Tag Archives: ‘could

How approval of Johnson & Johnson’s ‘one and done’ COVID-19 vaccine could change Canada’s vaccination game

A one-dose COVID-19 vaccine is now approved for use in Canada — and vaccine experts say the shot from Johnson & Johnson could give a major boost to countrywide vaccination efforts while offering a “real solution” to hasten the end of the pandemic.

Health Canada authorized its use and released details during a Friday morning announcement.

The vaccine, made by a subsidiary of Johnson & Johnson, is a non-replicating viral vector option and, unlike the three other vaccines previously approved for Canadian use, was tested during clinical trials as a single shot. 

So far, Canada is expecting 10 million doses, with options to purchase up to 28 million more if necessary, with most of those shots set to arrive by the end of September.

From a logistical standpoint, Toronto-based infectious disease specialist Dr. Isaac Bogoch said the benefits are clear.

“You can vaccinate more people in a shorter period of time,” he said. “You don’t have to clog up the vaccine centres with people getting their second dose — it’s one and done.”

The storage requirements are also less stringent than the early freezer requirements for the two mRNA-based vaccines from Pfizer-BioNTech and Moderna, with Johnson & Johnson estimating its single-dose option should remain stable for two years at -20° C — and can be stored for at least three months in most standard refrigerators.

Wondering how each of the leading coronavirus vaccines compares? Click here for a closer look at the vaccines Canada is betting on to stem the spread of COVID-19.

“You can way more easily get a vaccine like this into primary care clinics and pharmacies, which means that you can distribute it so much more broadly,” said Bogoch, who is also a member of Ontario’s vaccine task force.

That’s good news in this country and beyond, said Dr. Zain Chagla, a Hamilton-based infectious disease specialist and professor at McMaster University.

“In remote areas of Canada, it’s a big vaccine in that sense that it’s easy to transport and get around, and it’s big for the rest of the world,” he said. 

“This is a vaccine that could go into mass vaccine clinics in low- and middle-income countries that could be stored on the back of a motorcycle to make it into a very, very remote setting. That is very, very different than anything we have in that sense.”

WATCH | J&J vaccine good for less accessible, marginalized communities, doctor says:

As a single dose COVID-19 vaccine, the Johnson & Johnson product will be especially helpful for people who sometimes have difficulty accessing health care, says Dr. Lisa Bryski, a retired ER doctor in Winnipeg. 1:23

85% effective at stopping severe disease

But where the vaccine excels at convenience, it may fall short on overall efficacy — though there are a lot of factors at play, and it’s crucial to note the shot is proving highly effective at reducing cases of serious illness.

According to February briefing documents from the U.S. Food and Drug Administration, Johnson & Johnson’s shot was both safe and effective in clinical trials, where it reduced the risk of COVID-19 and prevented PCR-test confirmed cases at least 14 days after vaccination.

A month earlier, the company had announced its vaccine was 66 per cent effective in preventing COVID-19 against multiple variants in a global trial involving nearly 44,000 people.

That effectiveness varied from 72 per cent in the United States to 66 per cent in Latin America and 57 per cent in South Africa, where a new variant has spread.

In January, Johnson & Johnson announced its vaccine was 66 per cent effective in preventing COVID-19 against multiple variants in a global trial involving nearly 44,000 people. (Phill Magakoe/AFP/Getty Images)

That’s in contrast to the even more powerful protection witnessed in clinical trials for the Moderna and Pfizer-BioNTech vaccines, which showed efficacy levels — in terms of preventing symptomatic COVID-19 infection — of 94 per cent and 95 per cent respectively after two doses.

Those trials, however, took place before the rise of several concerning variants of this virus. Each company also tested for slightly different outcomes, meaning the efficacy levels aren’t apples-to-apples comparisons.

On Friday, Dr. Bob Wachter, chair of the department of medicine at the University of California, San Francisco likened it to comparing the scores of golfers who teed off during a calm moment to those who teed off when “winds were howling.”

“While it’s hard to make precise adjustment,” he said in a tweet, “it’s clear that equally good play will result in different scores.”

WATCH | Doctor who helped create Johnson & Johnson vaccine talks about its efficacy:

Dr. Dan Barouch, director, Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, says the Johnson & Johnson vaccine he helped to create is highly effective against COVID-19 and new variants of concern. 5:11

Crucially, Johnson & Johnson’s one-dose option did prove 85 per cent effective overall when it came to stopping severe cases of the disease specifically.

The company’s main study also showed that 28 days or more after vaccination, the shot 100 per cent prevented hospitalizations and deaths.

“I think people discount how much practicality means to this vaccine rollout,” Chagla said. “You do see severe illness going down with this vaccine. You see hospitalizations coming down with this vaccine.”

One-dose could offer ‘real solution’

Virologist and vaccinologist Alyson Kelvin, who is working on Canadian COVID-19 vaccine development at the University of Saskatchewan’s VIDO-InterVac research institute, said for all vaccine developers, a safe and effective single-dose option has been the ultimate goal.

“Because people will be more interested in taking a vaccine if they don’t have to go back for their second shot, and which means that a vaccine will be more effective at getting to that community immunity that we need,” she said.

Like Chagla, she’s not alarmed by a slightly lower overall efficacy level.

“The goal of the vaccine is to protect people. Keeping them out of hospitals, keeping them from succumbing to disease,” she said.

And Chagla stressed that ultimately, this one-dose option could offer a “real solution” that helps countries like Canada tackle this year-long pandemic and alleviate the current burden on the health-care system from a virus that’s still widespread.

“It may not be the final strategy for vaccination,” he said. “But it’s a pretty good ‘right now’ strategy for vaccination.”

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What a 3rd wave of COVID-19 could look like in Canada — and how we can avoid it

COVID-19 levels are declining from the devastating peaks of the second wave across much of Canada, but experts say the threat of more contagious coronavirus variants threatens to jeopardize our ability to prevent a third wave.

Canada has close to 850 confirmed cases of the variants first identified in the U.K., South Africa and Brazil, with at least six provinces now reporting community transmission — meaning there’s probably a lot more spreading beneath the surface than we know.

But as variant cases increase, overall COVID-19 numbers have dropped steadily in Canada, with just over 31,000 active cases across the country, about 2,900 new cases per week and 54 cases daily.

“Overall, we’re still doing well,” Dr. Theresa Tam, Canada’s chief public health officer, said during a news conference on Tuesday. “But things could change rapidly.”

So, is Canada destined for a third wave? Or will we be able to adequately respond to the threat of variants spreading across the country to avoid one altogether?

Parts of the country that have seen notable declines in cases have recently moved to reopen non-essential businesses and lift lockdowns in the face of fast-spreading variants, despite public health officials cautioning against doing so

WATCH | Federal modelling warns COVID-19 cases will rise with variants:

Variants are spreading and the virus is changing. But Ottawa’s new modelling reinforces a familiar message. Case rates may be down now, but ease up on restrictions too soon, and disaster could be close behind. 1:50

Is a 3rd wave in Canada inevitable?

Much like the first and second waves of the pandemic in Canada, the situation varies greatly across the country for a number of different reasons — ranging from geographic and demographic to political.

But even provinces and territories that have had fewer COVID-19 cases are still at high risk of devastating outbreaks, overwhelmed health-care systems and severe outcomes for vulnerable populations if variants spread rapidly.

Tam said Newfoundland and Labrador is a cautionary tale for the rest of Canada, where an outbreak of the variant first identified in the U.K., also known as B117, led to a spike in new cases in the community during a time when public health measures were “less stringent.”

