Two vaccines are already approved, two are under review, and two more are in the pipeline, making it possible that Canadians could eventually have access to at least six different COVID-19 vaccines.
With so many options, will Canadians get to choose which shot they get?
Federal minister of international development Karina Gould told a Global News station in London, Ont., that “the vaccine distribution happens via the provinces” and so “it would be up to the government of Ontario to decide where vaccines are going (in Ontario),” for example.
Global News has reached out to Canada’s provinces and territories for comment, with the majority suggesting it is too soon to say.
British Columbia’s ministry of health said those vaccinated in Phase 1 of its plan do not have a choice between Pfizer and Moderna (though they always know which one they’re receiving) but once more vaccines become available that could change, depending on supply and availability.
A spokesperson for Alberta said that “we are not providing eligible groups with a choice of vaccine at this time.”
Saskatchewan said only that “the availability of vaccine is determined by the supply as well as the logistic and handling requirements of the vaccine.”
A spokesperson for Manitoba said “it is far too early to speculate about vaccine choice” but that the province will “continue to update Manitobans with more information as it becomes available.”
In Ontario, a spokesperson said people do not get to choose which vaccine they receive “at this time” and that the two vaccines currently approved by Health Canada “are the same type, with similar efficacy in trials, and similar side effects.”
In Quebec, a spokesperson said, “due to the limited number of doses currently available to us, we cannot offer people a choice of vaccine,” adding, “it is the federal government that is responsible for the supply of the vaccine against COVID-19 to the provinces and territories.”
A spokesperson for New Brunswick said it’s “too early to say what will happen” when more vaccine options are made available.
In Nova Scotia, a spokesperson said only that “the Province makes decisions on which vaccine to send to a clinic based (on) factors such as location, supply, transportation and storage requirements.”
The Government of Newfoundland and Labrador’s department of health and community services told Global News that “the goal is to vaccinate as many people as possible as vaccines arrive in the province. At this time, Newfoundland and Labrador is not planning to provide vaccine options.”
In Prince Edward Island, a spokesperson said that “at this time, Islanders are not choosing between Moderna and Pfizer vaccines.”
Yukon said that since additional vaccines have yet to be approved “this is not a decision that has been considered yet.”
The Northwest Territories said “we will speak to that when another option (not Pfizer) is available.”
Nunavut said only that it is currently allocated the Moderna vaccine due to the extreme cold storage requirements of the Pfizer vaccine and resulting logistical challenges.
The ethics of choice
Beyond the question of whether or not Canadians will get to choose which company’s vaccine they get, however, is the question of whether Canadians should have that choice.
Bioethicist at Western University in London, Ont., Charles Weijer says at this point in time priority groups are the focus but it’s “conceivable” that Canadians could have that choice in the latter half of this year.
“It’s actually a day to look forward to, I think. Once there is choice, we’ll know that there are adequate supplies and that’ll be a good thing.”
Weijer, who was also a member of the working group that developed the World Health Organization’s ethical guidelines for COVID-19 human challenge studies, suggests that the COVID-19 vaccine should be treated like other medical interventions in Canada.
“If there’s more than one product licensed and available, typically we allow Canadians to make a choice.”
Natalie Kofler, molecular biologist and lecturer at the Center for Biomedical Ethics at Harvard Medical School, agreed that it is a possibility but raised concerns about worldwide distribution of vaccines.
“Given that Canada seems to have so many vaccines available, there might be the choice at some point,” she said, referencing that Canada has secured enough doses to vaccinate the population many times over.
Kofler says if scientific data shows that certain vaccines are better for those who are pregnant or for youths, for example, then those groups should have access to those vaccines, but when it comes to widespread choice, it becomes “a dicey question.”
She stressed that the pandemic is a global crisis that requires a global response.
“Before we start vaccinating our entire population, are there people who really need them in other countries that need this first so that we can ensure that we move beyond this pandemic as a healthy global community? Because what’s really concerning is what this can set up as an even greater emergence of inequity within this world,” she said.
“Many countries are going to be left behind if they can’t get up and running by at least having their front-line workers and those really most vulnerable being vaccinated.”
An international crisis
“Ensuring equitable access globally to COVID-19 vaccines is an exceptionally important issue,” Weijer said.
“Part of the reason it matters is our history in this space is just so bad.”
Weijer pointed to the 2009 H1N1 influenza pandemic as a very recent example. In that case, he says, a vaccine was rapidly generated and then “rich countries just systematically outbid poorer countries for access to the vaccine.”
As part of the response to COVID-19, the WHO partnered with the Coalition for Epidemic Preparedness Innovations (CEPI) and global vaccine alliance Gavi to launch COVAX, an initiative in which Weijer says Canada has played “an important role.”
