After false starts and supply glitches, Canada's immunization campaign makes progress

The nationwide vaccination campaign to immunize adults against COVID-19 is now well underway after a series of false starts and severe supply disruptions.

Nearly four months to the day after the first Pfizer shots were given to a small group of health care workers in Toronto, the provinces and territories have now administered roughly nine million doses of the three authorized products developed by AstraZeneca, Moderna and Pfizer.

While Canada was a laggard compared to virtually every other country in the western world in the early stages of this effort, the pace of inoculation here has quickened in recent weeks.

Here's a look at the state of play — and some answers to questions Canadians are asking.

How does Canada compare to other countries?

Excluding small island nations and European overseas territories like the Cayman Islands and Gibraltar, Canada now ranks among the top 10 countries worldwide in the number of new doses per 100 people being administered daily.

While Canada's slow rollout has attracted negative media attention — including a critical report by CNN — it now ranks 12th globally in terms of the number of people who have received at least one shot.

But that number may be misleading because health officials here — unlike those in many other countries — have pushed back administering second doses by some four months in order to get more people vaccinated with at least one dose. Nearly 24 per cent of the U.S. population is fully vaccinated; in Canada, that figure is less than 2 per cent.

Some studies, including one published this week in the respected medical journal The Lancet, suggest there's a great deal of antibody protection after a single dose.

While the vaccination campaign has stabilized, demand is still vastly outstripping supply, with millions of Canadians eager to get a shot to bring this year-long crisis to an end.

The United Kingdom and Israel, which have been particularly efficient at procuring and administering doses, have seen COVID-19 caseloads plummet in recent weeks. Israel has vaccinated 60 per cent of its population with at least one shot, while 50 per cent of Britons have received a dose.

Prime Minister Justin Trudeau suggested this week that the U.K. is facing a "very serious third wave." In fact, the U.K. is likely to avoid a third wave altogether because so many vaccines have been deployed there so quickly.

Canada's relative disadvantage compared to the U.S. — where, thanks to the robust American vaccine manufacturing sector, 198 million shots have been administered already — has also created a great deal of "vaccine envy."

How many shots will be delivered to Canada over the next two months?

Short answer: millions.

Long answer: Maj.-Gen. Dany Fortin confirmed Thursday that Pfizer is on track to deliver just over one million doses each week until the end of May. After that, the number of shots delivered is set to ramp up to 2 million a week throughout the month of June and beyond.

Roughly 17.8 million doses of Pfizer's vaccine are to be delivered in the April through June period.

By the end of June, at least 4.4 million doses of the AstraZeneca vaccine — produced by the company itself, the Covax vaccine-sharing facility and the Serum Institute of India — are expected to be on hand.

Massachusetts-based Moderna — which, like Pfizer, has developed a highly effective mRNA vaccine — has said it will ship 12.3 million doses of its product by Canada Day.

All told, Canada is expecting delivery of 44 million total doses over the first six months of this year.

Based on those figures, most provinces (and territories, although they're much further ahead) have said every adult will be immunized with at least one shot by the end of June.

There's a lot of uncertainty about those promises, however.

The wait for a second dose could be longer, given the National Advisory Committee on Immunization (NACI) has said provinces can wait up to four months between doses.

Public Services and Procurement Minister Anita Anand has said as many 110 million doses will be delivered to Canada by the end of September.

Haven't there been delays with the Moderna product?

Yes — and they've been very disruptive.

Moderna says it is facing a persistent "quality assurance" backlog at its production facilities — a roadblock that has resulted in days-long delivery delays for doses destined for Canada.

There aren't any production issues with the shots themselves but the process of double-checking each batch — and then getting them out the door — has been slower than expected.

The 855,000 doses of the Moderna product that were supposed to arrive the week of April 5 have only started to show up over the last several days — a disruption that upended planned immunization clinics in some provinces. This week, for example, some 10,000 appointments in Ontario were cancelled.

The 1.2 million doses that were supposed to arrive in Canada next week are now not expected until later this month, possibly as late as the first week of May.