“Provincial health authorities knew something was different when cases escalated over a matter of days, even before laboratory evidence confirmed the presence of the B117 variant,” she said.

Dr. Isaac Bogoch, an infectious disease physician and scientist with Toronto General Hospital, said variants have made it hard for anyone to predict the likelihood of a bad third wave of the pandemic in Canada with any degree of confidence.

“When you factor in variants of concern and you factor in not enough immunity in the population to protect ourselves, it’s clear that a third wave is certainly a possibility,” he said. “But I wouldn’t say it’s an inevitability.”

Storm clouds are pictured above a shipping vessel moored in English Bay in Vancouver on Jan. 25. Dr. Isaac Bogoch, an infectious disease physician and scientist with Toronto General Hospital, says a third wave of the pandemic is possible but not inevitable. (Ben Nelms/CBC)

Bogoch said the likelihood of a third wave depends on how Canadians respond to the loosening of restrictions and the increase in opportunities to mingle together and get into situations where the virus can more easily be transmitted.

“It also completely depends on how the provincial governments and the public health authorities choose to reopen their provinces and their ability to rapidly react to a rise in cases,” said Bogoch, a member of Ontario’s COVID-19 vaccine distribution task force.

“It doesn’t mean you have to stay locked down until everyone is vaccinated. It just means that as places reopen, they have to be extremely careful, proceed very slowly and be able to rapidly pivot if there’s any indication that there are cases plateauing or rising.”

What is the likelihood of a 3rd wave in Canada? 

Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, says that based on what we know right now, a third wave is “mathematically inevitable” in Canada because of three key factors.

The first is we know what third waves typically look like from previous pandemics, such as the 1918 Spanish Flu, which saw a brutal third wave during the winter and spring of 1919 — around the same point of the pandemic we’re in now.

Deonandan said societal behaviour is another factor that could lead to a more severe third wave if variants drive outbreaks as restrictions left and Canadians don’t strictly adhere to public health guidelines.

And the third factor is variants, which Deonandan said could be the driving “mechanism” for a devastating third wave in Canada given the extent to which they’ve already spread in recent weeks.

But he said the likelihood of a bad third wave could change with two major caveats.

“The first is: It is avoidable with sufficient public health response and precautionary action, but our history shows us that most governments are unwilling to do the hard public health response, and most populations are unwilling to tolerate that level of action,” he said.

“The second caveat is of course vaccination.”

A nurse prepares doses of the Pfizer-BioNTech COVID-19 vaccine at a clinic at St. Michael’s Hospital in Toronto on Dec. 22. Experts say we may not be able to vaccinate enough of the population fast enough in Canada to adequately slow the spread of variants in time before they take over. (Evan Mitsui/CBC)

The good news is that vaccines have not only been shown to be effective in the real world in reducing severe outcomes from COVID-19 but also in potentially curbing virus transmission.

But the catch is we may not be able to vaccinate enough of the population fast enough in Canada to adequately slow the spread of variants in time before they take over.

“It’s a race against time. We want to get the vaccines out there now, before variants get in,” said Dr. Anna Banerji, a physician and infectious disease specialist at the University of Toronto’s Dalla Lana School of Public Health.

“I really believe that we can get on top of this if we get people vaccinated and then make modifications to the vaccines as we need to.”

WATCH | How vaccines can keep up with coronavirus variants:

New coronavirus variants won’t necessarily mean new vaccines or vaccine boosters are needed. And if adjustments are needed, they would take less time to develop than the original vaccines. 2:01

Banerji said even if Canada has a third wave, it likely won’t be as bad as previous waves because she feels Canadians have learned tough lessons in the pandemic — such as in December, when people gathered over the holidays and cases skyrocketed.

“People see that our individual actions have an impact on the outcome, and so I think while people may feel disempowered, they’re realizing that their behaviour really does count,” she said.

“Once we get the vaccines out, things will change and we’ll start opening things up. So I’m still optimistic for the future, even if there’s a lot of fear out there.” 

How bad could a 3rd wave be in Canada? 

Deonandan said that while Canada may not be able to completely “vaccinate our way out of a third wave,” it could look completely different than waves we’ve seen in the past.

“What might happen is that our third wave is very high in cases but not as high in deaths, because we have done a pretty good job in vaccinating our long-term care centres if nothing else, and that’s where a large proportion of our deaths come from,” he said.

“But hospitalizations might be a different matter.”

Dr. Sumon Chakrabarti, an infectious disease specialist at Trillium Health Partners in Mississauga, Ont., said once those at highest risk are vaccinated, including seniors living in the community and in long-term care, hospitalizations will likely decrease.

“But people are going to worry if we open up, we’re just going to get tons of cases,” he said. “Yes — but they’re not going to be severe.”

Chakrabarti said if Canada sees a smaller third wave, or “wavelet,” the health-care system might be able to “absorb” the impact of COVID-19 better than previous waves and avoid becoming completely overwhelmed.

A nurse tends to a patient suspected of having COVID-19 in the ICU of a Toronto hospital in May. Infectious disease specialist Dr. Sumon Chakrabarti says if Canada sees a smaller third wave, or ‘wavelet,’ the health-care system might be able to ‘absorb’ the impact of COVID-19 better than previous waves. (Evan Mitsui/CBC)

South Africa recently saw a notable decline in COVID-19 cases despite the variant first identified there driving a spike in transmission, which could bode well for other countries hoping to control that variant from spreading.

But experts caution that a decline in cases could be short lived, as evidenced by countries hit hard by B117, such as Portugal, Spain, Ireland and the U.K., that later saw an even greater spike in cases driven by the variant.

If Canada is hit by a third wave, Bogoch said it’s likely that community-dwelling seniors and racialized communities will be disproportionately harmed.

“We know how to prevent this from happening. We have the tools that work, we know how to do this, we can prevent a third wave,” he said.

“There’s no reason to have a third wave. There’s no reason to have another lockdown. This is not related to the virus, and we have enough information about how this virus is transmitted. This is truly based on policy.”

Deonandan said while he agrees that a third wave could be prevented, he’s all but convinced Canada is destined to face one because of a lack of political will from parts of the country that are already pushing to reopen.

“It’s highly likely. I think we could do heroic things to avoid it, but we won’t,” he said.

“But what is uncertain is what the hospitalization and death toll of a third wave will be — it might not be as severe.”

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CBC | Health News

Pfizer says variant identified in South Africa could significantly reduce protective antibodies from vaccine

A top Pfizer scientist says the company is in intensive discussions with regulators to test a booster shot version of its coronavirus vaccine specifically targeted for a highly contagious variant that is spreading widely in South Africa and elsewhere.
A laboratory study released on Wednesday suggested that the coronavirus variant first discovered in South Africa may reduce protective antibodies elicited by the Pfizer-BioNTech vaccine by two-thirds, but it is not clear how much that reduces the shot’s effectiveness against this version of the pathogen.
Phil Dormitzer, one of Pfizer’s top viral vaccine scientists and a co-author of the study, said in an interview on Thursday that he believes the current vaccine is highly likely to still protect against the concerning variant first discovered in South Africa.
“A level of neutralizing antibodies that may be on the order of between a third and a half the level of neutralizing antibodies you see against the original virus does not mean you have only a third to half of the protection level, you may well have full protection,” he said.

Reduction in antibodies

For the study, scientists from the companies and the University of Texas Medical Branch (UTMB) developed an engineered virus that contained the same mutations carried on the spike portion of the highly contagious coronavirus variant first discovered in South Africa, known as B1351.

The spike, used by the virus to enter human cells, is the primary target of many COVID-19 vaccines.

