This story is part of Watching Washington, a regular dispatch from CBC News correspondents reporting on U.S. politics and developments that affect Canadians.
U.S. President Joe Biden says he’ll provide news soon on one of the most coveted bits of public health information at this stage of the pandemic: What happens to excess doses of COVID-19 vaccines in the U.S.?
With the United States hoping to have enough vaccines for every adult by May 31, there’s already speculation about where its millions of extra doses might end up.
Asked whether he intended for neighbours or allies to get access first, Biden said conversations have already begun with other countries.
“I’ve been talking with several countries already,” Biden said Tuesday.
“I’ll let you know that very shortly.”
WATCH | Canada talking to U.S. about surplus doses, says minister:
U.S. President Joe Biden says the White House is talking to several countries about sending them surplus vaccine doses once Americans have been immunized. Minister Dominic LeBlanc tells Power and Politics that Canada wants to be one of those countries. 2:37
Why this matters to Canada
Canada is among the countries pressing for access to that U.S. supply, though Washington has blocked exports of doses, including some close to Canadian soil, produced by Pfizer in Michigan.
Asked about Biden’s remarks, Intergovernmental Affairs Minister Dominic LeBlanc told CBC News Network’s Power & Politics that Canada is among the countries talking to the U.S. about obtaining vaccines.
“We’re certainly a country … that’s been having ongoing discussions with the Americans around a supply of vaccines for Canadians,” LeBlanc told host Vassy Kapelos.
“Obviously at a time when their government decides that they’re going to allow the export of vaccines made in the U.S., Canada would be one of the countries that would be having those conversations with the Americans.”
But LeBlanc said he’s not one of the Canadian officials talking to the U.S., and would not comment further because it was too early to be publicly discussing those conversations.
What happens next
Some American politicians have also suggested the U.S. should next send vaccines to its immediate neighbours, as part of reopening the borders between countries.
They include Vicente Gonzalez, a member of the House of Representatives from Texas who suggested excess U.S. supplies should be steered to Mexico and Canada, given the region’s economic integration and human connections disrupted by the pandemic.
In addition, Brian Higgins, a House member from a border area in Buffalo, N.Y., told CBC News in an interview last week that he’s urging the Biden administration to use all its leverage to help Canada get additional vaccines.
The U.S. is currently vaccinating citizens at a rate multiple times higher than Canada — and Higgins said evening out that disparity could help reopen the border.
Prime Minister Justin Trudeau said today the AstraZeneca-Oxford COVID-19 vaccine is safe and Canadians should have no concerns about receiving it, after nearly a dozen European countries suspended its use over concerns about blood clots.
“Health Canada and our experts have spent an awful lot of time making sure every vaccine approved in Canada is both safe and effective,” Trudeau said.
“The best vaccine for you to take is the very first one that is offered to you. That’s how we get through this as quickly as possible and as safely as possible.”
Trudeau said regulators are “following what has been happening with a specific batch used in Europe.” He said none of the AstraZeneca doses deployed in Canada have come from that batch.
All of Canada’s current supply is manufactured by the Serum Institute of India, which secured separate regulatory approvals from Health Canada. That version, which is biologically identical to the AstraZeneca shot but is manufactured under different conditions, has been branded “Covishield.”
Out of the approximately 5 million European residents who have received AstraZeneca’s shot, about 30 have experienced “thromboembolic events” — clots forming in blood vessels — and a very small number of deaths have been reported.
Quebec Premier François Legault, who joined Trudeau today for a funding announcement for an electric battery plant in Montreal, said health officials in the province have told him there’s nothing to worry about.
“There’s absolutely no risk associated with the AstraZeneca vaccine. It’s in fact safe,” he said in French. “They’re assuring us there’s no risk.”
Trudeau said he will not hesitate to get a COVID-19 vaccine when the time comes. “I will wait my turn,” he said.
Other world leaders — like U.S. President Joe Biden, who, at 78, is much older than the 49-year-old prime minister — have received their shots publicly to boost public confidence in the products’ safety and efficacy.
Trudeau’s mother Margaret, who lives in Quebec, recently received a dose.
WATCH: Trudeau says ‘I will wait my turn’ for COVID-19 vaccine
Prime Minister Justin Trudeau said he will wait for his turn to receive a COVID-19 vaccine. 0:59
France, Germany suspends AstraZeneca vaccine
On Monday, France and Germany joined Denmark, the Netherlands, Norway, Iceland and Ireland and several other countries in suspending the use of the vaccine.
Germany’s health minister said the decision was taken on the advice of Germany’s national vaccine regulator, the Paul Ehrlich Institute, which called for further investigation into seven reported cases of clots in the brains of people who had been vaccinated.
“Today’s decision is a purely precautionary measure,” Jens Spahn said.
The European Union’s medicines agency and the vaccine maker itself have said that blood clots are not uncommon and there’s nothing to indicate that the vaccine is to blame for these events.
“A careful review of all available safety data of more than 17 million people vaccinated in the European Union and U.K. with Covid Vaccine AstraZeneca has shown no evidence of an increased risk of pulmonary embolism, deep vein thrombosis or thrombocytopenia, in any defined age group, gender, batch or in any particular country,” the company said in a statement.
The World Health Organization said in a media statement Monday its global advisory committee on vaccine safety is “carefully assessing the current reports related to the AstraZeneca vaccine.”
“As of today, there is no evidence that the incidents are caused by the vaccine and it is important that vaccination campaigns continue so that we can save lives and stem severe disease from the virus. The AstraZeneca vaccine has been administered to more than 10 million people in the United Kingdom with no evidence of related serious adverse events.”
