The scientist who won the race to deliver the first widely used coronavirus vaccine says people can rest assured the shots are safe, and that the technology behind it will soon be used to fight another global scourge — cancer.
Ozlem Tureci, who founded the German company BioNTech with her husband, Ugur Sahin, was working on a way to harness the body’s immune system to tackle tumours when they learned last year of an unknown virus infecting people in China.
Over breakfast, the couple decided to apply the technology they’d been researching for two decades to the new threat.
Britain authorized BioNTech’s mRNA vaccine for use in December, followed a week later by Canada. Dozens of other countries, including the U.S., have followed suit and tens of millions of people worldwide have since received the shot developed together with U.S. pharmaceutical giant Pfizer.
“It pays off to make bold decisions and to trust that if you have an extraordinary team, you will be able to solve any problem and obstacle which comes your way in real time,” Tureci told The Associated Press in an interview.
Among the biggest challenges for the small, Mainz-based company were how to conduct large-scale clinical trials across different regions and how to scale up the manufacturing process to meet global demand.
Along with Pfizer, the company enlisted the help of Fosun Pharma in China “to get assets, capabilities and geographical footprint on board, which we did not have,” said Tureci.
Co-operation and collaboration
Among the lessons she and her colleagues learned was “how important co-operation and collaboration is internationally.”
Tureci, who was born in Germany to Turkish immigrants, said the company reached out to medical oversight bodies from the start, to ensure that the new type of vaccine would pass the rigorous scrutiny of regulators.
“The process of getting a medicine or a vaccine approved is one where many questions are asked, many experts are involved and there is external peer review of all the data and scientific discourse,” she said.
Amid a scare in Europe this week over the coronavirus shot made by British-Swedish rival AstraZeneca, Tureci dismissed the idea that any corners were cut by those racing to develop a vaccine.
“There is a very rigid process in place and the process does not stop after a vaccine has been approved,” she said. “It is, in fact, continuing now all around the world, where regulators have used reporting systems to screen and to assess any observations made with our or other vaccines.”
Tureci and her colleagues have all received the BioNTech shot themselves, she told the AP. “Yes, we have been vaccinated.”
Aim to develop new tool in fight against cancer
As BioNTech’s profile has grown during the pandemic, so has its value, adding much-needed funds the company will be able to use to pursue its original goal of developing a new tool against cancer.
The vaccine made by BioNTech-Pfizer and U.S. rival Moderna uses messenger RNA, or mRNA, to carry instructions into the human body for making proteins that prime it to attack a specific virus. The same principle can be applied to get the immune system to take on tumours.
“We have several different cancer vaccines based on mRNA,” said Tureci.
Asked when such a therapy might be available, Tureci said “that’s very difficult to predict in innovative development. But we expect that within only a couple of years, we will also have our vaccines [against] cancer at a place where we can offer them to people.”
For now, Tureci and Sahin are trying to ensure the vaccines governments have ordered are delivered and that the shots respond effectively to any new mutation in the virus.
On Friday, the couple were taking time out of their schedule to receive Germany’s highest award, the Order of Merit, from President Frank-Walter Steinmeier. German Chancellor Angela Merkel, a trained scientist herself, was to attend the ceremony.
“It’s indeed an honour,” Tureci said of the award. “Both my husband and I are touched.”
But she insisted developing the vaccine was the work of many.
“It’s about the effort of many, our team at BioNTech, all the partners who were involved, also governments, regulatory authorities, which worked together with a sense of urgency,” she said. “The way we see it, this is an acknowledgement of this effort and also a celebration of science.”
For years, Summer Heide didn’t eat spicy food because the slightest indigestion would trigger fears that she had stomach cancer.
She would lay awake at night, terrified that she would die and leave her children without a mother.
Heide, a 32-year old farmer from southeastern Saskatchewan, isn’t a hypochondriac. A rare and deadly stomach cancer runs in her family and, since learning she inherited a gene mutation that could cause cancer, she’s been forced to make agonizing decisions and take drastic steps to save her own life.
“It was just too much fear over the unknown,” Heide said. “There was always the little bit of ‘When is the ticking time bomb going to go off? When might I get the cancer?'”
Heide was only a toddler when her aunt, RoseMarie Lawrence, passed away from stomach cancer in 1991. She was just 29 years old.