Researchers tested the engineered virus against blood taken from people who had been given the vaccine, and found a two-thirds reduction in the level of neutralizing antibodies compared with its effect on the most common version of the virus prevalent in U.S. trials.

Their findings were published in the New England Journal of Medicine (NEJM).

University of Texas Medical Branch professor and study co-author Pei-Yong Shi said he also believes the lessened immune response observed is likely to be significantly above where it needs to be to provide protection.

Shi said that in clinical trials, both the Pfizer-BioNTech vaccine and a similar shot from Moderna conferred some protection after the first of two doses with an antibody response lower than the reduced levels seen in the laboratory study of the B1351 variant.

Still, Dormitzer, chief scientific officer of viral vaccines at Pfizer Vaccines Research and Development, said the company was developing plans to test a redesigned booster for the vaccine.

WATCH | Canada to ramp up coronavirus vaccine rollout: 

Canada has been promised millions more COVID-19 vaccine doses in the coming months, including more deliveries from Pfizer as vaccination campaigns ramp up. 4:05

“We’re not doing that primarily because we think that means that we’re going to need to change that vaccine,” he said. “It’s primarily to learn how to change strain, both in terms of what we do at the manufacturing level, and especially what the clinical results are.
“So if a variant comes along for which there is clinical evidence of escape, we’re ready to respond very quickly.”

Prototype vaccine targeting variant in the works

He said the company has already made a DNA template for a prototype vaccine targeting the variant and plans to manufacture a batch of it.

The company is proposing to do a Phase I clinical trial of a booster shot of that prototype vaccine that it would test against a booster for the current vaccine.

“This will be a immunogenicity study where you look at the immune response. And those studies are much, much smaller than the giant efficacy studies,” Dormitzer said.

“In immunogenicity studies you can look at the immune response of every person in the study. It’s not as definitive as efficacy data, for sure. But it can be gathered much more quickly,” he explained.

The company would likely conduct some animal testing in parallel as well, he said.

The U.S. Food and Drug Administration has not yet released a roadmap for how companies should design trials of coronavirus booster shots.

On Wednesday, Moderna also published a correspondence in NEJM with similar data previously disclosed elsewhere that showed a six-fold drop in antibody levels versus the variant identified in South Africa.

Moderna also said the actual efficacy of its vaccine against this variant is yet to be determined. The company has previously said it believes the vaccine will work against the variant. 

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CBC | Health News

Bill Gates says innovation sparked by COVID-19 pandemic could help eradicate global diseases

The innovation sparked by the coronavirus will better prepare the world for the next pandemic and could help eradicate global diseases in lower-income countries, Microsoft co-founder Bill Gates told CBC’s The Current.

“The pandemic is an incredible tragedy. We weren’t prepared for it. We bungled it once it came. But there’s some brilliant things going on,” said Gates in an interview broadcast Monday with The Current host Matt Galloway.

“We’ll be doing postmortems and we have to get this pandemic done and we have to invest so that the next time a pandemic comes we’ll get on top of it and the number of cases can be kept very small,” said Gates, who has written a new book titled How to Avoid a Climate Disaster.

Gates, who is co-chair the Bill & Melinda Foundation and has donated $ 1.75 billion to the fight against COVID-19, said lessons have been learned from the current pandemic, and that countries that have lost trillions of dollars are now willing to spend the money for innovation.

WATCH | Bill Gates on how the world ‘bungled’ the pandemic:

Gates says that while the world botched its response to COVID-19, ‘there’s some brilliant things going on.’ 0:33

He said the pandemic had led to great strides in global health and the development of vaccines, including mRNA vaccines, that could help end other deadly diseases found in lower-income countries.

“The amount of innovation which countries, because they’ve lost trillions, are now willing to fund … we’re going to make great progress in global health and that will help us not just be ready for the next pandemic,” he said. “It’ll help us with polio eradication, malaria, measles, all that area that causes so many deaths, mostly in poor countries.”

WATCH | Gates on innovation sparked by pandemic:

Microsoft co-founder explains why innovation as a result of the coronarvirus could better prepare the world for the next pandemic and help with other diseases. 1:05

For years, Gates had warned that the world was not prepared for a global pandemic. In 2015, his TED talk was titled: “The Next Outbreak? We’re not ready.”

“There were mistakes made when we didn’t get ready before the pandemic hit,” Gates said. “My 2015 talk was about the infrastructure we needed in place and even practising what I called germ games, which are like war games. But you’re simulating the disease.

“It would have been obvious that you have to deploy the commercial diagnostic sector as fast as possible, which the U.S bungled.”

Canadian COVAX controversy

Gates was asked about the Canadian government’s decision to receive COVID-19 vaccines from the global initiative known as COVAX, which was set up to distribute vaccines to lower-income countries. Canada has invested hundreds of millions of dollars in COVAX but has faced criticism for its plan to take vaccines from that pool.

“I think it’s predictable that when there’s a shortage of medical intervention like this, that the rich countries who funded the R&D and trials will be early in line,” Gates said.

Asked whether he would support companies turning over their intellectual property rights to vaccines, Gates said he might, if it would mean the creation of one additional vaccine. 

“But in fact, making vaccines is not about the the IP here, it’s about these factories being exactly right and passing strict regulatory review,” he said. “And IP is not the issue.”

Gates was asked about the issue of the so-called “Bill chill,” that some academics and organizations are reluctant to criticise his work.

“Any idea that somebody has on how we can do better on polio, malaria, pneumonia, diarrhea — the more critics we have, the better,” he said. “The main thing is people don’t care about that stuff. They don’t know about it.

“I wish there were 10 times as many experts saying: ‘You should have done this and you should have done that,’ because, hey, we’re just trying to have people live healthy lives.”

Target of conspiracy theories

Gates has also been the target of a series of conspiracy theories, including that he created COVID-19 in a lab and that he’s behind a plan to implant microchips in people to fight the virus. 

WATCH | Gates on conspiracy theories:

Gates addresses being the target of COVID-19-related conspiracy theories and how he hopes the media can get people more interested in the truth 1:27

“There’s like millions of messages saying those things,” he said. “I hope that we can make the truth more interesting than the conspiracy theory,” he said.

“The pandemic has people reaching for simple solutions to explain, ‘OK, why did this happen? And isn’t there some evil person behind the curtain there?’ “

Gates said he hopes mainstream or digital media can be more creative about how they get more people aware of the truth.

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‘We did the best we could’ — a conversation with the co-chair of Canada’s vaccine task force

Dr. Joanne Langley is a pediatric infectious disease physician and a professor in the departments of Pediatrics and Community Health and Epidemiology at Dalhousie University. Since last spring, she also has been co-chair of the task force that has been advising the federal government on COVID-19 vaccine procurement.

Interruptions in deliveries of vaccine doses to Canada have led to a tense debate about the Liberal government’s handling of the issue. Langley has been invited to speak the health and industry committees of the House of Commons later this month, but she spoke to CBC News this week about her role and how she sees Canada’s situation.

Langley says task force members were assembled by the federal government in late May and early June of last year. The task force then began to evaluate the scientific, technical and logistical merits of potential vaccine suppliers.

The following transcript has been edited for clarity and length.

Q: Who are the candidates at that point?

A: So there were two strains. There was domestic and international. For the domestic, ISED [Innovation, Science and Economic Development Canada] put out a call to any company for Strategic Innovation Fund [SIF] proposals. So there were, I think, 22 submissions to SIF from Canadian sites. And so we reviewed all of those. That was how we knew what was the potential in Canada.