The U.K. Medicines and Healthcare Products Regulatory Agency (MHRA) said Sunday there is no evidence the vaccine has caused any problems in that country — the AstraZeneca product has been in use there for months — and people should still get vaccinated when it’s their turn.
“Blood clots can occur naturally and are not uncommon. More than 11 million doses of the Covid-19 AstraZeneca vaccine have now been administered across the U.K.,” the MHRA told BBC News.
Most African countries will kick-start their COVID-19 vaccination programs by the end of March as efforts to procure doses for the continent’s 1.3 billion people gather pace, the World Health Organization (WHO) said on Thursday.
The world’s poorest continent faces logistical and financial obstacles to securing all the vaccines it needs, but the WHO-led COVAX facility has begun to bear fruit.
“This week Africa has been at the forefront of COVAX facility deliveries, finally, with almost 10 million vaccine doses being delivered to 11 countries as of this morning,” WHO Africa’s Matshidiso Moeti told a virtual news conference.
“We expect that around half of African countries will receive COVAX deliveries in the coming week and that most countries will have vaccination programs underway by the end of March.”
COVAX, also led by the GAVI vaccines alliance and other partners, plans to send about 1.3 billion doses to 92 lower- and middle-income nations, covering up to 20 per cent of their populations.
As of Thursday, Africa had reported at least 3,955,000 infections and 104,000 deaths.
As the Trudeau government is forced to explain delays rolling out COVID-19 vaccines, some of the world’s economic and health leaders are warning of catastrophic financial consequences if poorer countries are shortchanged on vaccinations.
At a video meeting convened by the Paris-based Organization for Economic Co-operation and Development (OECD) on Monday, Secretary-General Angel Gurria predicted that rich countries would see their economies shrink by trillions of dollars if they don’t do more to help poor countries receive vaccines.
The leaders of the World Health Organization and others also bemoaned the long-term damage of continued “vaccine nationalism” if current trends continue — rich countries getting a pandemic cure at a much higher rate than poorer ones.
It was a message that could provide some political cover for the Liberals, who have been widely criticized for shortfalls in deliveries of vaccines from Pfizer-BioNTech and Moderna while also facing international criticism for pre-buying enough doses of vaccines to cover Canada’s population several times over.
Some international anti-poverty groups have also criticized Canada for planning to take delivery of 1.9 million doses from the COVAX Facility, a new international vaccine-sharing program that is primarily designed to help poor countries afford unaffordable vaccines, but also allows rich donor countries — including Canada — to receive vaccines.
Trudeau and his cabinet ministers on the vaccine file have repeatedly said that the pandemic can’t be stamped out for good if it isn’t defeated everywhere.
They say Canada is a trading nation that depends on the welfare of others for its economic prosperity — especially with the emergence of new variants of the virus in South Africa and Britain.
But their protestations are usually drowned out in the domestic clamour that tends to highlight unfavourable comparisons of Canada’s vaccine rollout with the United States, Britain or other countries.
On Monday, Gurria — the veteran Mexican politician who has led the OECD for 15 years — brought the full force of his political gravitas by offering up a pocketbook argument that eschewed any pretence of altruism.
“It’s a smart thing to do. It is ethically and morally right. But it is also economically right,” said Gurria.
“The global economy stands to lose as much as $ 9.2 trillion, which is close to half the size of the U.S. economy, just to put it in context, as much as half of which would fall on advanced economies, so they would lose around $ 5 trillion.”
COVAX needs another $ 5 billion at least
The OECD is an international forum of more than three dozen mainly democratic and developed countries, including Canada, that aims to help foster economic growth and trade. It also conducts comprehensive economic research and issues the world’s most authoritative annual report on what rich countries spend on foreign aid.
Canada’s former finance minister Bill Morneau, who resigned last summer during the WE funding scandal, had said he was leaving politics because he long wanted to pursue the OECD leadership when Gurria departs later this year. In January, Morneau abandoned that ambition, saying he didn’t have enough support among member countries.
Meanwhile, Trudeau said last week that Canada remains committed to helping poor countries cope with COVID-19 through its $ 220-million pledge to COVAX, and its $ 865-million commitment to the ACT Accelerator, which tries to ensure low- and middle-income countries have equitable access to medical treatments during the pandemic.
But Jorge Moreira da Silva, the OECD’s development co-operation director, said COVAX is underfunded by $ 5 billion, while the World Health Organization is predicting at US$ 27-billion shortfall for the ACT Accelerator.
Dr. Tedros Adhanom Ghebreyesus, the WHO director-general, said 75 per cent of vaccine doses are being administered in 10 wealthy countries.
“It’s understandable that governments want to prioritize vaccinating their own health workers and older people first. But it’s not right to vaccinate young, healthy adults in rich countries before health workers and older people in low-income nations,” Tedros told the OECD forum.
“We must ensure that vaccines, diagnostics and life-saving therapies reach those most at risk and on the front lines in all countries. This is not just a moral imperative. It’s also an economic imperative.”
Trudeau has repeatedly said that all Canadians who want a vaccine will get one by the end of September but that it is too soon to say how the government will eventually decide to share its excess doses globally.
At Monday’s forum, a spokesman for the pharmaceutical industry said the bumps and grinds of vaccine delivery to poor countries would be transformed into “a huge success” in the coming months.
“I think it’s dangerous to talk about, you know, this is a huge moral injustice already now because … you will have significant rollout to developing countries,” said Thomas Cueni, the director-general of the International Federation of Pharmaceutical Manufacturers and Associations.
