By Michelle Pratt
The COVID-19 pandemic has proven to be one of the biggest public health emergencies to face modern society. While other pandemics have impacted large populations, the process to develop a vaccine typically takes eight to fifteen years; with COVID-19, there was an unprecedented accelerated development of multiple vaccines (Felter, 2021). In this way, the COVID-19 pandemic was also one of the biggest public health achievements in modern society, with numerous COVID-19 vaccines approved within one year of the virus first being detected.
This article examines some of the early challenges and successes of the vaccine roll-out across Canada and the United States. The author interviewed a panel of experts* in March, 2021 to get their opinions on the vaccine roll-out plans and approaches, which have been integrated into the discussion throughout the article.
The panel of experts included in the following:
● Dr. Dylan Taylor, Facility Medical Director, University of Alberta Hospital Preparedness and Response, Public Health Agency of Canada
● Ryan Imgrund, biostatistician
● Michael Colanti, Zuckerman Fellow – Harvard Centre for Public Leadership
● Richard Serino, Distinguished Senior Fellow, Harvard T.H. Chan School of Public Health
*Please note the opinions of the interviewees are their own and do not represent the opinions of the organizations to which they are affiliated*
Vaccine procurement in Canada
Canada had early challenges with vaccine procurement. In contrast to Operation Warp Speed in the United States which initially provided over $10 billion USD to companies to get vaccines to trial (Rabson, 2021), Canada was forced to rely on foreign vaccine manufacturers due to a lack of domestic vaccine manufacturing capability (Lexchin, 2021).
Unfortunately, this led to numerous delays and supply shortages. Despite ordering from multiple suppliers, shipments of vaccines were not always on schedule. In late January, Pfizer announced delivery delays and reduced the number of vaccines it sent to Canada in February and March, right as governments were planning large-scale vaccine rollouts.
While Canada had allocated $600 million for COVID-19 vaccine development in April 2020 (Rabson, 2021), years of underinvestment in domestic vaccine development and manufacturing limited Canada’s ability to scale up quickly to meet the challenge of COVID-19. Universities and companies working on vaccine development reported issues such as lack of funding to manufacture vaccines for clinical trials, lack of government support to run trials, and lack of manufacturing capacity (Chung, 2020). All interviewees agreed that the issues with vaccine development in Canada began long before COVID-19 and undermined its ability to manufacture vaccines domestically.
Vaccine allocation and distribution
All countries faced the same problem with early distribution: who should be vaccinated first when demand for vaccines far outstrips supply? In Canada, the National Advisory Committee on Immunization (NACI) established guidelines for distribution, which were then adjusted by provinces and territories “depending on local trends and transmission rate” (Public Health Agency of Canada, 2021a). Biomodels suggested different approaches to prioritization based on the underlying priorities. For example, if the priority was to reduce lives lost, vaccine distribution should go in descending order from the oldest to youngest populations as well as those with pre-existing medical conditions. If the aim was to reduce community transmission, targeting people aged 20 to 49 first would have the greatest impact as these populations were more likely to spread the virus, be frontline workers, and have school-aged children (Bubar et al., 2021). Using the available data, NACI ultimately recommended vaccine distribution based on the risk of exposure to COVID-19, risk of severe illness from COVID-19, and the safety of the authorized vaccines in the target populations (Public Health Agency of Canada, 2021).
Vaccine roll-out varied across the country as each province made decisions about who could administer the vaccine (e.g. professional qualifications required), where they would be distributed (pharmacies, public health units, etc.), and the order of priority. There was no standardized method of booking vaccine appointments, which often left citizens confused. However, in many cases the decentralized approach allowed provinces to be more nimble and react to conditions on the ground: Ontario revised its plan to focus on virus hot-spots during its second phase to slow the rate of transmission (Martin, 2021).
One of the most significant recommendations from NACI was to delay second vaccine doses beyond manufacturing guidelines to provide some protection to more people while supply remained limited, which enabled provinces to provide at least some protection to a greater proportion of the population more quickly.
Vaccine distribution in the United States
In the United States, states were responsible for vaccine distribution. Roll-outs varied across the country, with examples of major successes – such as West Virginia’s contracts with community pharmacies – and failures, such as Philadelphia’s Philly Fighting COVID scandal that alleged corruption and incompetence in the startup organization tapped to handle the city’s vaccine distribution program.
After President Biden took office, mass vaccination sites organized by FEMA were used to distribute vaccines faster with fewer resources required. However, where mega-sites such as stadiums received more doses than they could distribute, it came at the expense of local communities. In one instance in Wittman, Massachusetts, the more than 500 elderly residents were offered bus rides to the nearest mass vaccination centre when it was announced the town would no longer receive supplies. Only 25 residents took the offer (Chery, 2021), because people prefer to stay in their own communities.
Based on national data, the Biden administration shifted tactics in May, 2021 to focus on an increased use of pharmacies and community vaccination sites, while announcing a federal website to assist individuals with finding community vaccine sites (LaFrenier & Weiland, 2021).
Lessons for the future
Distribution of the COVID-19 vaccine in Canada and the United States faced many challenges. Governments adapted and updated recommendations, sometimes causing confusion for the population, while trying to remain responsive to new information and emergent conditions. It will take years of scientific studies to determine if some prioritization strategies were more effective than others; however, as of July 2021, 79.6% of Canada’s population and 66.5% of the US population over age 12 have at least one vaccine dose (Government of Canada, 2021; Center for Disease Control and Prevention, 2021).
While the long-term health and social consequences of COVID-19 will play out in the years to come, the COVID-19 pandemic has shown the importance of pre-pandemic investments in public health and health equity.
Michelle Pratt is an emergency management and business continuity advisor and is completing an internship with Richard Serino, a distinguished Senior Fellow at the Harvard T. H. Chan School of Public Health. She is currently the secretary for the IAEM Canada Alberta Region.
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