A spokesperson for Ontario Premier Doug Ford said that "while we know the federal government is working very hard to get us supply," the recurring Moderna delays have had a "significant impact on our ability to fulfil vaccine appointments."

"That's why we continue to see sites pausing operations and rescheduling vaccinations. The more consistent supply we have, the faster we will be able to accelerate our rollout and get needles into the arms of Ontarians," the spokesperson said.

Could the U.S. help us out and send more doses?

Possibly. The Biden administration sent 1.5 million doses of AstraZeneca to Canada last month.

U.S. regulators haven't even approved that product for use yet in the American marketplace — but the company is still manufacturing it in the United States. More than 20 million doses have been stockpiled already, according to Bloomberg News.

Trudeau has said his government will work with the U.S. to secure more supply.

"We have continued to engage with partners around the world, including the United States, about getting more doses quickly," Trudeau said on April 9.

What's going on with that one-shot Johnson & Johnson vaccine? 

Injections of that vaccine came to a halt in the U.S. this week after the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) jointly recommended a stoppage following reports of very rare blood clotting in six patients.

While 6.8 million doses of the J&J vaccine have been administered in the U.S. — the vast majority with mild or no side effects — the federal agencies said they wanted state and local officials to stop administering the shot until the FDA's immunization advisory committee could meet to review the blood clotting data to better understand any potential risks.

Health Canada regulators already have approved the shot for use here and they are in close contact with their U.S. counterparts about any possible side effects.

The first deliveries of that product to Canada are expected at the end of April — but there's been no clarity about how many doses will arrive at that time.

When will it be my turn?

The answer depends on where you live.

The provinces are still working through older Canadians, Indigenous peoples, some health care workers and people that are particularly vulnerable to contracting COVID-19 or developing severe symptoms (that last group has been loosely defined by NACI and has been interpreted differently by the provinces).

Among those 80 years of age or older, 84 per cent have received their first dose, while 69 per cent of people between the ages of 70 and 79 have had at least one shot.

Saskatchewan has been able to turn around shots quickly and it boasts the second-best record among the provinces in terms of the number of people vaccinated with one dose — second only to Quebec, which has been administering only first doses since the beginning of this campaign.

Twenty-three per cent of Saskatchewan residents have received a dose, compared to just 14 per cent of Nova Scotians.

Saskatchewan Premier Scott Moe has announced that people aged 47 and older can now get a shot at drive-thru clinics in Regina. In Saskatoon, the age is 52 and above.

In Ontario, by comparison, the public health and hospital-run clinics are still working through people over the age of 60 — and deploying some shots to people who live in COVID-19 "hot spots," as identified by their postal codes.

Pharmacies in Ontario are administering the vaccine to people aged 55 and over.

If NACI decides to drop the AstraZeneca-related age restrictions — for now, the shot can only be used on people 55 and older — that could make the vaccine more readily available to younger Canadians through 11,000 community pharmacies. Dr. Supriya Sharma, Health Canada's chief medical adviser, has suggested that new guidance could be coming soon from the immunization committee.

There's a lot of talk about millions of doses in freezers — is that true?

Sort of.

After the federal government delivers a big batch of shots to the provinces and territories — hundreds of thousands of Pfizer shots arrive each week — there's an inevitable delay between the point when a shot is placed in inventory and when it is actually administered to a patient.

Dr. Isaac Bogoch, an infectious diseases physician and a member of Ontario's COVID-19 Vaccine Distribution Task Force, pointed out this week that much of the product delivered is deployed relatively quickly.

In Ontario, Saskatchewan and Quebec, for example, more than 70 per cent all shots delivered are typically used the week they are received.

"At the beginning of the week there is plenty of Pfizer/Moderna but that quickly gets administered. We then wait for the next shipment," Bogoch said.

"What's left in the freezer? AstraZeneca. A lot of it. It's not exactly flying off the shelves for the 55-plus crowd unfortunately."

What about domestic manufacturing — could that help us out?

It could — if we had any.

The National Research Council-owned Royalmount facility is expected eventually to churn out tens of millions of doses of the vaccine developed by Maryland-based Novavax.

The first Canadian-made Novavax vials won't be produced until the end of the year, however.