We also did a more proactive review, and there was a vendor that went and basically tracked down every single company in Canada that had anything to do with vaccines, drugs, biologics, and looked at what their capacity was. We reviewed all those under this rubric. We had meetings with the proponents. ISED did due diligence on them.

We had particular questions that we would want answered. And then we made recommendations to ministers about those products. And we only speak about the ones that received funding because if they didn’t receive funding for their own benefit, those are confidential.

Boxes containing the Pfizer-BioNTech COVID-19 vaccine are prepared to be shipped at the Pfizer Global Supply Kalamazoo manufacturing plant in Portage, Mich. (Morry Gash/Pool via AP Photo)

And then internationally, what we did was basically track down around the world what vaccines were in what phase. So the WHO [World Health Organization] quite early on started tracking every single vaccine and what phase it was in. And so we reviewed those proponents and determined what [were] the most likely ones that were going to deliver a vaccine in 2021 — at that time, I don’t think we thought we’d have a vaccine by December of 2020.

And then we reached out to them and had meetings with them again and asked some questions in order to satisfy ourselves that they had scientific and technical merit, and also inquired about opportunities for partnering with Canadian universities or businesses or governmental scientists, or any possibility of bringing something here to Canada, rather than just buying the product …

Q: And was it the task force that came up with this approach of diversifying Canada’s purchases and going to seven different suppliers?

A: Yes, we recommended a portfolio. And there’s a number of different platforms. All of the vaccines we recommended fell into one of three platforms.

Q: A lot of attention is now on this question of domestic capacity and domestic manufacturing. Can you explain why … we didn’t end up with domestic manufacturing of vaccines?

A: I think we are going to have domestic bio-manufacturing of vaccines. So Medicago will ultimately be on Canadian soil. Novavax is another one. There are other announcements that will, I’m sure, be made in the coming weeks. But there is quite a strong bio-manufacturing strategy that has been determined and will unfold.

A volunteer participates in Medicago’s Phase I clinical trial for its COVID-19 vaccine candidate in Quebec City. (CNW Group/Medicago) (CNW Group/Medicago)

Q: The question that seems to get posed is, why don’t we have domestic manufacturing up and running right now? Why didn’t we pursue some kind of domestic manufacturing that would be up and running right now?

A: Okay, so that would be over a period of, say, August until now, about six months. The NRC [National Research Council] buildout started in the fall. So it started within months of these task forces being built.

These are not manufacturing processes that can be built in a month or two, or three or four or five or six, even. Some of them have to be explosion-proof. Some rooms have to be sterile. You have to have the highly qualified personnel who can do the tech transfer, who can receive the training and then demonstrate that they can produce the vaccine. These are processes that are very, very meticulous and have extremely high standards. And Health Canada, the regulator, is testing the batches that you’re producing.

These are biologics processes. If you had a farmer growing something in a field, you can’t just say, ‘Well, could you just grow that faster, please?’– Dr. Joanne Langley

So to get that kind of whole process of building a plant, getting the machinery in place, getting the highly qualified personnel to make the vaccine and then scale it up, fill and finish it and deliver it out and pass regulatory approval — that wouldn’t be able to be done in the period from, you know, August to January. But the NRC proposal was ultimately approved and they have started. The Medicago plant was already starting to be built at the beginning of the pandemic, so they just continued that.

I think the overall story is that there was effort put towards bio-manufacturing. It’s not something that happens on the turn of a dime. And my colleague Alan Bernstein had a very good kind of simile … Say that you were invited to dinner and you spent the entire day making this dinner for your two friends and you salted it perfectly and the right amount of turmeric, all these things. You know, it was in the oven for three minutes, not four, and after the meal, they say, “OK, this is just perfect. Can you make exactly the same thing for a thousand people two days from now?”

You know, these are biologics processes. If you had a farmer growing something in a field, you can’t just say, “Well, could you just grow that faster, please?” It’s not realistic to think that you could in a month or two have one of these huge bio-manufacturing plants up and running.

Q: One of the examples that gets cited is the United Kingdom, and the question of whether Canada could have expanded capacity or set up capacity as fast as they seem to have. Does that seem like a realistic possibility to you?

A: Well, the presumption there is that the U.K. didn’t have capacity. They already had several manufacturing plants for international vaccines. So it’s not true that they started from zero. That is really one of the myths that is circulating. They did accelerate what they were doing and they added capacity, but they already were producing huge amounts of vaccines.

Audrey Elson, 84, leaves with her daughter after receiving a dose of the AstraZeneca coronavirus vaccine at Lichfield Cathedral, in Staffordshire, England, Friday, Jan. 15, 2021. (Jacon King/PA via AP Photo)

A: In hindsight, is it possible that if the task force had gotten started even earlier … in March or February or January of last year, that Canada would be in a different place right now?

A: I suppose anything’s possible. It’s hard to say. I think we worked as hard as we could at the time we started our work together. I think someone tallied up and we had like 400 hours worth of meetings in the first few weeks because there was just such a sense of urgency.

And I really can’t speak to what is really kind of imaginary, to think of what might have happened had we met earlier. There certainly wouldn’t have been any data to review if we’d started in March because the first vaccine was the Moderna and they started [Phase I trials in March].

Certainly there was no idea that it was going to be our Canadian vaccine. It was just one of many international candidates …– Dr. Langley on the CanSino project

Q: One of the other things that’s been given a lot of attention is the CanSino project. Was that a significant setback for Canada? In addition to obviously falling through, did it distract or detract from the larger effort to get a vaccine?

A: My personal view would be that it was one of the vaccines that was evaluated, just like all the other international candidates. It wasn’t higher on the priority list. Every potential vaccine candidate was reviewed. So it wasn’t — certainly there was no idea that it was going to be our Canadian vaccine. It was just one of many international candidates that we looked at with scrutiny.

Q: In the last little while, a couple of companies have come forward and said, “We could help, or we could have helped.” Providence being one, PnuVax being the other. Is it possible to say why you didn’t recommend going with those options?

A: So as I said, anyone who submitted a request to the SIF Fund, if they were funded, then that information is public. But some of the information is confidential. And some of those people that proposed applications to ISED — I can’t say things about them that are confidential. So we only speak of the ones that were highly ranked and that were funded ultimately.

Q: Is it possible to say what was decisive about the domestic ones that you did go with?

A: I would say it’s multi-factorial. So really, they had to tick off a lot of boxes of having a good product that in all the data that they presented to us looked like it would be effective against the virus, that would induce an immune response, that would be safe for the host. That they had the experience with clinical development of vaccines or could benefit by partnering very quickly with other people who had that capacity that could scale up their product. That they were a financially stable company. And all of those things were looked at.

We wouldn’t have taken something that could scale but that wasn’t safe and effective, or that was safe and effective but there was no chance that you could make that vaccine in sufficient quantity. So really, all of those aspects were considered for every vaccine.

Public Services and Procurement Minister Anita Anand. (Adrian Wyld/The Canadian Press)

Q: Procurement Minister Anita Anand has said that she went to the international suppliers that the government ended up signing contracts with and asked whether they would be interested in domestic manufacturing in Canada and that, in every case, they essentially said it wasn’t possible. Should that surprise us?

A: What the minister has said … is consistent with that strategy, that we would look for that in every instance, to see where we could partner with Canadian scientists or businesses or could they even just fill and finish on our soil.

So there are many considerations for these vaccine companies. Ultimately, they have a responsibility to deliver a product and they have timelines they must abide by. They’re making vaccines — ultimately, most of them — for one or two billion people.

So there is a lot of effort if you don’t have a plant all ready to go that could produce that volume of vaccines that you need to consider when you’re thinking, “Should I make this partnering agreement?” So all those things would be considered by those companies and, ultimately, they may have already had agreements or they may want to use their own plant.