“I haven’t seen a single industrialized country, maybe with the exception of Israel, where young and healthy people are vaccinated.”
As countries such as Canada and the United States continue vaccinating millions of citizens, global health experts warn the pandemic could keep raging if lower-income nations don’t get their share of much-needed doses.
It’s a concern that’s growing even as Dr. Anthony Fauci, chief medical advisor to newly inaugurated U.S. President Joe Biden, announced on Thursday the country will rejoin the World Health Organization (WHO) — and with it, the COVAX Facility, a global initiative to ensure COVID-19 vaccines reach those in greatest need.
It’s long overdue, some say. Others worry it’s just the latest example of lip service after what’s so far been a deeply inequitable vaccine roll-out around the world.
“I would characterize the approach to global vaccine distribution as a massive failure,” said Jenna Patterson, the South Africa-based director of health economics at the Health Finance Institute, a U.S. non-governmental organization.
‘No doses in the pipeline’ for some countries
While Canada is among the nations signed on with COVAX, it’s also one of the wealthy countries buying up massive shipments from a slate of vaccine producers — with millions of doses already administered between them.
Meanwhile, other countries have no doses in the pipeline, with some lower-income nations waiting for international aid that could take months.
That could amount to “catastrophic moral failure” on a global scale, WHO director general Tedros Adhanom Ghebreyesus warned on Monday.
And from both an ethical and economic standpoint, the disparities could prove a lose-lose.
“Everyone wants to go back to some sense of normal,” said Dr. Ranu Dhillon, a global health physician who teaches at Harvard Medical School.
“But that won’t be possible unless we solve this globally.”
WATCH | WHO chief describes vaccine inequity between countries:
The wealthier countries of the world are buying up too much of the COVID-19 vaccine supply and leaving too little for poorer countries, says WHO Director-General Tedros Adhanom Ghebreyesus. 0:57
Ignoring vaccine equity could ‘prolong’ pandemic
On one hand, countries without COVID-19 vaccination programs could experience more infections and deaths for far longer; on the other, the possibility of vaccine-resistant variants emerging from ongoing hot zones could backfire on already-vaccinated countries as well.
“Not only does this me-first approach leave the world’s poorest and most vulnerable at risk; it is also self-defeating,” Tedros said at the opening of the annual meeting of the WHO’s executive board.
“Ultimately, these actions will only prolong the pandemic.”
Allowing the virus to continue its spread in certain regions could impact travel and tourism, supply chains and the world economy, warned several experts who spoke to CBC News.
The coronavirus doesn’t respect international borders, said Dhillon, evidenced by the ongoing global spread of variants first found in countries such as Brazil and the U.K., meaning there’s no way to end the pandemic by focusing solely on national response.
If transmission continues largely unchecked in lower-income countries, there’s a possibility that variants emerge that don’t respond to current vaccines being rolled out in wealthy nations, he said.
A situation like that could derail widespread vaccination efforts, travel routes and economic recoveries.
“We can’t control COVID unless we control it in the rest of the world,” echoed Dr. Anna Banerji, an associate professor at the University of Toronto’s faculty of medicine and the Dalla Lana School of Public Health.
“And so that’s an additional incentive to get the whole world working together to try to get all places, rich and poor, vaccinated as soon as possible.”
WATCH | U.S. health economics expert: one nation’s health affects another
Jenna Patterson, the South Africa-based director of health economics at U.S. non-governmental organization the Health Finance Institute, says an equitable global vaccination effort is crucial to fighting COVID-19 for both public health and economic reasons. 0:44
Canada has administered 700,000 shots
While Canada’s vaccination program got off to a slow start, including an imminent pause on shipments from Pfizer-BioNTech, it remains among the countries poised to vaccinate tens of millions in the months ahead.
Canada has administered close to 700,000 shots so far, providing at least one dose to roughly 1.7 per cent of the population.
Israel, the world leader in doses per capita, has vaccinated more than three million people; the United Kingdom more than five million; and the U.S. and China have both inoculated more than 15 million and counting.
That’s a stark contrast to some of the world’s poorest nations.
Many African countries, in particular, are in danger of being left behind as countries in other regions strike bilateral deals, driving up prices, according to the WHO.
The delay is, in part, because of the stringent cold-storage requirements for certain vaccines, which can be challenging to accommodate in remote areas. But WHO officials said they’re working to ensure countries’ readiness to receive shipments, and suggested clear inequities are also at play.
“It is deeply unjust that the most vulnerable Africans are forced to wait for vaccines while lower-risk groups in rich countries are made safe,” said Dr. Matshidiso Moeti, the WHO’s regional director for Africa, in a statement the organization released on Thursday.
Guinea is currently the only low-income country in Africa to provide its residents with COVID-19 vaccines, and to date, according to the WHO, those have only been administered to 25 people.
No doses yet in many countries
Patterson, who’s based in South Africa and was speaking for the Health Finance Institute, said it’s in the world’s best interest to ensure all countries are vaccinated against this virus, on both economic and moral fronts — since the death toll in unvaccinated regions could continue skyrocketing while infection rates drop elsewhere.
“And COVID has displayed this better than any other disease, how the health of one nation affects another,” she said.
South Africa is the hardest-hit country in Africa with more than 1.3 million cases to date. It’s also now known for first discovering one of several concerning new variants of the SARS-CoV-2 virus — one which appears to be more transmissible, and potentially capable of evading some level of immune response.