That kind of stomach cancer, known as diffuse gastric cancer, is particularly sneaky. Cancer cells grow in loose clusters — not a tumour — that can easily move and multiply in the stomach lining. Initial symptoms, such as heartburn, seem innocuous. By the time the cancer is detected, it’s usually too late.
Heide’s uncle Luke Lawrence, RoseMarie’s husband, remembers asking the doctor whether their two children were at risk of getting the cancer.
“I was very concerned for my children because I knew nothing about cancer,” he said. “[The doctor] says ‘Cancer is not contagious.’ At that time, they didn’t know anything about hereditary forms of cancer.”
Sixteen years later his daughter Erin, Heide’s cousin, was diagnosed with the same cancer that had killed her mother.
She was 20 years old and passed away within seven months.
Before she passed away, doctors suggested Erin get genetic testing. She took a blood test, one that didn’t exist before her mother died, and discovered she had a rare mutation in the CDH1 gene that causes Hereditary Diffuse Gastric Cancer Syndrome. It’s a disorder that can pass down through families and puts people at a high risk for developing stomach cancer at a young age.
A child has a 50 per cent chance of inheriting the gene mutation from a parent who is a carrier.
“We didn’t know none of this until it was far too late because Erin had already been diagnosed with Stage 4 of this form of cancer,” said Luke Lawrence, “So [the testing] was to create an awareness for the family, more so than what we could do for Erin. That’s why we did it.”
The family calls it “Erin’s Gift.”
In 2007, Heide and seven other family members went for predictive genetic testing to see if they also carried the gene mutation. Five tested positive, including her grandmother, her father, and herself.
Heide was 19 when she got the results.
“It was devastating, obviously, but I think I was so young and naive that I didn’t actually think about what that meant,” Heide said.
What it meant was Heide’s chances of developing the deadly stomach cancer by age 80 were as high as 83 per cent. Women who have the mutation also have an estimated 60 per cent risk of developing lobular breast cancer in their lifetime.
Genetic testing revealed that Summer Heide has a gene mutation that increases her chances of developing a deadly stomach cancer. That discovery has forced Heide to make agonizing decisions that affect her life and the lives of her children. 5:21
Demand for genetic testing increases
Demand for cancer-related genetic testing has increased exponentially over the past two decades, according to the Canadian Association of Genetic Counsellors. Referrals to some genetic testing clinics in the country have doubled or even tripled in recent years.
“Patients are more aware of it, physicians are more aware of it, and the testing has become better. The technology has improved,” said Ingrid Ambus, a genetic counsellor at North York General Hospital in Toronto, adding that testing can now diagnose hereditary cancer syndromes beyond the more common ovarian and breast cancers.
Less than 10 per cent of cancers have hereditary causes, but researchers have identified more than 80 genes in which mutations can be passed down through families and potentially cause cancer.
Ambus said patients often find it “empowering” to know that a cancer runs in their family so they can seek counselling, screen for the cancer, make lifestyle changes or have preventative surgery.
A genetic counsellor advised Heide that the only way for her to prevent aggressive gastric cancer would be to remove her entire stomach, a procedure called a prophylactic total gastrectomy.
She met with a surgeon in 2007, but was told there wasn’t enough clinical information available at that time to guarantee that she could have children after a total gastrectomy.
She decided to wait.
Soon, she would have to make another difficult choice.
Passing on the gene
When Heide and her husband were ready to have children, they had the option to do in-vitro fertilization (IVF) with pre-implantation genetic diagnosis on her embryos. That would have allowed them to only implant embryos that didn’t have the mutation.
“I didn’t want to do that,” said Heide. “I do feel like some feel like it’s a little bit selfish, because I could spare my kids from having the gene. But I wouldn’t get the kids that I have if I were to choose that, and I would never choose anybody different.”
After Heide and her husband had their first two children, Mikka and Harlow, her anxiety began to grow. She was tortured by the fact that her cousin Erin had passed away just seven months after diagnosis. Heide wondered whether cancer was already forming inside her.
“No one would love [my daughters] like me. So every, like, Christmas or birthday, or any type of holiday, I would always go above — take lots of pictures, make it perfect — in case it was their last one with me,” she said.
Heide still resisted the idea of getting an invasive surgery to remove her stomach. She was worried about long-lasting side affects, including diarrhea, vomiting and fatigue.