We had many good discussions about that. And ultimately, one is a possibility. And who knows, there may be more in the future. The story’s not completely written yet.

Health-care workers wait in line at a UHN COVID-19 vaccine clinic in Toronto on Thursday, January 7, 2021. (Nathan Denette/The Canadian Press)

Q: I don’t know if this has even been suggested, but just to throw it out there — was it ever considered whether we could have somehow gotten involved with the U.S. initiative Operation Warp Speed?

A: I think one would have to consider whether at the time of the previous administration, there would be interest in partnering with other countries to make vaccines for Canadians.

Q: Can you say whether it was considered?

A: We looked at everything. We met with task forces in the U.K. and New Zealand, Australia, just to share ideas. We also met with some folks from Germany. So our thinking was not boxed in. We were being very creative, as were the ministries who were helping us, trying to create opportunities and do things in a new way. So I would say there was hardly anything that wasn’t considered.

Q: In the latest rankings, we were something like [39th] in vaccinations per capita. How should Canadians feel about that? Is there an explanation in your mind for why we’re at where we’re at?

A: So the immunization rollout is a provincial-territorial responsibility. I think at this point they’ve probably delivered all the vaccines that are available. But some provinces are holding back the second dose so that they make sure everyone gets their doses according to schedule, which is perfectly rational. And so I think we will be getting more vaccines.

We sometimes have to wait and be patient. But making a fuss about it does not solve the problem. And making demands doesn’t solve the problem.– Dr. Langley on vaccine delivery disruptions

It’s not unanticipated that there would be stoppages to vaccine supply. For those of us that have been working in vaccine science for two decades, that is routine because these are biologic processes. The general public may be used to, well — we’re ordering cars, why can’t you just put the wheels on and the engine and what’s the delay? It is very different for vaccines and for all biologics.

So I’m not surprised that there were interruptions to the supply chain. I am assured that everyone who’s manufacturing a vaccine at this time is working 24/7 to get them out as soon as possible. So when there’s supply chain problems, my approach would be, “Okay, find out what the problem is.” And then we sometimes have to wait and be patient. But making a fuss about it does not solve the problem. And making demands doesn’t solve the problem.

Q: But Canadians may ask, “Why do we seem to have fewer vaccines than a lot of European countries? Why do we seem to be behind so many countries?” Do you have an explanation for that?

A: I would say it’s probably just due to the schedule of when the shipping occurs and the timing of it. So there’s so many multilateral contracts, plus the COVAX contracts [and] every single country’s shipping time is something that’s usually kept confidential. They don’t publish those.

And also, if you have a smaller country with a smaller jurisdiction, with a smaller geographic area, you can deploy the vaccines you get much more quickly than we can in Canada, obviously, because our population is dispersed among rural and urban locations. It’s easier to deliver vaccines when everyone’s concentrated in the same geographical area.

Q: But would you then argue that this place that Canada is in right now was sort of unavoidable?

A: I would say that there’s [nearly] 200 countries in the world and everyone deserves vaccines. And I don’t think we should be putting so much attention on who gets them first and second and third. The production line is pumping out vaccines. We will get them in due time. And at the same time that people are pointing out, “Well … that’s terrible,” other people are saying … “Why don’t we expand our view beyond our own borders to the peoples of the world who need vaccines?”

Just be content for a little bit that we are going to get enough vaccines for all Canadians by September and worry less about are we getting them today or tomorrow, and do your best to get through this pandemic without spreading disease until you get the opportunity to have a vaccine. Because right now, many people in the world do not have that opportunity to look forward to.

Q: In hindsight, do you think there was anything you, the task force, could have done differently?

A: I don’t think so. There was a lot of learning along the way. I mean, we adapted as we went. We had a process of consultation that was really marvellous, where all views are entertained. And you don’t go into the discussion with a set point of view. You may have a completely different point of view after the consultation, which was wonderful because we’re all in such different areas, we can see different aspects of each issue. We’ll continue to do that.

You know, science is changing, the evidence is changing, the portfolio might need to change, but we’re committed to doing that change. Nothing is written in stone because we know that new information might emerge. And so, I think if you have that learning attitude, you can’t really look back and say, “Well, why didn’t we do this?” We did the best we could with the information that was available.

Q: Because I’m sure you’ve noticed there is a lot of angst about the fact that Canada is not doing better. And it feels like there’s a searching for — well, there must have been something Canada could have done differently to acquire quicker or more plentiful vaccines. Does it feel to you like there’s not an obvious alternative?

It’s very difficult for any one country to solve the problem of vaccines — even the U.S., who threw so much money at this, requires supply chains from other countries.– Dr. Langley on vaccine production

A: I mean, my alternative is quite an optimistic one. And it would be a world where we looked at these issues globally. So what we had to do for this pandemic is try and figure out a solution on the spot and try and create alliances to solve problems because all countries are really interdependent.

It’s very difficult for any one country to solve the problem of vaccines — even the U.S., who threw so much money at this, requires supply chains from other countries. So if on a global level the World Health Organization or some other international agency was able to secure bio-manufacturing at the start of a pandemic plan to make 14 billion doses of vaccines — if it was a two-dose schedule — I think that could have accelerated it rather than people in each country, all 200 of us, trying to figure out how we’re going to get vaccines.

If you look at climate change, it’s the Paris Accord where everyone makes a commitment to address the problem in a way that you’ve all agreed is scientifically and socially the best path forward — then you’re more likely to solve climate change. But each country on their own cannot solve climate change. Smallpox was solved because we took a global approach everywhere. The whole world agreed to have a particular strategy for smallpox elimination. And they did that country by country by country, and we eliminated smallpox.

So that would be my answer to the question of what could we have done better. I think it’s coming. I mean, COVAX is something like that. It’s not quite there, but it’s on the path to a global approach to these issues that threaten us all.

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Support for essential workers could bring COVID-19 under control faster in Canada, doctors say

Doctors are calling for more supports for essential workers facing “life-or-death” inequities, saying it will do more to control coronavirus outbreaks than high-profile punishments of those who break the rules.

COVID-19 has exacerbated existing problems — not only among long-term residents bearing the brunt of deaths from the virus — but also for people struggling to get by despite working on the front lines on farms, in warehouses and grocery stores.

Now, these vulnerable workers can face additional challenges from authorities such as breaking Quebec’s curfew order or living in cramped, poorly ventilated quarters that make it easy for the coronavirus to spread. 

Nav Persaud, a family physician in Toronto who holds the Canada Research Chair in health justice, said he’s “dispirited” by how little attention inequity receives. 

“It’s always been a life-or-death issue, health inequities,” Persaud said. “People not being able to afford basic necessities like healthy food, medication, safe housing has always killed people and put people’s health in jeopardy.”

An Amazon warehouse north of Calgary in Balzac, Alta., that reported an outbreak of COVID-19 last spring. Doctors say warehouse workers need immediate access to paid sick leave to help control coronavirus outbreaks. (Jeff McIntosh/The Canadian Press)

He said much of the coronavirus transmission happening now in the Greater Toronto Area is from people going to work or interacting in ways that won’t be stopped by charging those holding large parties, for instance. 

“I think the people who benefit most from those punishments are the authorities, because they can exert their power and give off the impression that they’re being helpful when they’re not,” Persaud said. “It would be better if they were providing supports.”

In Toronto, Persaud said people who rely on public transit to get to work from priority neighbourhoods with a disproportionately higher number of COVID-19 cases may face long, crowded commutes on buses. That’s why the greater supports he’s seeking also includes extended public transit.

