The news gods were smiling upon me last week. On Thursday, I filed a column noting that Ontario needs to have a plan in place to deal with a surge in vaccine, should any of the three that were then awaiting approval get the nod from Health Canada. Ontario's early vaccination effort struggled before beginning its stride; John Michael McGrath's piece here explaining that the effort is now going much better is required reading. The danger, I warned on Thursday, was that all our gains had been made during a time of relative scarcity of vaccine, as the federal government had had delivery issues with both our (then) suppliers. Pfizer had to retool its production facilities to meet massive demand, imposing painful but apparently brief delays on production. Moderna hasn't really explained its woes, but reporting has suggested it’s had supply-chain issues lining up the necessary components.
Our apparent better standing now, I warned, might be in part because we simply don't have enough vaccine to really test our distribution system. And we'd better be ready for that to change, so that a sudden infusion of newly approved vaccines won’t crash the whole system. We'd look real cute with freezers full of vaccine just as a third wave hit.
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I considered the column something of an "evergreen" — something that wasn't strongly pegged to anything currently in the news and would be just as worthy a few days later as it had been the moment I filed it. Filled with an affable spirit, I told my editor, hey, just run it whenever is most convenient for you! My editor took the position that there was no time like the present. The column was live within an hour or so.
And that’s a good thing, too. Because my evergreen wouldn't have lasted a day.
On Friday morning, Health Canada approved the AstraZeneca vaccine. AstraZeneca has received some negative press for its allegedly mediocre performance relative to the spectacular Pfizer and Moderna vaccines, which were produced with cutting-edge technology. AstraZeneca has proven to be 62 per cent effective against moderate illness, which is well below the miraculous 95 per cent for both Pfizer and Moderna. But that's for moderate illness with some symptoms of sickness.
AstraZeneca has thus far proven to be basically 100 per cent effective at preventing deaths and critical illnesses requiring hospitalizations. That might change in the real world, outside labs and clinical trials, but we can already say with confidence that the vaccine is enormously effective at reducing the most dangerous outcomes of COVID-19. Given that COVID-19 is most deadly among those over 60 (and, really, over 70 and 80), reserving the most effective vaccines for the elderly and most vulnerable and using AstraZeneca to further protect the most resilient segment of the population (those under 60 without major health problems) could be a winning strategy that gets us out of this pandemic quickly.
But there's that key word: "quickly." The vaccines are coming. Ontario needs to be ready immediately. The first doses could arrive by Wednesday. The early shipments will be relatively modest — 500,000 doses from an Indian production facility, before tens of millions of doses begin arriving from U.S. facilities over the next few months. But assuming Ontario gets roughly 40 per cent of the total, in line with its share of the national population, that's almost 200,000 doses that will be arriving by pleasant surprise. Will the province be ready?
I suspect it will. Local public-health units are pushing ahead with the vaccine rollout more aggressively than the province's official timeline would imply, and I'm sure the 200,000 extra doses will be snapped up and distributed rapidly. But this is still a useful early test. Up until now, our problem has been a lack of vaccines. Beginning right now, the problem could well be a glut of vaccine, especially if the logistics are choppy and result in overlapping large deliveries all landing (literally) in a matter of days. This is especially true since the other two vaccines I mentioned in my column on Thursday, Johnson & Johnson and Novavax, are also still under review and could be approved soon — sooner than you'd think, if my experience last week is any indication.
Not all of that distribution effort will be up to the provinces, but some of it will be. The provinces will have to move quickly to transport and preserve what supplies the federal governments make available. That will mean having in place not just the logistics for storing and transporting vaccine, but also the personnel to oversee the process, to administer the vaccines, and to track the progress (and the digital capacity to back all these efforts up — databases and registries aren't exactly a Canadian forte).
These are not abstract problems. They're real, and they're going to get even more real, soon — perhaps very soon. At least we now have some clarity on the schedule for three of the five vaccines, and perhaps soon a fourth. That's good. But this is a challenge that's going to transition from a boardroom planning meeting to a vaccination site inside a hockey rink or convention centre near you in the very near future. Let's be ready.