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Canada hits supply chain issues, emphasises First Nations groups in vaccine roll-out
As the world begins to roll-out COVID-19 vaccines — both those that have and have not officially passed Phase 3 trials — countries are grappling with issues including supply chains, public disinformation and scientific challenges (the release of Oxford–AstraZeneca’s final results highlights lingering unknowns over the most effective dosing regimen and how well it works in older adults).
With much attention is paid to vaccine development and distribution in the UK and US, Canada’s journey to vaccine roll-out offers what could be the most useful case study for Australia, especially with regard to supply chain issues, federal-state relations, and First Nations collaboration and prioritisation.
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Canada received its first 30,000 doses of the Pfizer/BioNTech mRNA-based vaccine — which Canada Health approved with conditions on December 9 amid a deadly second wave — on Sunday night, with Global News reporting the first injection went to a nursing home resident in Quebec City.
While Justin Trudeau told Canadians last week the country would receive 249,000 early doses before the end of 2020, CNN reports that minister of Procurement Anita Anand subsequently made clear at a press conference on Monday the number could actually be less than half that.
Anand emphasised that Canada’s early roll-out will not be as widespread as either the US or UK ,due in part to the “fiercely competitive” global scramble for early doses.
“We are dealing with an incredibly competitive global environment,” Anand said. “We’ve been able to negotiate hard, with fortitude, to bring early doses into this country.”
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While she did not go into any further details, Canada made an advance purchasing agreement (APA) with Pfizer in August for a total of up to 76 million doses; for some context, Time reports the company scaled back plan to manufacture up to 100 million doses by the end of 2020 to 50 million following difficulties securing all the materials needed to produce the drug at large-scale.
Additionally, on December 8, Pfizer was forced to reiterate it will honour the Canadian deal despite an executive order by Donald Trump to ensure priority access to COVID-19 vaccines procured by the US government (which has an APA for 100 million doses and capacity to acquire 500 million more).
Distribution plans promote collaboration and prioritisation of First Nations communities
Now, Global News explains that each Canadian province is currently working through unique distribution plans, which are based on the country’s National Advisory Committee on Immunization (NACI) recommendation that initial doses be offered to:
- Residents and staff of congregate living settings that provide care for seniors;
- Adults 70 years of age and older, beginning with adults 80 years of age and older, then decreasing the age limit by 5-year increments to age 70 years as supply becomes available;
- Health care workers (including all those who work in health care settings and personal support workers whose work involves direct contact with patients); and
- Adults in Indigenous communities, where infection can have disproportionate consequences.
Canada Health’s December 4 document ‘Canada’s COVID-19 Immunization Plan: Saving Lives and Livelihoods‘ identifies seven key elements of the country’s immunisation response:
- Communicate and engage with Canadians: Individual Canadians must be confident in the safety and efficacy of the vaccines and understand government decisions on priority populations and sequencing and empowered to make informed choices about immunisation. To support this, federal, provincial and territorial (F/P/T) governments will provide ongoing access to comprehensive, accurate and clear information about the available vaccines and immunisation plans (for example via the Canada.ca website) and in partnership with First Nations, Inuit and Métis leaders, health professionals, and other stakeholders or sectors.
- Secure sufficient supply of vaccines: Through those advance purchasing agreements with seven companies, Canada has secured enough doses to provide access to vaccines to all Canadians by the end of 2021. Canada secured these doses based on the advice of the COVID-19 Vaccine Task Force, a multidisciplinary group of experts and industry leaders in the field of vaccines, and vaccines will be rolled out in phases as they arrive from manufacturers; the earliest vaccines are expected to arrive between late December 2020 and March 2021 (an estimated 6 million doses), and will be delivered to high-risk populations first, with more vaccines arriving over the course of 2021. The vaccine supply strategy also includes options for purchasing additional vaccines.
- Regulatory authorisation for safety and efficacy: While it can normally take around 10 months to review vaccine submissions, the urgent need for COVID-19 treatments saw Canada’s federal minister of Health sign an Interim Order Respecting the Importation, Sale and Advertising of Drugs for Use in Relation to COVID-19 to introduce more flexibility to speed up the review and authorisation of drugs and vaccines for COVID-19. It allows Health Canada to accept rolling submissions for drugs and vaccines that have promising evidence and clinical trials underway, meaning the department will receive and review information as it becomes available from the manufacturer. Health Canada still reviews all data that is necessary to decide if a vaccine is safe and effective and of high manufacturing quality, and will publicly share details about the review and ongoing monitoring of vaccine safety and effectiveness after authorisation.
- Manage the allocation and distribution of vaccines efficiently and securely: As part of a plan to ensure safe handling requirements are met with respect to temperature control and security, an Immunization National Operations Centre (NOC) for COVID-19 has been established as the federal logistical coordination entity and focal point for managing vaccine delivery and collaboration with provinces and territories for distribution. Supported by a multidisciplinary team of experts, including the Canadian Armed Forces, the Centre has been designed to support partners involved in Canada’s immunisation rollout and lead the tracking of vaccine delivery and distribution. The NOC worked closely with provinces and territories to have 14 sites across Canada to be ready to receive COVID-19 vaccines by December 14, 2020. FedEx Express Canada and Innomar Strategies will support the NOC with logistics and vaccine distribution.