But providing more supports is harder for politicians from all levels to do than chastising individual rule breakers, he said. 

“I’m in favour of there being rules and the rules do need to be enforced, but I think these are relatively unimportant incidents in the grand scheme of things.”

A recent opinion article by three physicians points to how Ontario’s modelling showed three times more daily confirmed cases among communities with the most essential workers compared with communities with the least. Researchers in California reported a similar observation that hasn’t yet been peer reviewed by outside experts.

Call for supports to control outbreaks faster

Martha Fulford, an associate professor of infectious diseases at McMaster University in Hamilton, Ont., would like to see an immediate “liveable support” such as paid sick leave as a fundamental for essential workers. 

“It’s extremely easy to stay home and be in isolation for somebody like me. I have a big house, I have a big yard, I can click on Amazon and get my stuff delivered,” Fulford said. “But who’s delivering it? What choice does the person delivering to my house have?

“If we don’t provide the same sorts of supports for all the essential workers, this is never going to come under control.” 

Doctors say if essential workers are now a key driver of transmission then the coronavirus won’t be contained unless they’re able to stay home when sick or potentially exposed without having to worry about putting food on the table. 

Dr. Nav Persaud, seen here in 2018, favours rules to control the COVID-19 pandemic, but said some some infractions by individuals aren’t a priority, compared to broader supports that are needed. (Craig Chivers/CBC)

Fulford also noted that the highest rates of transmission are among people living in crowded conditions or working in large warehouses

“I’m not an economist, I’m just a physician, but I can’t help but think in the long term, it would be far more cost effective to invest money in the areas where we’re seeing the highest transmission, and support them, than shut down an entire economy.”

Facilitate work from home when possible

Persaud said punishments such as charges and fines for violating COVID-19 safety rules often hit individuals rather than institutions such as employers. 

He sees the charges laid against Cargill for the country’s largest workplace outbreak in High River, Alta., as an exception and “a fairly extreme example.” The allegations haven’t been tested in court.

For other workplaces, Persaud suggested addressing larger, underlying issues contributing to outbreaks, such as office managers asking staff to come in to perform duties that could be done from the safety of home.

WATCH | Why Peel Region’s workplaces struggle with COVID-19 outbreaks:

Ontario’s Peel Region, just west of Toronto, has long been a hotspot for COVID-19, but the high number of warehouses and transportation facilities may be partly to blame. 2:15

Another recent high-profile case of charges being laid include a couple in Durham, Ont., east of Toronto, who are accused of obstructing contract-tracing efforts of public health officials investigating the introduction of the B117 variant of the coronavirus first identified in the U.K.

A third involves a penthouse owner in Vancouver who welcomed party goers. 

In contrast to charges, Fulford highlights a role model for countering conditions for outbreaks: hospitals.

“We have had hospital outbreaks and we’re not pointing fingers or getting angry because we understand, we do a root-cause analysis to figure out where we went wrong and we do better next time,” Fulford said.

Despite the best efforts of employers and workers, outbreaks can sometimes happen because of sheer bad luck.

Fulford said when an outbreak occurs in a workplace, bringing in infection prevention and control experts is a more productive approach than laying charges

“It’s a very unusual situation for me that we would be criminalizing public health interventions.”

Fulford said drug-resistant tuberculosis is one of the few instances that the Quarantine Act has been enforced for individuals. 

In the context of COVID-19, Fulford gives the example of someone who decides to meet family members from outside their household at a park and gets charged for breaking pandemic public health rules.  

In such a case, Fulford favours educating people and explaining why such behaviour is a problem to encourage them not to do it again — not naming and shaming. Otherwise, there could be unforeseen consequences for public health.

“Contact tracing is going to become a hundred times more difficult if the fear is that you’re going to be charged, your name is going to be in the newspaper.”

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Quebec native Antony Auclair could taste Super Bowl glory tonight

There are about 1,700 people in Notre-Dame-des-Pins, a small municipality in Quebec’s Beauce region, and chances are on Sunday night they will all be watching the Super Bowl.

The community’s claim to fame, aside from a picturesque covered bridge crossing the Chaudière River, is Antony Auclair, a six-foot-six, 256-pound tight end for the Tampa Bay Buccaneers.

Auclair’s success is a major point of pride for the town of Notre-Dame-des-Pins. Strung up along the side of Highway 173 is a banner that cheers on Auclair’s team.

The town’s mayor, Lyne Bourque, wears a signed Buccaneers mask as a show of support.

The town of Notre-Dame-des-Pins is showing its support for homegrown football star Antony Auclair. (Radio-Canada)

Now in his fourth season with Tampa Bay, Auclair signed with the team as an undrafted free agent in 2017 after playing at Laval University in Quebec City.

If Laurent Duvernay-Tardif hadn’t opted out of the NFL season to work on the front lines of the COVID-19 crisis in Quebec, two of the province’s homegrown football pros would be facing off as the Buccaneers go up against last year’s champs, the Kansas City Chiefs.

Following in the footsteps of Duvernay-Tardif, Auclair will become the 17th Canadian to appear in a Super Bowl, though there’s a good chance he won’t get playing time because he’s not on the starting line.

A once-in-a-lifetime opportunity

Auclair’s younger brother Adam, a defensive back for the Ottawa Redblacks, is in Tampa Bay to cheer on his brother’s team in person.

“It’s kind of crazy to live this with my brother,” he told CBC’s All in a Weekend“I’m pretty excited about the game. I’m excited to feel the vibe of the Super Bowl even if there are less fans in the building.”

Adam said he wasn’t sure about travelling to the U.S. because of the pandemic restrictions, but he ultimately decided that this was a “once-in-a-lifetime opportunity” he couldn’t pass up.

Beyond that, he said everyone who will be in attendance at the game has to present a COVID-19 negative test.

Tampa Bay Buccaneers tight end Antony Auclair pictured with his parents, Julien Auclair and Marie-Andrée Quirion, who are both from Notre-Dame-des-Pins. (Pascal Ratthé/Radio-Canada)

Auclair’s parents will be watching from their home in Notre-Dame-des-Pins, and according to Adam, “they are going to be really, really close to the TV.”

Hard work pays off

Auclair is one of a handful of people who have graduated from playing football at a Canadian university to securing a spot in the NFL.

Adam attributes his brother’s success to his work ethic, saying he is one of the hardest working members of the team.

“When I was playing with him at Laval, he was always, after every practice, going to the gym. Or studying plays before he went to bed. He was always giving more than anyone else on the team. And he’s also a great leader, he’s a leader who will show by example and I think that’s what the coaches over there liked about him.”

Antony Auclair played for the Rouge et Or in Quebec City before going pro. (Laval University Rouge et Or)

This sentiment is echoed by Auclair’s former coaches.

“He always wanted to know more. He always wanted to work harder than everyone else. He was often the first in the field,” said Mathieu Bertrand, special teams co-ordinator for the Laval Rouge et Or. “Going to the NFL is one thing, but staying there for four years is another.”

“My biggest dream now is that he can bring the Super Bowl trophy back to PEPS (Pavillon de l’éducation physique et des sports de l’Université Laval) sometime in the spring,” said head coach Glen Constantin.

In this 2017 file photo, Adam Auclair of Laval University accepts the Presidents’ Trophy for outstanding defensive player during the U Sports All-Canadian Football Awards Gala. (Aaron Lynett/The Canadian Press)

True to form, Adam says Auclair is extremely focused ahead of the game.

“Even if he is probably not going to play this weekend, he is ready to play if his name gets called,” said Adam.