Yet the country hasn’t vaccinated any of its residents and is set to pay more than twice as much per dose for its batch of the AstraZeneca coronavirus vaccine from the Serum Institute of India compared to purchases made by countries in the European Union, according to a Reuters report.
Malawi, a low-income country in southeastern Africa, also has no vaccination campaign underway, even though the situation on the ground is a “disaster” according to Dr. Titus Divala, a physician and lecturer with the University of Malawi College of Medicine.
“I think we’re going to be in a situation where we do need the vaccine, but we don’t have access to it for some time,” Divala said.
COVAX aims to bring 600 million doses to Africa
Through the COVAX initiative — organized by the WHO, the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance — international aid is meant to arrive, albeit slowly, in the shadow of vaccination programs elsewhere that are months ahead.
The coalition has secured at least two billion doses of vaccines from multiple companies, with sources telling Reuters on Thursday that Pfizer-BioNTech, one of two companies with vaccines currently approved for use in Canada, will be signing on as well.
COVAX has committed to vaccinating at least 20 per cent of the population in Africa by the end of 2021 by providing a maximum of 600 million doses, with a first round of 30 million doses expected to start arriving in countries by March.
The WHO, however, warned shipments and timelines could change if vaccine candidates fail to meet regulatory approval — or if production or funding challenges arise.
Alison Thompson, an associate professor at the University of Toronto and researcher on ethics and public health, said countries like Canada and the U.S. who participate in COVAX need to either support other countries’ vaccination efforts financially or, at some point, take a backseat so other nations can enter the crowded queue.
“That’s a hard sell politically,” she added, “but it really does raise the question about, what are Canada’s global obligations to public health?”
Need to ‘mass-manufacture’ globally
Dhillon, the physician from Havard, said this pandemic has shown the level of innovation and technology available, and now it’s just a matter of scaling up to meet international need.
“How do we mass-manufacture these vaccines in the quantities needed globally?” he questioned. “There is manufacturing capacity in other areas of the world. We need to remove issues with patents, we need to remove issues with intellectual property.”
It’s all easier said than done in a charged climate where citizens are clamouring to access shots in short supply within their own borders, and Canada is no exception.
But Dhillon compared the current vaccine landscape to the therapies that emerged to prevent AIDS, the often-devastating illness caused by HIV, or human immunodeficiency virus.
Wealthier nations accessed those first, he explained, while poorer countries were left waiting, with many of those infected in the developing world still starting therapy late.
“Instead of waiting to look back in retrospect and question why we didn’t do more — I think we’re in that moment now,” Dhillon said.
Pfizer has slashed in half the volume of COVID-19 vaccines it will deliver to some EU countries this week, government officials said on Thursday, as frustration grows over the U.S. drugmaker’s unexpected cut in supplies.
Romania will get 50 per cent of its planned volume this week and supplies will only improve gradually, with deliveries not returning to normal until the end of March, Deputy Health Minister Andrei Baciu told Reuters.
It was a similar situation in Poland, which on Monday received 176,000 doses, a drop of around 50 per cent from what was expected, authorities said.
The Czech government was bracing for the disruption to last for weeks, slowing its vaccination campaign just as the second dose of vaccinations get underway.
“We have to expect that there will be a reduction in the number of open vaccination appointments in the following three weeks,” Health Minister Jan Blatny told reporters on Thursday, with Pfizer deliveries falling by about 15 per cent this week and as much as 30 per cent for the following two weeks.
Pfizer and its German partner BioNTech have declined to comment on the cuts beyond their statement last week, which announced cuts to deliveries as they ramp up manufacturing in Europe.
Some countries reckon they can handle it. Norway has an emergency stockpile and will continue administering doses as planned, the government’s public health body said.
The U.S. drugmaker has told Bulgaria and Poland it will replace missing doses, top officials said.
But Denmark’s Serum Institute said its 50 per cent loss of shots this week would lead to a 10 per cent shortfall for the first quarter.
Italy reacts angrily
With governments across the region still reeling from the surprise cuts, officials say the reductions are undermining their efforts to inoculate their citizens and tame the pandemic, which has killed more than two million people.
On Wednesday, Italy threatened legal action against Pfizer, after the company said it was was cutting its deliveries by 29 per cent to the Mediterranean country.
Pfizer’s move was having a serious impact on vaccination plans drawn up by local authorities, the governor of the northern Emilia Romagna region said.
“Due to the reduction in doses, many regions have been forced to slow down or even suspend new vaccinations to ensure administration of the second dose to those who had already received the first,” Stefano Bonaccini told Reuters in an email.
WATCH | Provinces complain, but powerless amid Pfizer situation:
Pfizer told Canadian officials there would be delays in deliveries of its vaccine, but the delays now mean Canada will receive zero Pfizer-BioNTech vaccines next week. It’s left provinces scrambling to manage the doses they have left. 2:42
In Hungary, where the authorities gave the go ahead for the use of Britain’s AstraZeneca and Russia’s Sputnik V vaccines ahead of the EU drug regulator, a senior official called on Brussels to try and ensure that deliveries from Pfizer and other vaccine makers would stick to schedule.
“We would be happy if the [European] Commission could take steps as soon as possible to ensure that Pfizer and other manufacturers would change deliveries,” Prime Minister Viktor Orban’s chief of staff Gergely Gulyas said.
The problem has spread to countries outside the trading bloc, too – Canada is facing delays, as is Switzerland, where the mountain canton of Grisons got only 1,000 shots from Pfizer this week, far short of the 3,000 it had been anticipating.
