Which Canadians get the COVID-19 vaccine first? Experts have to decide

When scientists predict that a COVID-19 vaccine could be approved as soon as the new year, they raise an alluring prospect: An early 2021 end to the pandemic and all its devastation.

But if Canadians are hoping for a quick, pharmaceutical end to the crisis, they’re in for a disappointment, experts say.

In the event science pulls off the miraculous feat of producing one or more safe and effective vaccines within a year of the emergence of the coronavirus, administering them widely will take several months more.

Unprecedented logistical challenges and massive worldwide demand means a long wait for many people — and difficult decisions about who gets the vaccines first.

“We’ve never had a situation where we’ve rolled out a single vaccine for 35 million (people) all at once, as it were. That’s just not possible,” said microbiologist Alan Bernstein, head of the CIFAR science-funding charity. “We don’t have enough doctors and capacity to do that all at the same time. And that’s even assuming we’ll have enough of the vaccine right from the start.”

Experience with the vaccine produced for the 2009 pandemic-flu strain suggests chaos.

There was less demand for the H1N1 influenza shot than is expected for immunization to a coronavirus that’s several times more lethal. But Canada still experienced delays in distributing the serum, controversy over professional athletes jumping the queue and long waits as Canadians flooded vaccination clinics.

Several experts contacted by the National Post urge federal and provincial governments to begin planning now, and do it transparently.

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That includes creating a science-based priority list, they said. Should the elderly and other vulnerable groups be at the head of the line? Or maybe the 20-somethings driving new spikes in the epidemic?

*“* Those conversations should hopefully start to be communicated with the public… so people aren’t taken aback,” said biochemist Matthew Miller, a virus expert at McMaster University. “Getting out in front of these things is going to be really useful, explaining who is going to get this first and why”

Health Canada did not immediately respond to questions about its rollout preparations. There is some evidence of advance planning, with the government recently ordering 75 million syringes to deliver the injections.

Vaccines have in the past taken three or four years at minimum to develop. But a remarkable worldwide effort using a variety of different technologies has produced well over 100 vaccine candidates for SARS-CoV-2, the COVID-19 virus, with more than 20 now in expedited human trials.

No candidate has yet passed the key test — Phase 3 studies that determine if they actually protect people against COVID-19 — but optimistic predictions abound.

The head of an Oxford University team developing a vaccine said this week it could be ready for the first recipients by December. The top European Union drug regulator said Tuesday that approval of a vaccine this year is possible.

It’s expected that several different vaccines will end up on the market. Even then, the scale of manufacturing needed to immunize the world is eye-watering. There are 7.8 billion humans, most of whom will likely want a shot.

Some vaccine developers, like the Oxford team and its corporate partner AstraZeneca, are gearing up to produce millions of doses even before regulators approve the vaccine.

Canada’s chief bet now is on a vaccine developed by the Chinese firm CanSino. If its product is proven safe and effective, a refurbished National Research Council facility in Montreal is expected to produce up to 100,000 doses a month — enough to cover all Canadians within 30 years.

Canada’s limited production capacity means it may have to rely on foreign manufacturers, said Volker Gerdts, CEO of the University of Saskatchewan’s VIDO-Intervac research facility. And that means competing with other countries for limited supply.

Gerdts’ centre in Saskatoon is developing its own promising COVID-19 vaccine, slated to enter clinical trials this fall, but is already looking outside Canada for a manufacturing partner, he said.

Another massive challenge will be the actual process of getting the vaccine into people’s arms. Authorities should be marshalling as many health professionals as it can for that task, including family doctors, pharmacists and even retired nurses, said Dr. Gerald Evans, chair of the Queen’s University infectious disease division.

“We need to be working on that so when the vaccine hits our shores, we’re ready,” said Evans.

He estimates that every Canadian who wants it could be immunized within two to three months if such preparations were made.

Others are not so optimistic.

The process will likely take at least seven to nine months, said Dr. Jeff Kwong, a University of Toronto public health professor. “Many months at the least,” said Miller.

-The priority list-

That raises the question of a priority list.

There seems to be a rough consensus among experts that first would be those most at risk from COVID-19, including people over 60, or with underlying conditions like cardiovascular disease, hypertension and diabetes.

Frontline health-care workers should also be near the front of the queue. Next would be those in “congregant” work situations that have experienced outbreaks, like meat plant employees and migrant farm workers, said Bernstein.

But there is also an argument for prioritizing 18-to-34-year olds, in an effort to curb community transmission, said Evans.

Children were a priority to receive the H1N1 vaccine in 2009. But they would be further down the list for a COVID-19 shot, given they tend to suffer relatively mild symptoms, and are not viewed as accelerators of the epidemic, he said.

There is also the moral consideration of getting the vaccine to poorer nations without the resources to strike expensive production contracts.

“If you were the prime minister right now, your job would be to make sure Canadians get access to vaccine. That goes for every president and every prime minister in the world,” he said.

“But I think we want to do it in a way … that is ethical and not just rich countries snapping up all the vaccine.”