“I told him to enjoy every moment and I think that is really what he’s going to do. Even if he’s not playing, it’s a really big accomplishment that he’s going to be there.”

All in a Weekend11:15Adam Auclair on his brother Antony’s journey from the Beauce to the Super Bowl

Today Quebecer Antony Auclair will become only the 17th Canadian to appear in a Super Bowl. But long before he was suiting up for the Tampa Bay Buccaneers, he was squaring off against his brother Adam, outside their home in Notre-Dame-Des-Pins, in the Beauce. Adam Auclair, himself a player with the CFL’s Ottawa Redblacks, tells us what brought his brother to the biggest game of his career. 11:15

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What Canada could do to take advantage of the lull in COVID-19 vaccine shipments

This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

Canadians hoping to get vaccinated against COVID-19 are stuck in limbo across much of the country.

While vaccination programs are well underway for high-risk populations, shipment reductions and ongoing uncertainty mean there is a lull — potentially for weeks or even months — before Canada sees a steady flow of supplies.

The tide is set to turn eventually, with Prime Minister Justin Trudeau saying on Friday that he has assurance from Canada’s two key suppliers, Moderna and Pfizer, that a combined six million shots are still coming down the pipe before the end of March. 

Multiple other vaccines could also gain a stamp of approval alongside the shots already being used. Paying into the World Health Organization co-led COVAX program is set to pay off and Canada recently inked a deal to produce millions of Novavax doses domestically.

That gets shots into the country. But what about getting shots in arms?

With a federal government goal in place to vaccinate all residents who want the shot before the end of 2021, and millions of Canadians longing for an end to the pandemic, this waiting period comes with an opportunity to scale up vaccination programs — before the bulk of shipments arrive on provinces’ doorsteps.

Members of the public arrive to receive a dose of a COVID-19 vaccine at a temporary coronavirus vaccination hub set up at Villa Park football stadium in Birmingham, central England, in early February. (Jacob King/AFP/Getty Images)

Dr. Naheed Dosani, a Toronto-based palliative care physician and advocate for health justice, said Canada is in a “race against time” to build up community outreach, decentralize vaccination sites and combat vaccine hesitancy.

“We can’t waste time. Every minute, every hour every day counts,” he said. 

“Down the road, we don’t want to look back and think in early February, we were kind of just waiting for vaccines, we could have done more to address education and provide information for our communities.”

Decentralize vaccine sites

Other medical experts agree this lull period is critical, giving Canada a chance to learn from the successes of countries that are further ahead in their vaccination programs.

Earlier this month, Ontario’s COVID-19 science advisory table released a report outlining takeaways from Israel, where roughly 80 per cent of older adults in the country are vaccinated as scientists there are tracking a drop in COVID-19 cases, hospitalizations and critical illness.

“Israel worked around the clock to vaccinate as quickly as possible,” said Toronto-based geriatrician Dr. Nathan Stall, one of the table members.

And it goes beyond speed, he said.

Instead of just hospital or pharmacy-based vaccination sites, Israel created pop-up and drive-thru centres — leveraging teams of community-based nurses, physicians and other medical professions to vaccinate residents rapidly. 

People across the U.K. are being vaccinated in the community at sites like this pharmacy in London. (Dan Kitwood/Getty Images)

“We really, really want to try to decentralize vaccine sites away from hospital systems into the communities, and I think it’s very, very important to engage community leaders, especially in areas in remote places where accessibility is a huge issue,” said Dr. Sumon Chakrabarti, an infectious diseases physician at Trillium Health Partners in Mississauga, Ont.

“And you know, this is going to be absolutely key in getting as many Canadians vaccinated as possible.”

That’s the approach in the U.K. as well, where more than 10 million citizens have been vaccinated against COVID-19 to date.

The country is using a mix of community clinics and pharmacies, hospital sites and large-scale venues like sports stadiums, totalling around 1,500 sites, with mobile units planned for highly rural areas.

The goal, according to the U.K. government, was to have every resident living within roughly 16 kilometres of a vaccination centre.

Canada’s COVID-19 vaccine rollout has gotten off to a sluggish start, but there could be lessons to learn from countries such as Israel, which has vaccination clinics operating around the clock. 3:11

Provinces look to decentralization

Unlike the U.K., Canada has to contend with a population spread out over a vast geographic area. Even so, provinces are exploring decentralization in a variety of ways, although some frameworks are more fleshed-out than others. 

In Ontario, which began its vaccine rollout within the hospital system, regional public health units are  preparing and presenting vaccination plans, which may include work with community physicians and pharmacists, provincial officials told CBC News on Tuesday.

Saskatchewan has vaccination sites spread  across 10 different zones, with doses heading to more than 50 different communities, while Manitoba is primarily taking a “supersite” approach with large-scale vaccination clinics happening at several facilities like a gymnasium and convention centre, alongside the shots doled out by physicians, pharmacists and pop-up clinics.

Manitoba Premier Brian Pallister visits the province’s new COVID-19 vaccination centre at Winnipeg’s Convention Centre Friday. (John Woods/The Canadian Press)

Meanwhile, British Columbia’s provincewide immunization plan notes 172 community-based vaccine clinics are  being organized and will be held at large facilities, including school gyms, arenas and convention centres.

“Mobile clinics in self-contained vehicles will be available for some rural communities and for people who are homebound due to mobility issues,” the plan said, adding more details will be released before April.

On the East Coast, Prince Edward Island officials announced vaccine clinics in several cities set to launch in late February — and recently made changes to a law that comes into effect this month and will eventually allow pharmacists to provide COVID-19 vaccinations alongside their usual roster of shots.

Community-based approach

But ensuring that community clinics can offer vaccines widely and efficiently requires significant planning beyond finding buildings or hiring staff.

“This short amount of time, until the next series of vaccines are rolled out in large numbers, is the time to develop those prototype clinics — if you haven’t done them — to make sure you’ve got a vaccination recording system in place and have all your communications sorted out,” said Dr. Joanne Langley, a pediatric infectious disease specialist at the Halifax-based Canadian Center for Vaccinology

Multiple experts who spoke to CBC News stressed that communication needs to include trusted community leaders, culturally sensitive messaging and information about vaccine programs provided in a variety of languages.

Toronto-based physician Dr. Naheed Dosani says during this lull period when Canada is waiting on a steady supply of vaccine shipments, it’s crucial to reach out to communities, provide educational materials and combat vaccine hesitancy. 0:42

“You can have some person on TV just talking, telling you to get vaccinated, but it’s different if you have somebody who’s trusted in the community, whether it’s a community member, priest, doctor that you know,” said Chakrabarti.

In the Toronto area, Dosani said there’s a groundswell of innovation and support from local organizations, with community health centres already working to address vaccine hesitancy among communities where it is common — and rooted in long-standing trauma and distrust of the mainstream medical system.

But governments need to support those efforts as well, he said. 

“If we are taking an equity-based approach, what that means is putting more resources and supports in place so that the people who are less likely to take the vaccine get the supports and education that they need to so that they do take the vaccine.”

Booking system hiccups

As vaccination campaigns scale up to include more members of the community, building large-scale booking systems has been a key priority in different countries to manage the massive number of appointments.

Earlier this year, Canada’s federal government awarded international accounting firm Deloitte a multimillion-dollar contract to build a national computer system to manage the COVID-19 vaccine rollout.

But there may be lessons to learn there, too. South of the border, the same system is being used in multiple states, with U.S. media outlets reporting that it’s proving buggy and unreliable

Meanwhile, in some areas of Florida, other types of online-only booking systems have sparked frustration among seniors — the age group most at risk of dying from COVID-19 — and led to reports of people stuck refreshing web pages to snag one of the limited spots or flying in from abroad to get vaccinated.