Minister Gould is co-chairing the COVAX Advance Market Commitment (AMC) Engagement Group “which is the mechanism to ensure that vaccines are delivered in the developing world,” she told Global News.
“From the get-go, Canada has been supporting multilateral and global efforts to make sure there is a fair and equitable distribution of vaccines,” she said.
“We can be at a point where we’ve vaccinated hopefully everyone here in Canada by September, but if the rest of the world still has the pandemic raging we’re not going to be able to get back to the things that we like to do — travelling, trading, visiting family and friends, having people come visit us here in Canada — until we really get the pandemic under control everywhere.”
Canada has contributed $220 million to the initiative, Gould says, and has also committed to donating excess physical vaccines to COVAX.
COVAX can also expect a boost from the United States, which confirmed intentions to participate just hours after Joe Biden officially took office as president of the United States last Wednesday, the Washington Post reported.
Just two days earlier, WHO Director-General Tedros Adhanom Ghebreyesus had warned that the world is on the brink of “catastrophic moral failure” in sharing vaccines. At that time, at least 56 bilateral deals had been signed.
As of Jan. 18, Tedros said more than 39 million vaccine doses had been administered in 49 higher-income countries whereas just 25 doses had been given in one poor country.
“We’re not all in the same pot putting money in and also getting our doses through COVAX,” Kofler said.
“We’re putting money in, then we’re also doing your side game of buying doses — more doses than we actually even need — and making sure we’re fine. Things fall a little bit apart when you don’t have vested interest in the success of the project.”
She added that COVAX is also “delayed in their approval process,” having only recently approved the Pfizer-BioNTech vaccine.
“That’s also on the company’s responsibility because they’re choosing where they enter in for emergency approval in these different nations. And they’ve also chosen to first go for approval in high-income countries that are likely going to be more profitable for these companies once they send out their shipments.”
Who gets the most effective vaccines?
So far, Canada has approved the Pfizer and Moderna vaccines which are both said to be over 90 per cent effective in protecting people from the coronavirus.
The AstraZeneca and Oxford University vaccine and the Johnson & Johnson vaccine are currently under review in Canada, with a decision on AstraZeneca expected first.
A spokesperson for AstraZeneca told Global News on Jan. 21 that, so far, the United Kingdom, Argentina, Dominican Republic, El Salvador, India, Mexico, and Morocco “have provided authorization” for emergency supply of its vaccine.
A Public Health Agency of Canada spokesperson told Global News on Jan. 19 that Health Canada experts will be taking part in a meeting of the European Medicines Agency, EMA, on Jan. 29 “to discuss authorization of the AstraZeneca vaccine.”
Pooled data from December showed an efficacy rate of 70 per cent for the AstraZeneca vaccine.
Phase 3 data released by Johnson & Johnson and its subsidiary Janssen on Jan. 29 suggests its vaccine — which only requires one dose — is 72 per cent effective overall at preventing moderate to severe COVID-19, 28 days after vaccination.
Novavax, which had yet to submit data to Health Canada as of Dec. 25, said on Jan. 28 that its vaccine appears to be 89 per cent effective based on early findings from a British study.
Kofler says efficacy is a “challenging thing to really nail down at this point.”
“These weren’t challenge trials (which involve people being deliberately infected), it was people going about their daily life to see if they were somewhat more protected — they were still wearing masks, they were still doing other things to protect themselves from COVID,” she explained.
“They are statistically sound, I’m not debating that. I’m just saying that I think it’s likely that as time progresses, AstraZeneca’s efficacy will probably work out to be a bit higher than what it’s showing.
“Scientifically, there’s no reason to believe it wouldn’t be a highly effective vaccination.”
Weijer says the AstraZeneca vaccine, and a few others, were always going to be the most appropriate choices for low- and middle-income countries.
“If differential efficacy was driving the choices that Canada was making or was driving the choices that low- and middle-income countries were making, that certainly would be unfair. But I don’t think that’s what’s been going on.”
Instead, Weijer says decision-making comes down to cost and refrigeration.
“Pfizer’s about $25 a dose. The Moderna’s about $40 a dose. That’s unaffordable for low-income countries. The AstraZeneca vaccine comes in at around $3 a dose.”
As well, because the AstraZeneca vaccine is an adenoviral vector vaccine, it only requires regular refrigeration instead of freezing like the Moderna vaccine or deep-freezing like the Pfizer vaccine, which are both mRNA vaccines.
“The lack of access to sort of basic refrigeration in the poorest countries in the world before coronavirus was interfering with the delivery of about 40 per cent of of the world’s vaccine doses,” he stressed.
“This is a longstanding problem. The AstraZeneca vaccine, therefore, was really the only one that was going to be feasible for low- and middle-income countries.”
— with files from Global News’ Jigar Patel, Sean Boynton, and Emerald Bensadoun as well as Reuters’ Emma Farge.