Ontario announced this week that it is expanding eligibility for a third dose of COVID-19 vaccine. A few select Ontarians living with extremely elevated risk factors had already been eligible, and many had indeed received their third doses. Following updated federal guidance and recommendations last week, the province says that, starting this weekend, double-dosed people over the age of 70, those who were previously vaccinated with two doses of AstraZeneca or a single Johnson & Johnson shot, health-care workers, and Indigenous Canadians (and those who live with them) will qualify for a third dose.
This revised guidance reflects both the unique risk factors for each group and emerging science that shows that the protection offered by two shots gradually wanes. (While the government stresses that the AstraZeneca and Johnson & Johnson vaccines remain safe and effective, it says that their overall efficacy is believed to be lower than that of mRNA vaccines, so an mRNA top-up should give these people better protection.)
This news was not unexpected. After the release of the revised federal guidance, the Ontario government had been quick to say that it would issue its own new information soon. Indeed, it took only a few days. What’s arguably more interesting is that the government also says that, beginning early in the new year, it will roll out boosters to the rest of the population; Ontarians will become eligible for third shots, again of an mRNA vaccine, six to eight months after their second.
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I don’t have much to say about the choice to roll out boosters to Ontarians, except in that I think it will help address an issue I wrote about here recently. Earlier this fall, while on a routine trip to a local pharmacy to refill my daughter’s puffer prescription, I got to chatting with the pharmacist and saw that, behind him, in a little fridge or freezer with a clear glass door, were boxes marked PFIZER and MODERNA. He confirmed that it was indeed vaccine and added that it was spoiling faster than he could use it. Canada’s supply, so constrained at the beginning, had vastly surpassed remaining demand. We are still moving our vaccination rate up, but just a tiny bit at a time. Long gone are the days of mad scrambles to get a shot and lineups stretching for blocks around buildings. We now have more than we can use and have indeed paused new deliveries. It seemed absurd that the vaccine, precious beyond description just a few months before, was now spoiling unused. But it was.
Making more Canadians eligible for third shots will hopefully not only help us continue to enjoy the current level of low infection and hospitalization that is now the norm across most of the country but also mean that less of the vaccine goes to waste.
The real theme of that column, though, was the global shortage of vaccine. Most of the world remains unvaccinated due to vaccine-supply issues. Canada has already said that it has contracts in place with Pfizer for sufficient doses to cover children aged five to 11, once they’ve been approved (that’s expected to come in the next several weeks, or so we’re told). The gradually increasing eligibility for boosters will likely mop up some of our current excess supply, but, next year, when we move into a phase of boosting the general population, sooner or later, we’re going to need more vaccines. The rich countries are already snapping up the vaccine that’s available; developing countries, if they can afford it at all, are paying premiums to vaccinate their populations just so that they can get access to the Pfizer or Moderna vaccines that are otherwise flowing to the rich nations. The best chance billions people in the world have of getting vaccinated will come when developed countries, including Canada, have more than they need. Canada thought it did, but if we’re going to boost everyone, that’s more supply we’ll be taking.
Vaccine equity is a big deal. It is in our interest to make sure the world is vaccinated, as COVID-19 will remain a threat to everyone until it’s stamped out everywhere. But I’m also a realist. Countries always operate in their own self-interest, not in alignment with their professed moral values. You can lament this if you will, but you can’t credibly claim to be surprised by it anymore. When the chips are down, nation-states look after their own; they always will. When Canada starts buying up doses to boost our already highly protected population, that’ll mean a zero-sum game the world’s poorest people will lose. (And we should also remember that other countries will put their needs over ours — remember our PPE shortages early in the pandemic. This stuff cuts both ways.)
There is a solution here, in the long-term, anyway: dramatically increase the world’s mRNA production capacity. This is happening; Canada is developing a facility in Mississauga that would be capable of cranking out hundreds of millions of mRNA vaccine shots a year — enough to take care of our own population with millions of doses left over to donate to the developing world. This is wonderful news, for both selfish and altruistic reasons. It’s a perfect combination! In the meantime, Canada and other nations should continue donating vaccines and money; we announced another large donation just a few days ago.
But it really is more capacity that will solve this problem, for us and for the world. The good news is, the extra capacity is coming. The bad news is, it’ll be a few years until it’s ready, and we’ll just have to make it through those years as best we can.