There is renewed uncertainty around delivery dates and amounts of Moderna vaccines for Canada. While Ottawa has secured more AstraZeneca doses, some criticize the plan to draw supplies from the COVAX vaccine-sharing initiative. 2:19

Those approaches require computer literacy and cause unnecessary chaos, Stall said. 

“My fear is you’re going to have a vaccine booking system that’s going to be like purchasing playoff tickets for a sports team where everyone’s going to line up, crash the system, try and book as fast as they can,” he said.

“And you’re going to leave behind the people who need the vaccine the most.”

Yet, even more traditional booking methods can come with hiccups.

Prince Edward Island set up a dedicated phone line so anyone aged 80 or older can start booking COVID-19 vaccine appointments, seven days a week. It’s already so popular that seniors are struggling to get through, prompting the province to boost the number of people taking the calls and, soon, to start offering online booking options as well. 

Islanders can book appointments now by phone by calling 1-844-975-3303, but there are a lot of callers this week. An online booking option may be ready next week, Dr. Heather Morrison says. 6:26

Sustain public health measures

With so many facets to a vaccination rollout, at a scale and speed Canada hasn’t experienced before, the process is rife with challenges — but that’s where this lull might  come in handy.

“I appreciate that we don’t have an adequate supply yet to be vaccinating the general public,” Dosani said. “But there is a lot of time that’s just passing right now that can be used for things like public education.”

Officials are also stressing the need to maintain now-engrained precautions to keep the coronavirus at bay while Canadians await widespread inoculations.

Outbreaks keep happening throughout the country in high-risk populations and communities, including long-term care homes, correctional facilities, Indigenous communities and in remote areas, said Dr. Theresa Tam, Canada’s chief public health officer, in a statement on Thursday.

“These factors underscore the importance of sustaining public health measures and individual practices and not easing restrictions too fast or too soon,” she said.

“This is particularly important in light of the emergence of new virus variants of concern that could rapidly accelerate transmission of COVID-19 in Canada.”

It’s a tense time, but light at the end of the tunnel may be closer than it seems.

“Our job is to keep ourselves and our families safe until we get that vaccine,” Langley said.

“And once it’s rolled out in the whole population, we’ll be in a different place.”

To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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Semiconductor Shortage Could Cost Automakers $61B in Lost Sales

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We’re starting to see some numbers attached to the ongoing semiconductor shortage and accompanying predictions for how much of a drag the issue might be in 2021. Current predictions suggest automakers could lose some $ 61B in sales worldwide. Discussions between the auto industry and its chip manufacturing partners also sound as if they could be going better.

At first glance, a sales reduction of that magnitude doesn’t sound like much. The top 10 auto manufacturers on Earth collectively earn about $ 1.63T in revenue per year. $ 61B isn’t much, by comparison, objectively speaking.

The coronavirus hit the automotive industry pretty hard in 2020, however, and even though sales recovered more strongly than expected in the back half of the year, automakers across the world saw their sales fall by 10-20 percent year-on-year. Nissan took a particular whack, with sales down 33 percent. These 10-20 percent annual declines were actually cheered for being much smaller than expected, but manufacturers are in no mood to leave money on the table.

Relationships between TSMC and the various automotive companies have hit a low point, with each blaming the other for the current shortage, according to Bloomberg. If you ask the automotive manufacturers, the problem is that TSMC and its ilk are preferentially allocating capacity to gadget manufacturers. If you ask the foundries, the automotive companies are so in love with lean manufacturing, they refuse to keep reasonable hardware stockpiles on hand. TSMC recently pledged to shift some manufacturing and allocate additional resources to the automotive industry, while pointedly observing its inability to magically conjure production resources out of thin air.

If I had to guess, I’d guess automakers aren’t used to dealing with the longer production timelines that semiconductor companies require. Having allocated production away from car manufacturers in early 2020, it’ll take time to allocate production back towards them. Bloomberg’s article specifically mentions that it may take until Q3 to completely work through the production issues. If you squint, you can see the industry broadly coming into alignment around the idea that we won’t see a return to normal conditions in Q1. Right now it looks like Q2 should slowly begin to recover. Maybe we’ll see MSRPs and easy product availability by the end of Q2 — or maybe we’ll see shortages bleed into the start of Q3. Right now, nobody seems to know.

Most likely, this period of constant shortages of everything will give way to erratic shortages of whatever product you most wanted to buy, which will, in turn, fade off to sporadic non-availability of things you find it annoying to wait a few weeks for. It will inevitably manage to be the wrong week for nearly everyone, all of the time. But hopefully, problems will clear up within six months.

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Samsung Believes the Automotive Chip Shortage Could Impact Phones

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The ongoing automotive chip shortage is reportedly having ripple effects throughout the industry. Samsung is reportedly concerned that problems in one area of the semiconductor market could spill over into others.

The problem is that there’s not enough chip capacity to go around, according to the Financial Times. Automakers have lobbied governments and chip manufacturers for help worldwide. TSMC has pledged to expedite orders for auto manufacturers, and other foundries across the world are likely making similar vows. That company’s statement on the topic is relevant to Samsung’s concerns: “While our capacity is fully utilized with demand from every sector, TSMC is reallocating our wafer capacity to support the worldwide automotive industry.”

TSMC has previously indicated it was converting some manufacturing to respond to additional demand in the automotive sector. But the fact that its capacity is fully utilized means the foundry is playing a game of musical chairs as far as who gets allocation priority on which product lines. Automotive chips aren’t typically built on leading-edge process nodes, but the nature of the semiconductor shortage has caused shortages across the entire industry.

TSMC’s Q2 2020 revenue, with additional data on revenue by node.

Samsung is specifically concerned that it won’t be able to deliver new phones on time because foundries will be too busy building chips for other companies, including the automotive industry. Foundry shortages could squeeze the smartphone industry by limiting the number of devices available in-market. Samsung is particularly exposed in this scenario: It’s both the largest smartphone manufacturer in the world, the largest DRAM manufacturer, and the largest NAND manufacturer. If smartphone supplies are limited, Samsung will eat the hit in three separate ways.

The fear of an automotive slowdown has led governments to put an unusual amount of pressure on TSMC, according to the report. Companies in the US, Japan, and Europe have reportedly engaged in direct talks with the foundry, as well as raising the issue with Taiwan’s government.

“We believe that as economies are struggling due to the pandemic, governments, especially in the countries hit worst by the virus, see car demand as a rare growth impulse important for their overall economies,” an unnamed Taiwanese official told the Financial Times. “We would not normally see this kind of approach if it were only about a few individual companies.”

The reason we’re in this mess in the first place, ironically, is that the market for cars bounced back faster than expected. During the pandemic, TSMC reduced the capacity it allocated for vehicle production after auto sales cratered. Now that vehicle sales are ticking up again, auto manufacturers need that capacity back. Problem is, it’s still in use producing everything else.

ExtremeTech suspects that companies will soon start talking about semiconductor shortages easing in June or July rather than the March-April timeframe that’s been floated recently. AMD has already indicated it expects supply to remain tight through this time frame, and it’s not the only TSMC customer that’s going to be supply-limited.

Pre-built gaming systems remain the best way to get your hands on a new AMD Ryzen 5000, Radeon, or Ampere GPU. It’ll be interesting to see if Rocket Lake picks up any customers on the basis of being easier to find in-stock. Auto manufacturers haven’t made any dramatic business moves in response to the ongoing supply problem, at least not yet. Hopefully, the demands of various markets can be met without destabilizing any specific market.

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