She’d also had one of her veins cut during a routine endoscopy — a diagnostic test to look for cancer — and began to vomit blood and lose consciousness.
“I was mentally making peace with myself and God that maybe my time had come. That shakes a person deeply,” she said.
From that point on, she had a deep fear of medical procedures. She would schedule a gastrectomy, then cancel.
Then, in 2014, her younger sister, Ali Kowaluk, decided to get genetic testing.
Kowaluk admits she had procrastinated. Then she got married and began to contemplate having children. She knew it was time to visit a genetic counsellor at the Royal University Hospital in Saskatoon.
She tested positive for the gene mutation and knew immediately that she would have the surgery.
Kowaluk had her entire stomach removed at the age of 23. Afterward, the surgeon told her that tests on tissues removed from her revealed Stage 1 cancer.
“So that was hard to hear, still hard to talk about. I don’t talk about that part very much,” Kowaluk said, choking up.
Undetected, the aggressive cancer would have certainly gone on to kill her. The surgery saved her life.
“I could not be here today,” Kowaluk said.
Now a mother of one-year-old Winston, Kowaluk is shaken by how close she came to passing away like her cousin Erin.
Kowaluk’s near-death experience was a wake-up call for big sister, Heide.
One night, after both of her daughters fell asleep during their bedtime story, one curled up under each arm, she lay there praying to God and silently sobbing. The next morning, she woke up with mental clarity. It was time to have the surgery.
“Knowing you carry a gene with such devastating potential is a heavy weight to carry. It was heavier than I could mentally handle any longer,” she said.
Heide got her stomach removed at Calgary Foothills Hospital in 2015.
The recovery took nearly a year and was excruciating, she said. She could barely get off the couch some days.
Two years after the surgery, despite not knowing if it was possible, she got pregnant and had a third child, a boy named Huxley. It seemed to reset her body, she said.
The next generation
Today, Heide stands in her kitchen, sunshine pouring through the window, snacking on tiny bites of chicken and cottage cheese.
The 5-foot-5, 105-pound woman eats every couple hours and only small amounts, because she doesn’t have a stomach to digest and store food. She has to chew everything until it’s mush, and eating and drinking fluid at the same time pushes food into her small intestine too quickly and makes her sick.
She has reached a level of peace and confidence with her health that she hasn’t had in years.
“Of course, I wish we didn’t have this gene, but it’s also a gift that we know about it, because I might not be sitting here today if I didn’t know about it,” she said.
Unfortunately, her worries aren’t over.
“The worry about myself has now been put onto my kids, because I just worry and hope that none of them have the gene,” Heide said,
Each of her three children, and Kowaluk’s son, has a 50 per cent chance of inheriting the gene mutation. They can get tested when they’re 18.
The two women hope that, by then, medical advancements will provide better options for testing, treating and preventing the disease.
“I have high hopes for him,” Kowaluk said of her son Winston.
Heide shares the same optimism.
“It’s hard, but it is what it is. We’re lucky that we get a chance at life.”
Toni Pressley was looking forward to a comeback season with the Orlando Pride after overcoming breast cancer.
But then life threw the veteran defender another curve with the coronavirus pandemic and the impact it had on the Pride, who had to withdraw from this summer’s Challenge Cup tournament because of positive tests.
“You go through things through soccer, and it can kind of be an up and down roller coaster, like you’re starting, you’re not starting, you perform well, you might have a bad game here and there, you have injuries and whatnot,” Pressley said. “But I think, in general, we’re all a lot stronger than we think we are and we can overcome almost anything. I’ve certainly learned that with going through having breast cancer, that I don’t think we’re given anything we can’t handle.”
Pressley has been a mainstay around the National Women’s Soccer League, and with the Pride since 2016. Last year, just as she was settling back into the starting lineup after a season-opening injury, she noticed she was tired and achy a lot. There was also a small lump in her right breast.
WATCH | CBC Sports’ Signa Butler speaks with NWSL’s new commissioner Lisa Baird
CBC Sports’ Signa Butler speaks with the NWSL’s new commissioner Lisa Baird about the league’s core values and its return to play. 4:45
At first, it didn’t make sense. Breast cancer didn’t run in her family. She was only 29. She was an athlete. A vegan. But her fear mounted quickly.
