 are already in Phase 3 trials.
Her guess is the first round of doses will come in the first quarter of 2021 and the number of approved vaccines will gradually ramp up from there.
Toronto Medical Officer of Health Dr. Eileen de Villa said Monday she is hopeful the city’s highest risk populations will get the vaccine by spring, while B.C. Provincial Health Officer Bonnie Henry said she is confident a vaccine will be available for everyone in the province by this time next year.
Quebec public health director Dr. Horacio Arruda said last month that vaccinations for high-risk populations could start as soon as January.
Who will get vaccinated first?
Saxinger said there is “no way” Canada will get enough doses for everyone in the initial rollout, so governments will have to decide who gets immunized first.
It will be up to each province to determine specifics, but Canada’s National Advisory Committee on Immunization (NACI) has released preliminary guidelines, recommending priority goes to those at high risk of severe illness and death from COVID-19, including people who are older or have other high-risk conditions; health care workers and others most likely to transmit COVID-19 to high-risk people; anyone providing essential services (e.g., police, firefighters, grocery store staff); and those whose whose living and working conditions put them at higher risk, including Indigenous communities.
Why is mass distribution such a problem?
A whole distribution network has to come into place to make it happen, and McKesson, the country’s biggest pharmaceutical distributing company, has concerns about the logistics.
Pfizer and Moderna are both using RNA technology, which requires ultra-freezing at -80 C—a capability most facilities don’t have—and could necessitate centralized mass-distribution clinics. Moderna said its vaccine can be stored at fridge temperatures for up to 30 days, which might make it a more practical choice as it could be stored at a typical doctor’s office.
Still, McKesson wrote in a recent paper that “the existing public and private vaccine supply chains in Canada are not equipped to support frozen and/or ultra-frozen COVID-19 vaccines at scale, and even if the vaccine is refrigerated, the sheer scale of doses to be distributed will overwhelm existing infrastructure.”
Will Canadians refuse the vaccine?
Saxinger is more concerned with the importance of developing strong public messaging to ensure people get the vaccines when they do arrive, given the “hazardous” information landscape that has facilitated a proliferation of conspiracy theories and disinformation.
A September Angus-Reid poll found 16 per cent of Canadians are unwilling to get a COVID-19 vaccine, with Albertans being the most in opposition at 28 per cent.
“It’s a massive, massive operationalization to figure out,” Saxinger said.
“I don’t think that dims my enthusiasm about vaccines. It just means that we’ve got to get planning on all this stuff in advance as much as possible.”
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Correction, Nov. 18, 2020: An earlier version of this story said that Canada pre-bought 358 million doses of the developing vaccine from COVAX. In fact, the doses were part of seven advanced purchase agreements, which are separate from COVAX.