If all goes according to plan, Canadians will start getting vaccinated for the novel coronavirus early next year.
And one of the people spearheading those efforts is a Canadian from Sherbrooke, Que. — Nicolas Chornet, senior vice-president of international manufacturing at Moderna.
He moved to Switzerland in August to set up the U.S. drugmaker’s European office and has not seen his extended family in almost a year. But they, too, ask him for constant updates.
“Hey, how fast can we get this? Because we want to see you and we want you to travel and come and see us again,’” his family asks him about the vaccine, he says.
According to deals signed so far, Canada could have access to up to 414 million doses of COVID-19 vaccines from seven different manufacturers.
The shipment and distribution of the vaccine — once approved — will, however, be a Herculean effort involving a lot of manpower, a web of logistical challenges and scientific constraints.
Promising candidates from U.S. pharmaceutical companies Pfizer, Moderna and Johnson & Johnson as well as the U.K.’s AstraZeneca, are all currently under a rolling review process, which means vaccine data is being submitted for regulatory approval to Health Canada as it becomes available.
“Canada is one of the countries that moved very, very fast in securing a vaccine with us. It’s one of the first countries or one of the top countries to receive our supply also,” Chornet said.
Canada is not manufacturing any COVID-19 vaccines because it has a limited production capacity, especially for the vaccine candidates that are currently proving to be the most promising.
This means it will need to import the vaccines, adding another layer to the logistical labyrinth that has also set off political turmoil.
Last week, members of the opposition slammed Prime Minister Justin Trudeau over his comments that countries like the United States, Germany and the U.K. — some of which have domestic pharmaceutical facilities — will get vaccines before Canada.
Moderna’s supplies to Canada will come all the way from the Swiss city of Visp — home to some 8,000 people — where the company has set up a secondary production plant, in addition to its U.S. headquarters, to meet the global demand.
“Of course, our level of production or inventory will be lower than in the United States,” Chornet said, before adding: “In our distribution here (in Europe), we’ve optimized the supply chain so we can distribute as fast as possible to all the countries.”
The U.S. will receive approximately 20 million doses from Moderna by the end of the year.
Last week, Trudeau said a majority of Canadians should be vaccinated against the coronavirus by next September. That means roughly 75 million doses for the country’s entire population if two shots are given.
Since the start of the pandemic, more than 400,000 people in Canada have been infected and at least 12,400 have succumbed to the virus.
Long-term care homes have borne the brunt of the pandemic, with outbreaks reported at several hundred nursing homes.
More recently, hospitalizations are soaring across provinces. Quebec, Alberta and Ontario are among the worst affected.
A vaccine will come as a relief for lockdown-weary Canadians – 65 per cent of whom say they intend to get a vaccine when it’s approved by Health Canada and available for free, according to a new poll this week. Meanwhile, an Ipsos poll conducted exclusively for Global News found that 74 per cent of respondents are worried that the public distribution of a vaccine would be too slow to stop a greater spread of COVID-19.
The National Advisory Committee on Immunization (NACI), has identified key populations that should get immunized first, including the elderly and those with underlying health conditions, as well as health-care workers, according to its preliminary recommendations.
“This will probably be the most complex deployment of vaccines that we’re attempting in Canada, or I would suggest even around the world,” Daniel Chiasson, president and CEO of the Canadian Association for Pharmacy Distribution Management, told Global News.
So how will it work?
Cold storage
Both Pfizer and Moderna’s vaccines need to be kept in cold storage and have specific temperature requirements.
Pfizer’s vaccine must be shipped and stored at -70 C, while Moderna’s can be stored for up to six months at -20 C.
This requires a certain level of infrastructure that Canada may not have if vaccines are deployed in a short time frame, Chiasson said.
“The bottleneck for me is likely to be at the warehouse level,” he said.
“Do we actually have sufficient capacity with the right equipment in terms of refrigeration or frozen capacity to do it? … The infrastructure exists today. Do we have enough of it?”
In anticipation of a vaccine’s arrival, the federal government has ordered 26 ultra-cold freezers required for Pfizer’s vaccine and another 100 needed for Moderna’s. So far, 34 freezers have arrived, according to Public Services and Procurement Canada.
U.S.-based Thermo Fisher Scientific is among those companies supplying the cold storage to Canada.
“The criticality of this is huge, being able to manage the temperature from the point of manufacturing through distribution and ultimately to preparation for injection. It just can’t be overstated,” Dr. Alex Esman, general manager and senior director for cold storage at Thermo Fisher Scientific, told Global News.
“Typically, these freezers are used today in research… but now these freezers are going to be just in slightly different places … like in the pharmacy or in a doctor’s office or a clinical office.”
ESBE Scientific, a distribution company in Markham, Ont., told Global News it has already supplied stocks to the federal government, and the provinces of Ontario and Alberta.
Distribution
While the federal government is overseeing the procurement and authorization of the vaccines at the national level, provincial health authorities are currently working on their individual plans to decide where the vaccines will be deployed and administered and who will get them in what order.
The Canadian military has also said it is preparing to help with the country’s vaccine roll-out more broadly.
Retired general Rick Hillier, who led the NATO forces in Afghanistan, was recently tapped to lead the vaccine roll-out for the province of Ontario.
“We’re talking to the IT professionals, they’re talking about building a system that is already in progress on iPads to use at those sites to log where the vaccines are, where they’re going to connect that to health cards to make sure that we have a record that somebody has been vaccinated,” Hillier told Global News.
At the city level, immunization teams will then be responsible for making sure the vaccines get delivered to the identified priority groups, and for carrying out the immunizations in the community.
Matthew Pegg, the head of Toronto’s COVID-19 Immunization Task Force, says the roll-out will be a “massive undertaking” that will require a lot of planning and co-ordination.
The “biggest hurdle,” he said, is identifying facilities that can store vaccines and serve as a location for people to get vaccinated.
“We need facilities where we can install whatever the requirements will be for refrigeration or freezers,” Pegg told Global News.
His team is currently looking for facilities to serve as warehouses for all of the expected inventory.
Second dose and followup
Vaccines from Pfizer, Moderna and AstraZeneca will require two doses.
Pfizer’s booster shot will be given three weeks after the first one, while Moderna’s is spaced four weeks later. In AstraZeneca’s clinical trials, the second dose was given a month later.
Dr. Michael Finkelstein of the Toronto Public Health says it will be important to report and investigate any adverse effects and make sure patients return for that second dose.
“We have a lot of experience with people getting vaccines, but much less experience with people needing two doses,” he told Global News.
“And so it’s going to be very important for us to be able to remind people and making sure that they get the message they have to come back.”
If both Moderna and Pfizer’s vaccines are approved, the first batch of what’s expected to be six million doses — enough for three million Canadians — will begin arriving in early January.
But the actual work of the roll-out will be far from over.
— With files from Emanuela Campanella, Global News.