“I kind of knew it would be a possibility just because of all the doctor’s appointments that I had been going to leading up to that moment. By that time, I had a mammogram, I had a biopsy, I had an MRI. So I kind of put it in my mind, `OK, going through all these different appointments and this process, this could be a real possibility that you could have breast cancer.”‘
The day after she was told, she played in a game.
Pressley ultimately chose to have a double mastectomy. She triumphantly returned for the Pride’s final game in October last season, entering as a sub in the final moments.
Finally healthy, she was looking forward to this season. Then it all came to an abrupt stop in March, just as teams had opened training camps, because of the coronavirus.
The NWSL put together a plan to bring all the teams to a bubble in Utah for the Challenge Cup, becoming the first professional team sports league in the U.S. to play amid the pandemic. But a week before the tournament began, the Pride was hit by a number of positive COVID-19 tests and they were forced to withdraw.
Watching from afar
Pressley said it was difficult to watch from afar as the rest of the league celebrated a successful tournament.
“It was really tough, just with how last season went and the challenges and hurdles that I went through personally. And then to go off into the off-season and work really hard and then to come back, and to have that happen to us as a collective, to not be able to go to the Challenge Cup,” she said. “It was really disappointing because we all worked really hard to display all of our hard work, through our performance, in this tournament, And to have that taken away, it was really disappointing.”
Once the Challenge Cup concluded, teams went back to their local markets for a fall series of matches against regional foes. The Pride wraps up its four-game series Saturday against the North Carolina Courage, a game which will be nationally televised on CBS.
The Pride (0-2-1) are coming off a 2-1 loss to the Houston Dash last weekend. Pressley came in at the half, providing veteran help on defence for goalkeeper Brittany Wilson, who was making her NWSL debut.
“Toni is composed,” Pride coach Marc Skinner said. “That comes from understanding who she is as a person and understanding her game.”
With the fall series nearing an end, Pressley is already looking toward next season.
“Last season, I felt really confident and obviously, having cancer was a major setback, but I don’t really feel like I’m still hindered by that. I feel like I did before. I feel normal. I feel, you know, healthy. I feel fit,” she said. “So I’m just really looking forward to showing that in these final games and then hopefully next season as well.”
Justice Ruth Bader Ginsburg said Friday she is receiving chemotherapy for a recurrence of cancer, but has no plans to retire from the U.S. Supreme Court.
The 87-year-old Ginsburg, who spent time in the hospital this week for a possible infection, said her treatment so far has succeeded in reducing lesions on her liver and that she will continue chemotherapy sessions every two weeks.
“I have often said I would remain a member of the Court as long as I can do the job full steam. I remain fully able to do that,” Ginsburg said in a statement issued by the court.
She said her recent hospitalizations, including one in May, were unrelated to the cancer.
A medical scan in February revealed growths on her liver, she said, and she began chemotherapy in May.
“My most recent scan on July 7 indicated significant reduction of the liver lesions and no new disease,” she said. “I am tolerating chemotherapy well and am encouraged by the success of my current treatment.”
Court hears arguments again in October
Ginsburg went to a hospital in Washington on Monday evening after experiencing fever and chills. She then underwent a procedure at Johns Hopkins Hospital in Baltimore on Tuesday afternoon to clean out a bile duct stent that was placed last August, when she was treated for a cancerous tumour on her pancreas.
Ginsburg, who was appointed by former U.S. president Bill Clinton and joined the court in 1993, has been treated four times for cancer.
In addition to the tumour on her pancreas last year, she was previously treated for colorectal cancer in 1999 and pancreatic cancer in 2009. She had lung surgery to remove cancerous growths in December 2018.
She has also endured other health setbacks in recent years, including breaking her ribs in a fall in late 2018.
The court has finished hearing arguments for the 2019-20 term. Several cases that were to be presented before the court the past term were postponed until October, in the next term, due to the coronavirus pandemic.
Cancer is one of the most common causes of death, but the huge variation in types of cancer can make early detection a challenge. A team of researchers from the US has developed a blood test that might be able to help identify early-stage tumors using the power of AI. The test can detect over 50 different cancers and narrow down tumor location to specific areas of the body.
At its most basic, cancer is uncontrolled cell growth. There are many different types of cells in the human body, and almost all of them can become cancerous. Unfortunately, many cancers don’t present with noticeable symptoms until the disease has progressed to the later stages. Once cancer begins spreading to other body systems, it becomes much harder to treat.