The EU has approved the Moderna vaccines, but the authorization came a few weeks after similar action in Canada, the United States, Britain and Israel, with the first deliveries made only a week or so ago.
Moderna has committed to delivering 10 million doses by the end of March and 35 million each in the second and third quarter, reflecting a process that will take time to ramp up. Another 80 million doses are also to be delivered this year but without a clear timetable yet.
Meanwhile, at a meeting of EU health ministers last week, Belgium said bottlenecks in the supply of the so-called Low Dead Space syringes were likely when Pfizer begins to deliver bigger volumes of its shots.
A Belgian diplomat said the country had urged the EU executive commission to speed up joint procurement for syringes to avoid “unnecessary delays.”
While there is no immediate shortage of the syringes — which are designed to ensure the maximum amount of vaccine is extracted from vials — there are not enough syringes for mass vaccination, a spokeswoman for the Lithuanian health ministry told Reuters on Thursday, saying the Baltic country had joined the EU procurement scheme.
“What is now not a problem, can easily become a very big problem tomorrow,” she said.
Canada is falling behind in its initial rollout of COVID-19 vaccines at a critical time in the pandemic, and experts say our most vulnerable populations are being left at risk.
Despite having months to prepare for the deployment of the initial shipment of vaccines to those most threatened by COVID-19 in long-term care facilities, a consistent rollout plan has yet to fully materialize on the ground.
“It just seems to be chaos right now,” said Alyson Kelvin, an assistant professor at Dalhousie University and a virologist at the Canadian Centre for Vaccinology evaluating Canadian vaccines with the VIDO-InterVac lab in Saskatoon.
“We know who is a vulnerable population, so we need a strategy of actually vaccinating them.”
Long-term care residents were largely left out of Canada’s initial rollout of the Pfizer-BioNTech vaccine, which requires storage temperatures of –80 to –60 C, in favour of waiting for the more easily transportable Moderna vaccine and vaccinating health-care workers first.
But once thawed, the Pfizer-BioNTech vaccine can be used for up to five days at basic refrigeration temperatures — meaning it could be taken out of distribution hubs across the country and brought into long-term care facilities directly during that window of time.
“We treated the Pfizer vaccine with as much care and respect as possible and that really created all these hub sites,” said Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton and an associate professor at McMaster University. “And I think that did hinder some of the innovation and the ability to do things elsewhere.”
Fragmented rollout across Canada a ‘failure’
The federal government has deployed almost 500,000 doses of both the Pfizer-BioNTech and Moderna vaccines to distribution sites across the country since mid-December, but the actual rollout of vaccinations is up to the individual provinces and territories.
Quebec took the bold step of actually putting its vaccine distribution centres inside long-term care facilities, making it easier to inoculate residents as quickly as possible.
While British Columbia made the decision to move the Pfizer-BioNTech vaccine from its distribution sites almost immediately into long-term care homes to inoculate residents and staff upon receiving its first doses.
Yet Ontario decided against bringing the Pfizer-BioNTech vaccine directly into long-term care homes initially, despite other provinces doing so, and is only now doing so more than three weeks after receiving its first shipment.
Dr. Vera Etches, Ottawa’s medical officer of health, announced Tuesday the city would be transporting the Pfizer-BioNTech vaccine out of its distribution hub at the Ottawa Hospital and directly into long-term care residences, after vaccine-handling criteria from Pfizer were changed.
Despite receiving 53,000 doses of the Moderna vaccine last week, which is much easier to bring into long-term care residences, only 3,000 doses have actually been administered in Ontario as of Tuesday.
Ontario has pledged to vaccinate all residents, health-care workers and essential caregivers at long-term care homes in the hardest hit regions of Toronto, Peel, York and Windsor-Essex by Jan. 21, but has not set a deadline for the rest of the province.
To date, fewer than 1,000 long-term care residents have been vaccinated in Ontario.
“The provincial health-care systems aren’t experts in newly emerging viruses, brand new speedy vaccine platforms and pandemics,” said Kelvin. For that reason, ongoing communication from the federal government to the provinces and territories and local level is essential, she said.
“To leave each province and territory to have to come up with their own plan, when they’re not experts in this, I think is a failure.”
Kelvin said putting experts with relevant backgrounds in long-term care at the helm of vaccine rollouts across the country could have mitigated some of the missteps made so far.
“We need somebody who’s knowledgeable about long-term care facilities in Canada and their current functioning states,” she said.
WATCH | Vaccination lessons from around the world:
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
Chagla said Ontario could have either proactively opened up more vaccine distribution centres, or used the five-day model of thawing the Pfizer-BioNTech vaccine and getting it directly into long-term care facilities in order to vaccinate those most at risk sooner.
‘Rules are made to be broken’
Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003, says provinces need to be much more flexible in how they roll out the vaccines.
“You want to do what got done in studies, because you know what the outcome of studies were,” she said, referring to the clinical trial data for both COVID-19 vaccines.
“However, this is a pandemic and rules are made to be broken.”
Quebec and Manitoba decided not to reserve second doses for those who had received their first shot in an effort to speed up their vaccination campaigns, while Ontario has asked Health Canada to “look into” the possibility of providing Moderna’s vaccine as a single dose.
McGeer said Canada should be focused on the most effective way to use the vaccines it has in hand, as opposed to letting them sit in freezers, even if that doesn’t always line up entirely with the usage guidelines.