- Decide on vaccine use and sequencing based on expert advice: A limited vaccine supply will be available at the beginning of the immunisation response, with provinces and territories drawing on the independent expertise of public health, scientific and medical experts (including the National Advisory Committee on Immunization) to work out jurisdiction orders and access for high-risk populations, such as the elderly, residents and staff of congregate living arrangements such as long term care facilities, front-line health care workers, and Indigenous people in remote and isolated communities (see recommendations of the National Advisory Committee on Immunization December 4, 2020 advice to the Public Health Agency on Canada). F/P/T governments will work with First Nations, Inuit and Métis leaders on vaccination distribution and communication.
- Administer vaccines rapidly and equitably: Provinces and territories are responsible for, and have processes in place to, prepare their health systems and health care providers to allocate, deliver, store, distribute, and administer vaccines within their jurisdictions. F/P/T governments have been working closely with First Nations, Inuit and Métis leadership to support readiness to receive and administer the vaccines, including procuring necessary supplies and equipment. Regional vaccine oversight bodies coordinating the administration activity, progress, challenges and solutions must be inclusive of First Nations, Inuit and Métis representatives for both rural and urban populations.
- Monitor vaccine safety, effectiveness and coverage: Strong immunisation surveillance systems are essential to monitor the safety and effectiveness of COVID-19 vaccines, make adjustments as necessary, and to achieve a level of vaccine coverage that will slow disease transmission and ultimately decrease rates of illness, hospitalizations and deaths. Existing vaccine surveillance structures will enable vaccine monitoring, assess vaccine effectiveness, and understand and address adverse events, which are to be expected, and will not necessarily change the risk/benefit profile of the vaccine. If any new safety issues are confirmed, Health Canada and provincial/territorial governments will take appropriate action, which could include communicating the new risk to Canadians and healthcare providers or changing the recommended use of the product. Data comes from the frontlines, vaccine suppliers, and regulators in Canada and abroad, which enables the identification of issues, assessment of any events, and timely and appropriate action. Data on COVID-19 vaccine safety, coverage, effectiveness and use will be invaluable for informed decision-making by governments and First Nations, Inuit and Métis communities.
Further, the policy explains how distribution will require close collaboration between all governments, Indigenous peoples, experts and partners in Canada and abroad:
- Federal government: Procure vaccinations on behalf of all jurisdictions; authorise vaccines for use; support efforts in partnership with all jurisdictions via new National Operating Centre; provide scientific guidance on vaccine use; coordinate pan Canadian surveillance and reporting; and liaise with international partners.
- Provincial and territorial (P/T) governments: Decide the policy and process for vaccination distribution. Plan, store, administer and deliver vaccination programs to the populations they serve, including deciding on how to sequence the initial and subsequent doses; manage, track and share data on coverage and adverse events.
- All governments together with respective Indigenous leaders and key partners: Provide reliable information to the public and promote vaccine confidence; coordinate delivery systems to First Nations, Inuit and Métis populations; monitor and respond to safety signals; monitor coverage; and assess vaccine effectiveness.
- Expert advisors across many fields: Advise on vaccine candidates and prioritisation of early doses; ensure evidence-based approach; and support technical logistics planning and delivery.
- International collaborators: Share information and collaborate across health, scientific and regulatory communities.
Source: Canada Health.
- The US Food and Drug Administration has released data that finds the Moderna vaccine — which announced 94.5% efficacy in November under first interim analysis of its Phase 3 study — is highly protective for adults and prevents severe cases of COVID-19, news The New York Times explains means the agency intends to grant emergency authorisation for use on Friday.
- America began rolling out the Pfizer-BioNTech drug on Monday, three days after it won emergency-use authorisation, while the country’s death toll has passed 300,000 — nearly 120,000 more than the next worst-hit country, Brazil.
- According to progressive outlet Common Dreams, a bipartisan COVID-19 relief package unveiled late Monday includes liability protections that would retroactively protect corporations from coronavirus-related lawsuits, a top Republican priority that civil rights groups, unions and small business-owners argue would give corporations carte blanche to force employees back into dangerous workplaces.
- Finally, while not technically related to COVID-19, the Congressional Budget Office last Thursday released a report examining the federal budgetary costs of proposals for single-payer health care systems that, based on the Medicare fee-for-service program, found universal healthcare would save US$650 billion per year.
Podcast corner: on facing collective trauma
Finally, something to keep in mind as Victoria emerges from lockdown and adjusts to a COVIDSafe Summer: a recent podcast episode from science/society outlet Undark, ‘Ep. 50: Studying and Surviving the Pandemic’s Collective Trauma‘, which explores research from South African academics on the impacts of societal inequalities and collective trauma from the country’s pandemic.