A routine test that could flag potential cancers early on could save untold lives and reduce medical costs. The team, consisting of researchers from the Mayo Clinic, Cleveland Clinic, and other institutions, focused on analyzing signals from so-called “cell-free DNA” (cfDNA). That’s genetic material shed by cells that circulates freely in the blood. All cells leak a little DNA, and that includes the cells in tumors.
While cancer does involve genetic alterations, those changes are minor and often limited to specific sections of DNA. A better way to spot the evidence of cancer in cfDNA is by assessing methylation patterns. In methylation, a methyl group (CH3) replaces a hydrogen atom on cytosine or adenine — those are two of the four base pair molecules that make up your genetic code. Methylation can affect the way your genes are expressed without actually changing the underlying sequence. Importantly, methylation can be a cause or result of cancer.
The team started with blood samples from 3,000 patients, half of which had one of the 50+ cancers included in the study. This was “labeled” data, allowing the AI to learn the methylation patterns in cfDNA for various cancers and for no cancer. To test the algorithm, researchers put to work categorizing 1,200 new samples, and the results are encouraging.
The AI is able to detect 93 percent of stage IV cancers, 81 percent of stage III, 43 percent of stage II, and 18 percent of stage I tumors. The rate of false positives was just 0.7 percent. When it spotted cancer, the AI was able to identify the location of the tumor with 93 percent accuracy.
The team is hopeful this technique could scale to larger populations. Detection of early cancers is still low, but those tumors are rarely found via other means. Identifying 18 percent of cancers early could still be very helpful, and additional training could make the AI better at detecting cancer in the early stages.
As Canadian doctors brace for the full surge of the COVID-19 tsunami, its ripples are already causing delays in cancer care.
The pandemic has created surreal experiences for everyone, including the 617 people in this country who are diagnosed with cancer each day on average, according to the Canadian Cancer Society.
“My biggest fear would be the collateral damage caused by the pandemic and the collateral damage is something like cancer care,” said Dr. Jory Simpson, a surgeon at St. Michael’s Hospital in Toronto who treats breast cancer.
Cara Heitmann, 53, of Toronto had her breast reconstruction cancelled and her mastectomy that was scheduled for next week is being postponed.
“I’m angry and I’m scared,” said Heitmann, who lives alone and runs her own business. “I don’t know if or when I will have surgery. I don’t know if the cancer will spread. I don’t know if it will metastasize. I don’t know if I will survive this.”
Heitmann said she has access to her surgeon’s case notes that list her as a priority case. “I haven’t been told what is now my prognosis.”
Cancer care prioritized for patient safety
Simpson said that so far, if a patient has a deadly tumour needing emergency surgery, it will be removed. But as hospitals struggle to make space for COVID-19 patients, there’s a new set of priorities including:
Patients with solid tumours, including breast and colon cancer, may wait up to four weeks.
Early-stage cancers such as prostate or thyroid may wait up to two months.
Ontario’s health minister, Christine Elliott, said the decisions are made based on the evidence for each case.
“I know that is not a comfort to people with cancer that are having their surgeries postponed,” Elliott told reporters on Thursday. “Those decisions are being made based in consultation with cancer-care experts.”
Dr. Mary Gospodarowicz, a radiation oncologist and medical director of the Princess Margaret Cancer Centre in Toronto, said the hospital is focusing on preserving capacity to treat people with COVID-19 and keeping the hospital environment safe for patients and staff.
“Physicians would like to treat patients as quickly as possible and very promptly, but in these times of community transmission of COVID, decreasing the number of patients that come to the hospital and also interact with us is also safer for patients,” Gospodarowicz said.
That’s because people with cancer are more susceptible to COVID-19 infection and, in those with reduced immune systems because of chemotherapy or radiation, the course of the infection may be more severe, she said.
Chemotherapy treatment and follow-up is being delayed unless critical, and where possible, follow-up appointments are conducted online or by phone, she said.
“We’re trying to call as many patients who had appointments as possible and then decide based on the phone call whether the patient needs to be seen in person or not,” Gospodarowicz said.
Since clinic visits for follow-up and assessment are deferred, the number of patients coming to Princess Margaret has dropped from about 2,000 a day to 1,000 a day, with as many appointments as possible done by phone or virtually.
“The trickle-down effect of this is it causes a lot of anxiety,” Simpson said. “Physicians and surgeons can provide reassurance right now that in some cases of cancer, waiting four weeks extra for surgery probably won’t impact your ultimate prognosis.”