WATCH | Weighing the pros and cons of going ‘off label’:
In order to distribute more COVID-19 vaccines faster, some jurisdictions are looking at using different vaccine doses, vaccination schedules and possibly mixing and matching vaccines. Experts say these choices are about weighing the risks of going ‘off label’ and the potential rewards. 2:01
She said that includes being open to the possibility of administering more initial doses to people as quickly as possible and spacing the second doses differently over a longer period of time.
“While we have to be careful with messing with what we’re doing with vaccines, we also really want to be focused on the most protection for the largest amount of people in the shortest period of time,” she said.
“And that definitely means being open to half doses, spreading doses further apart, mixing vaccines.”
Chagla agrees there are ways to pick up the pace that could be considered, including prioritizing giving people their first dose without reserving their second.
“But I don’t think we’re even at that point yet,” he said. “We just need to start getting the logistics up, and again, using the supply we have before we start reconsidering.”
The U.K. has come under fire for its decision to stretch the interval between doses to up to three months, as opposed to the recommended three to four weeks, and for opening the door to giving a person doses of two different vaccines.
Israel has made the decision to use up its initial supply of COVID-19 vaccines as quickly as possible in order to vaccinate as many people with the initial doses it has, with more than two million people set to get a shot by the end of the month.
“We need to be open to the concept that the way [the vaccines] were studied is not necessarily the best way to use them in the middle of a pandemic,” said McGeer.
“In Ontario, it actually doesn’t matter, because we’re so far behind in delivering vaccine that we could give second doses to everybody that’s had a first dose and we wouldn’t make a dent in our vaccine supply.
Canada, which has reserved enough doses to vaccinate its residents against COVID-19 several times over, is in talks with other governments about a plan to donate shots to lower-income countries, according to three sources familiar with the matter.
Canada has made deals to buy more doses per capita than any other nation, according to researchers at the Duke Global Health Innovation Center in North Carolina.
It is among a handful of wealthy nations that reserved billions of doses between them before late-stage trial data came in, ensuring they would get access even if only one or two vaccines worked.
Canada could donate extra doses through the World Health Organization-backed COVAX facility, which would distribute them among recipient countries, said a Canadian government source to Reuters.
Separately, a COVAX source confirmed discussions were going on between Canada and other governments and organizations involved with COVAX, a facility created to ensure equitable access to COVID-19 vaccines.
“We are not going to allow those doses to go to waste,” said a third source.
Sources declined to be identified as the discussions are confidential.
Asked about the issue in a parliamentary committee meeting on Monday, deputy procurement minister Bill Matthews said Canada “would have options” if all seven suppliers had their vaccines approved but that it was “too early” for a plan.
It is not yet clear whether any country will receive more vaccine doses than it can use. Only Pfizer and Moderna have released late-stage trial data, and Canada has deals in place to buy at least 20 million doses from each of the two companies.
But while different vaccines work in different ways, nearly all target the same part of the coronavirus, and some experts see strong early data as an indication that other vaccines may also work.
Demand could exceed supply
Canada’s discussions follow a tack set by the European Union, which has told member states they can donate extra doses to low- and middle-income countries.
The approach could undermine efforts to ensure vaccines are distributed fairly around the world. COVAX, led by the GAVI vaccine group, was created to buy vaccines and share them among countries, not to distribute donated leftovers.
Its aim is to make two billion COVID vaccine doses available by the end of 2021, and it has raised more than $ 2 billion US in funding, but needs $ 5 billion more to meet its goal.
If rich countries do not close that funding gap, and then wait until most of their own residents are vaccinated before sharing doses, millions of front-line workers and vulnerable people in poorer countries could face a long wait for vaccination.
Demand for a vaccine is expected to exceed supply into 2022 and beyond. A recent vaccine modelling report from the Center for Global Development estimated that there would not be enough doses to vaccinate everyone until 2023.
Canada, with a population of about 38 million, has ordered up to 414 million vaccine doses through seven purchase agreements. In the unlikely event all seven are approved, that would be enough to vaccinate the country more than five times over. It is expected most of the early vaccines will require two doses.
Countries straining to contain a second wave of COVID-19 are turning to faster, cheaper but less accurate tests to avoid the delays and shortages that have plagued efforts to quickly diagnose and trace those infected.
Germany, where infections jumped by 4,122 on Tuesday to reach 329,453 cases in total, has secured nine million so-called antigen tests per month that can deliver a result in minutes and cost about $ 7.75 each. That would, in theory, cover more than 10 per cent of the population.
The United States and Canada are also buying millions of tests, as is Italy, whose recent tender for five million tests attracted offers from 35 companies. Switzerland, where new COVID-19 cases are at record levels, is considering adding the tests to its nationwide screening strategy.
Germany’s Robert Koch Institute (RKI) now recommends antigen tests to complement existing molecular polymerase chain reaction (PCR) tests, which have become the standard for assessing active infections but which have also suffered shortages as the pandemic overwhelmed laboratories and outstripped manufacturers’ production capacity.
PCR tests detect genetic material in the virus while antigen tests detect proteins on the virus’s surface, though both are meant to pick up active infections. Another type of test, for antibodies the body produces in response to an infection, can help tell if somebody has had COVID-19 in the past.
Like PCR tests, antigen tests require an uncomfortable nasal swab. They can also produce more “false negatives,” prompting some experts to recommend they only be used in a pinch.
Still, the alarming rise in new infections globally has health officials desperately pursuing more options as the winter influenza season looms.
WATCH | Is Canada on the wrong track with COVID-19 testing?
