Who will be first in line for a COVID-19 vaccine?

Vaccine distribution programs exist to deliver seasonal flu shots in Canada, but there is nothing on the scale that will be needed for COVID-19


Canada’s former top soldier has been tasked with seeing to the “ethical, timely and effective” distribution of COVID-19 vaccine in Ontario.

Rick Hillier, a former chief of defence staff and ex-commander of NATO forces in Afghanistan, was announced as head of Ontario’s newly formed COVID-19 vaccine distribution task force by Premier Doug Ford on Monday.

The premier, stinging from criticism over his government’s move to impose another lockdown in Toronto and Peel that increasingly looks like it could have been avoided, trumpeted Hillier’s appointment “as a sign that we are making progress in the fight against COVID-19.”

Well, let’s not get ahead of ourselves.

The other members of Ontario’s task force have yet to be appointed. More importantly, we still don’t know when a vaccine will be available in Canada – the earliest estimates say by the end of March. We also still don’t know how many doses Ontario is in line to receive. Those details are still being worked out between the province and the federal government.

But one thing’s for sure – it’s going to take military-like precision to ensure delivery of vaccines when they do arrive. There is no field operations guide where that’s concerned. An entirely new manual will be needed.

While vaccine distribution programs already exist to deliver seasonal flu shots in Canada, there is nothing on the scale that will be needed for COVID-19.  

The U.S. embarked on the development of a massive distribution system to deliver vaccines during the H1N1 pandemic in 2009. Back then, manufacturing shortages led to delays in distribution. By the time a vaccine got to those who needed it most almost two years later, the virus was mostly gone.

A similar scenario played out in Canada. Stockpiles of anti-viral medications were distributed. But a 2017 review by Canada’s Pandemic Influenza Preparedness task force points to the “many challenges” faced by the pandemic immunization program. Those include “uncertain timelines for vaccine delivery, prioritization, logistics of local campaigns and communication of changing recommendations.”

Those challenges look to be more pronounced with COVID-19 given the physical distancing and masking requirements, for one. People won’t just be able to just show up at their doctor’s office or line up for their shot.

There’s also the added logistical challenge with the transportation of a vaccine. The most promising vaccines so far need to be stored in a deep-freeze. The federal government is reportedly in the process of acquiring special equipment to handle that.

The fact that more than one dose may be needed to control the virus will mean additional resourcing and infrastructure to allow for follow-up. “This is particularly important if people experience adverse effects from the first dose,” says Thomas Tenkate, associate professor of Ryerson University’s School of Occupational and Public Health.

There are also ethical considerations when it comes to equitable distribution of a vaccine.

As the 2017 task force review points out, those most affected by pandemics – namely, vulnerable populations like homeless people and those in low-paying frontline jobs – have historically been left out of the distribution chain.

The debate on who should get the vaccine first is also complicated by science. Some epidemiologists suggest younger people should be targeted since they are the ones now spreading the virus most. Others argue that older people who are more likely to die from infection should get the vaccine first.

At the same time, efficacy issues linger with the vaccine candidates announced so far. Three vaccines have been reported to be effective in controlling the virus. Two of those, by Pfizer and Moderna, have already applied to the U.S. Food and Drug Administration for “emergency authorization” to start manufacturing the vaccine.

But how well the vaccines work in older people, those with underlying health conditions and in preventing severe disease is still not clear. How long a vaccine will protect from a virus is also not known.

As The Lancet points out in its editorial on news of a vaccine last week: “Whether the vaccines prevent transmission of SARS-CoV-2 or mainly just protect against illness is largely unknown too.” If it’s the latter, then achieving herd immunity through immunization “becomes a difficult prospect.” 

Sixty to 70 per cent of the population will have to be immunized to reach herd immunity, the point at which the virus no longer spreads in the general population. Immunizing enough people to reach that point will take months.

Pfizer and Moderna say they may have up to one billion doses available by 2021, but how many will be directed to low-and middle-income countries is unclear. The companies are not part of international efforts led by the UN to distribute the vaccine in developing countries.

And while some pharmaceutical companies have agreed not to profit from a vaccine, Pfizer and Moderna have yet to make any such commitment, which has raised the spectre of a repeat of the hoarding and price gouging that took place over personal protective equipment early in the pandemic.

Canada has agreements to purchase millions of doses of a vaccine from both Pfizer and Moderna.

@enzodimatteo

Comments (1)

  • Eric November 28, 2020 04:26 AM

    Hillier will kill the virus by shooting Hellfire missiles at it.
    Problem solved in every NATO country, from Esquimalt to the Black Sea!

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