Cancer specialists said, while the situation is fluid and unpredictable, they’re doing their best to expedite cancer surgeries, while routine screening of healthy people has stopped.
WATCH | Mary Swark-Hougaard talks about her frustration at having to delay her breast cancer surgery because of COVID-19:
Mary Swark-Hougaard was recently diagnosed with breast cancer and needed urgent surgery. She thought ‘it would have been done by now,’ but the COVID-19 pandemic has closed most operating rooms. 5:58
A Hamilton Health Sciences radiation oncologist is the city’s first confirmed positive case of COVID-19, a hospital spokesperson has confirmed.
On Wednesday, CBC learned that a staff member in her 30s tested positive for COVID-19 after returning from a personal trip to Hawaii. Since the doctor’s return to the hospital’s Juravinski Cancer Centre, she was in contact with both cancer patients and staff members.
The doctor was at work on the afternoon of March 9 and was tested that same day. She received confirmation of a positive test on March 10 and has been in self-isolation since.
The 32-year-old, who lives in Burlington, Ont., returned from her trip Saturday.
“This incidence was detected very quickly and all proper processes were followed,” said Dr. Wes Stephen, executive vice-president and chief operating officer at Hamilton Health Sciences.
“When she began to show symptoms, infection-control protocol was swiftly initiated and she was tested in a safe environment.
“Out of an abundance of caution, last week, Hamilton Health Sciences expanded its criteria for testing beyond the standard case definition to include any travel outside Canada. As a result, this case was identified as quickly as possible. She is now in self-isolation protocol.”
Those who may have had contact with the physician are being contacted. That includes her patients, other patients and staff who might have been exposed.
“I hope it’s not my doctor,” Theresa Campbell, a 64-year-old cervical cancer patient, says. “It’s here. We knew it was coming … I’ll be putting a mask on.”
Jim Douglas, 70, left the hospital today after an appointment for his throat cancer. “It’s scary that it’s here,” he tells CBC News. “That kind of stuff scares me because I’m in a position right now where my immune system in the next little while could be compromised because of the treatments I’m having. I’ve got to be very careful.”
But as the word spreads, patients and volunteers are hearing the news from one another. Some are wondering where the staff member was within the hospital.
Dr. Simon Oczkowski, president of the Hamilton Academy of Medicine and a critical care physician at Hamilton Health Sciences (HHS), said healthcare professionals knew a first case would probably appear in Hamilton, but news it was a doctor was “particularly troubling.”
“For us as a profession this is probably our worst case scenario — the first confirmed case is a doctor who was at a hospital.”
He added doctors have been cancelling their travel plans and taking precautions to make sure they don’t get sick.
“We all know we’re going to be exposed to this if there’s a major outbreak. We all know there’s going to be a substantial risk of us getting affected and we all want to work as hard as we can to prevent ourselves from getting infected, bringing it to our families, spreading it among our patients.”
Precautions taken at the hospital
In the meantime, HHS is working alongside the city’s public health department and says it has done the following:
Directed those who were in direct contact with the physician to go into self-isolation at home, for a period of 14 days.
Told others, including patients, who may have had indirect exposure because they were in clinic at the same time to self-monitor for any symptoms (fever above 38 degrees, coughing, nausea, etc.) and report the onset of any illness to public health officials.
Cleaned the physician’s office space, the clinic area and other spaces at the Juravinski Cancer Centre to remove the risk of the virus remaining on surfaces.
The hospital says there is no need for anyone else at the centre or other HHS sites to take any action.
“There is no escalated risk today at our clinic, it is functioning as usual,” said Aaron Levo, the vice-president of public affairs at HHS.
There have been 93 cases of COVID-19 identified in Canada so far, with 41 of those in Ontario, including this latest case.
As the global number of coronavirus cases nears 120,000 people in 115 countries, chances of stopping its spread are now considered unlikely. So public health officials have turned their attention to slowing it down.
During a news conference in Ottawa on Wednesday, Prime Minister Justin Trudeau announced a $ 1-billion fund to help Canadians cope with the spread of COVID-19.
Ontario’s chief medical officer of health, Dr. David Williams, will hold a media briefing at 2 p.m. ET at Queen’s Park to give an update on the virus.