There is a growing push to have Canada focus on COVID-19 tests that detect who is contagious rather than who is positive for the virus. These tests are available elsewhere in the world, cheaper and can be done at home, but they aren’t approved in Canada. 6:05
The World Health Organization (WHO) reported more than two million new cases last week, bringing the total worldwide to 37 million, with more than one million deaths from COVID-19.
“These point-of-care tests could make a big difference,” said Gerard Krause, epidemiology department director at Germany’s Helmholtz Centre for Infection Research.
No test, no flight
Krause said low-priority patients — those without symptoms — could initially be screened with antigen tests, leaving the more accurate PCR tests for those showing signs of the disease.
Antigen tests have already gained traction in the travel industry. Italian airline Alitalia offers Rome-Milan flights exclusively for passengers with negative tests and Germany’s Lufthansa has announced similar testing plans.
But the pandemic’s vast scale has strained the ability of countries to test all of their citizens, making it difficult to track the twisting paths of infection comprehensively and prevent a resurgence.
In the United States, for example, reliance on automated PCR machinery over the summer left many patients frustrated as they waited for a week or more for results.
Testing in Europe has also suffered glitches.
France does over a million tests a week, but its free-for-all testing policy has led to long queues and delays in results, prompting French researchers to come up with a test they say can produce results in 40 minutes without using a swab.
Italy is doing between 800,000 and 840,000 tests a week, more than double April’s levels, according to the Ministry of Health. But a government adviser, University of Padua microbiology professor Andrea Crisanti, said the country needs two million tests a week to really get on top of the virus.
In the Netherlands, where infection rates are among Europe’s highest, the government has been scrambling to expand weekly testing and lab capacity to 385,000 tests by next week, up from 280,000 currently. The target is nearly half a million tests a week by December and just under 600,000 by February.
But some people have been waiting days for a test. Authorities blame overwhelming demand from those without clear symptoms for clogging up the system.
In response, rapid antigen tests have been restricted to health workers and teachers, while others go on a waiting list.
The various hitches highlight a conundrum for governments: how to get people back to work while tracing the virus within the population quickly — without running out of supplies.
Siemens Healthineers, which on Wednesday announced the launch of a rapid antigen test kit in Europe that can deliver a result in 15 minutes, said the volumes of such diagnostic tests being circulated globally now are “at the limits” of what manufacturers can supply.
Rivals, including Abbott Laboratories and Becton Dickinson, also offer numerous COVID-19 diagnostic tests, and more and more companies are jumping in.
Swiss diagnostics maker Roche announced plans on Tuesday to launch a new antigen test by the end of the year. Its fully automated systems can provide a result in 18 minutes and a single lab machine can process 300 tests an hour.
By early 2021, the Basel-based company said it could make some 50 million of the new tests a month, on top of the rapid point-of-care tests it already sells.
Roche said the test could be deployed in places such as nursing homes or hospitals, where speedy results could thwart a potentially lethal outbreak.
“The primary use case is the testing of symptomatic patients,” a Roche spokesperson said. “The secondary use case is the testing of individuals suspected of infection … which could also include asymptomatic patients.”
Expert opinion, however, on just how to use antigen tests is evolving and remains the subject of debate.
PCR remains gold standard in diagnostic testing
Switzerland, where reported new infections spiked to 2,823 cases on Wednesday from as low as three per day in June, is only now validating the accuracy of the rapid tests.
“Deployment of the rapid tests — where it makes sense — will be integrated into our testing strategy,” a spokesperson for the Swiss health ministry said. “We’ll update our testing recommendations in November.”
Sandra Ciesek, director of the Institute of Medical Virology at the University Clinic in Frankfurt, Germany said rapid antigen tests could be an option for asymptomatic people planning to visit elderly patients at nursing homes.
But people should refrain from using them as a definitive substitute to judge their infection status.
“The PCR test remains the gold standard,” Ciesek said. “An antigen test should only be used as an alternative if PCR is not possible in a timely manner.”
But what about globally? Which countries will get the vaccines first?
Many wealthier nations are already making bets on vaccines still in relatively early stages of development, with no guarantee that they will ever perform well enough to gain approval or protect their populations.
That has many concerned about “vaccine nationalism,” where countries look out for their own interests at the expense of others.
Here’s a closer look at what wealthier countries are doing to ensure supplies for their own citizens, how that might affect other countries, how Canada might fare and what efforts are being made to distribute a vaccine more fairly.
What can countries do to obtain a vaccine first?
There are a few different ways wealthier countries can try to ensure their own supplies:
Provide funding for the development and manufacture of their own candidates to help speed it up.
Manufacture a vaccine within their own country and prevent it from being exported.
Make deals to reserve or preorder large numbers of doses.
And even some richer countries, including Canada, weren’t always first in line if they didn’t have their own manufacturing facilities. During the swine flu outbreak in 1976, for example, the U.S. decided to vaccinate its entire population before it would allow vaccine producers to export their products to Canada.
What are countries doing to ensure their own supply?
The U.S. has a program called Operation Warp Speed, which aims to produce a vaccine faster than anyone else. President Donald Trump has said he hoped it would be available before the end of the year.
The program has already announced that it’s providing more than $ 6 billion US to pay for development, manufacturing and preorders or reservations for hundreds of millions of doses of promising vaccine candidates from U.S.-based Johnson & Johnson, Moderna, Novavax, Pfizer and Merck, along with U.K.-based AstraZeneca.
Similarly, the European Commission has a plan to use an emergency fund worth €2.4 billion (almost $ 3.7 billion Cdn) to buy up to six vaccines in advance for 450 million people.