The health-care system is wasting millions of dollars by buying cancer medications that are thrown out because of the way they are packaged by drug makers — in one-size-fits-all vials that hold too much for most patients, a study found.
“It’s outrageous,” said drug policy researcher Alan Cassels, who is familiar with the study.
“We have so many demands on our health-care dollars for drugs and doctors and hospitals and so on. So, to see this kind of waste is appalling.”
The waste costs as much as $ 102 million over a three-year period, according to the study published two years ago in the medical journal Cancer.
“What people don’t realize is that wastage is actually a real cost that’s borne by the provinces or hospitals [and] ultimately the taxpayers,” said Dr. Matthew Cheung, a senior co-author of the study and a hematologist at Sunnybrook Health Sciences Centre in Toronto.
The drugs are administered in very specific doses based on a patient’s weight and/or height, then, because of concerns about possible infection from reusing the same vial, nurses discard the rest.
Some hospitals have been trying to reduce waste by sharing vials, but can only do that with patients who need the same drug on the same day, since many of these medications have a short shelf life once opened.
The study looked at 12 high-priced injectable cancer drugs and found that the amount being wasted per vial ranged from zero to 87.5 per cent.
“We realized that drug wastage is actually a huge component of what we’re paying. And again, when we’re wasting drugs, we’re increasing costs without getting any extra benefit,” said Cheung.
In the U.K., the government told drug companies in 2016 they must produce some cancer medications in packaging that reduces waste if they wanted to be considered in the bidding process for which drugs it will purchase.
Since making the change, the U.K.’s National Health Service tells Go Public it’s saving an estimated 18 million pounds ($ 31 million Cdn) per year.
Drugmakers will ‘scream and complain’
Cassels — who is part of the Therapeutics Initiative, an independent drug analysis group based in the University of British Columbia’s Faculty of Medicine — says the same hard-nosed negotiations done in the U.K. need to happen here.
He says the group that negotiates prescription drug prices here — the Pan-Canadian Pharmaceutical Alliance (PCPA), of which all the provinces are members — needs to pressure drugmakers to produce smaller vials and give refunds for what’s not used.
Cassels says he expects the drug companies will “lobby and scream and complain,” over anything that adds to the cost of production.
“But at the same time, the public agencies have a monopoly in terms of paying for these drugs and they should be able to go to the mat in terms of negotiating the best prices and negotiating refunds if necessary,” he said.
He also says the negotiating process also needs to be less secretive. Right now, Canadians are kept in the dark about what the country is paying for these drugs and what specifically is part of the negotiating process.
“The biggest problem with drug prices is sometimes we don’t even know what the drug prices are … so we don’t really know what we’re paying for. When you think about other things that we use public money for, like building bridges or roads, those costs are known down to the penny. Whereas in the drug world, oftentimes, the drug costs are completely hidden.”
Asked if vial sizes and refunds for unused portions are part of the price negotiations, PCPA tells Go Public those talks are “confidential at the request of the manufacturer.”
The confidentiality includes pricing information, budget impact estimates, “and other sensitive information is held in confidence and is not disclosed, except in accordance with applicable law or with the consent of the parties,” the alliance said.
The provincial agencies that comprise PCPA are, mostly, equally secretive — except for B.C., where the Provincial Health Services Authority tells Go Public it typically does ask drugmakers to offer smaller vials.
But, it points out, the vial sizes are set when the drugs are submitted to Health Canada for marketing approval — and making a change is a long process. Health Canada didn’t respond to questions about that.
‘Typical dose,’ says drugmaker
When Deb Hebert, who is battling non-Hodgkin’s lymphoma, went to get her stem cell-stimulating drug plerixafor injected by the oncology nurse last month, she realized her dose only required about three-quarters of what was in the vial.
“I asked her what was going to happen with the rest of the medication. She told me that it would be discarded,” said Hebert, who has been on sick leave since August from her job as a finance administrator at CBC in Calgary while she battles the disease for the third time.
The same thing happened with Hebert’s second dose the next day. Each injection used about 75 per cent of a vial. At $ 7,893 per vial, that works out to a waste of about $ 3,900 between the two doses.
Sanofi, the company that makes Hebert’s medication, says it sells the drug in that vial size because it’s a “typical dose for the majority of the patient population,” and, it says, to account for any spillage while the drug is being administered.
The company adds, the drug is “preservative-free and therefore does not support multi-dose usage.”
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