Germany, France, Italy and the Netherlands have also signed a deal with AstraZeneca for over 300 million doses of its vaccine, which they say all EU members can participate in.
The federal government has created a $ 600 million fund to support vaccine clinical trials and manufacturing in Canada.
It is also “closely monitoring vaccine development efforts — domestically and internationally — and will work quickly to negotiate advanced purchase agreements with vaccine manufacturer(s) to secure supply for all Canadians as soon as it is feasible,” Geoffroy Legault-Thivierge, a spokesperson for the Public Health Agency of Canada, told CBC News in an email.
However, as of July 30, it hadn’t yet announced any such agreements.
The government has also announced it is ordering enough equipment, such as syringes, alcohol swabs and bandages, to give at least two doses of a vaccine to every Canadian when one becomes available.
Still, experts warn that Canada currently doesn’t have much manufacturing capacity for vaccines, even those developed in this country — many of which would be manufactured elsewhere and some of which would likely be licensed to foreign companies for manufacturing.
Quebec City-based Medicago is the first Canadian vaccine candidate to begin clinical trials. But CEO Bruce Clark has said that his company’s main manufacturing plant is in the U.S., meaning there’s no guarantee that a supply would reach Canada in a timely manner.
Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University and the IWK Health Centre in Halifax, said Canada is a very small market.
“And we will not have a vaccine if the manufacturer doesn’t apply for approval,” said MacDonald, who has done research on ethical issues surrounding vaccines.
In the past, some manufacturers have not prioritized Canada, she said. For example, the manufacturer of the chicken pox vaccine didn’t apply for approval in Canada until it had already been available in the U.S. for five years.
Why should all countries have access to a vaccine?
Because it’s a global pandemic and our world is interconnected, outbreaks in any country have the potential to travel to other countries and cause outbreaks there, MacDonald said. “For you to be safe … your country needs to be safe and all other countries need to be safe.”
That’s even the case if the entire population is vaccinated, she said, as a given vaccine usually doesn’t work for everyone.
Due to manufacturing and distribution constraints, when a vaccine first becomes available, there isn’t expected to be enough of it to vaccinate the entire populations of even countries wealthy and lucky enough to have preordered it. That means most of their populations could remain at risk for a long time if the pandemic isn’t under control in other parts of the world.
Outbreaks also tend to be worse and harder to control in poorer countries, posing a higher risk to both their own populations and the world.
Dr. Joel Lexchin, a professor emeritus at York University in Toronto who has studied pharmaceutical policy, said many wealthier countries such as Canada are able to do a pretty good job of controlling the virus without a vaccine through such measures as physical distancing, frequent handwashing, mask wearing and temporarily shutting down certain businesses and services.
Meanwhile, lower-income countries where many people live in crowded conditions — some of them with limited access to things like clean water and soap — are struggling with both controlling the epidemic and treating those who have fallen ill.
“I think you need to look at where the outbreak is still the greatest threat to public health and also where the medical care resources are the lowest,” Lexchin said.
“You can make the case that however much we need a vaccine in Canada, there they need it much more than we do.”
What about global efforts to ensure a fair distribution?
There are some, but perhaps the biggest is the COVAX Facility, an initiative of the World Health Organization; Gavi, the Vaccine Alliance, which is a public-private partnership founded by the Bill & Melinda Gates Foundation that vaccinates children against deadly diseases; and the Coalition for Epidemic Preparedness Innovations, which aims to develop vaccines to stop future epidemics.
COVAX is pooling money from dozens of countries to invest in vaccine candidates around the world, with a goal of delivering two billion vaccine doses globally by 2021.
The program is designed to connect developing and developed nations, with all partners getting enough doses of a successful vaccine for 20 per cent of their populations, initially prioritizing health-care workers. So far, it’s signed on 75 higher-income countries — including Canada but not the U.S. — to partner with 90 lower-income countries that together represent more than 60 per cent of the world’s population. It’s also joining forces with vaccine manufacturers.
The program includes investment in production facilities and incentives to scale up through preorders.
Because most vaccine candidates are not expected to succeed and make it to market, COVAX is designed to get higher-income countries to participate by improving the chance that they’ll invest in a successful vaccine.
“This is an initial opportunity for a wealthy country to kind of hedge their bets and protect their own interests and also contribute to a global effort to secure vaccine for people living in countries where the resources are not there to do it on their own,” said Prof. Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics in Baltimore.
Gavi, the Vaccine Alliance, says it has raised $ 600 million US from higher-income countries and the private sector to provide an incentive for manufacturers to make enough vaccine to ensure access for developing countries.
Will efforts for a fair distribution of vaccines work?
York University’s Lexchin said it’s not clear if vaccines will be fairly distributed. He noted in an article in The Conversation that even for COVAX, rich countries will get the vaccine before poorer countries. And all countries will only be able to vaccinate their highest-priority groups, including health-care workers — just 20 per cent of the population through the program, limiting its influence.
Lexchin said in an interview that middle-income countries such as Brazil and Mexico sometimes fall through the cracks, as they’re not poor enough to take advantage of lower prices offered by manufacturers, who set the prices.
He said he thinks leaders, including Canada’s, need to step up as well, by requiring that vaccines and treatments be made available at affordable prices to low- and middle-income countries if government funding was received for their development.
Still, MacDonald of Dalhousie University is cautiously optimistic.
“We’re in better shape to be more equitable about a COVID-19 vaccine globally than we were for the influenza pandemic,” she said.
“Do I think we’re going to get it right? … I hope we’ll get it more right.”