COVID-19 vaccination in Canada

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COVID-19 vaccination in Canada
COVID-19 Vaccination Rates in Canada by province.svg
Percentage of the population vaccinated with at least one dose as of August 25, 2021
DateDecember 14, 2020 (2020-12-14) – present
LocationCanada
Also known asVaccins contre la COVID-19 (French)
CauseCOVID-19 pandemic in Canada
Organized byHealth Canada
Public Health Agency of Canada
Provincial and Territorial governments
Municipal government in Canada
Participants27,842,441 people with at least one dose administered of Pfizer-BioNTech, Moderna or AstraZeneca
25,281,808 fully vaccinated people
(to which the first and second doses of vaccine were administered) [1]
Outcome73.02% of the Canadian population has received at least one dose of a vaccine[1]
66.3% of the Canadian population is fully vaccinated
WebsiteGovernment of Canada
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The COVID-19 vaccination program in Canada is an ongoing, intergovernmental effort coordinated between the bodies responsible in the Government of Canada to acquire and distribute vaccines to individual provincial and territorial governments who in turn administer approved COVID-19 vaccines during the COVID-19 pandemic in Canada. Some provinces have asked local municipal governments, hospital systems, family doctors and independently owned pharmacies to aid in part, or in full with vaccination rollout.[2] The vaccination effort in full is the largest such immunization effort in the nation's history; it started in mid-December 2020 and is currently ongoing.[3]

Health Canada is responsible for approval and regulation of vaccines (and other pharmaceuticals), while the Public Health Agency of Canada (PHAC) is responsible for public health, emergency preparedness and response, and infectious and chronic disease control and prevention. Vaccines are approved by Health Canada, purchased by the Government of Canada and distributed by PHAC to individual provinces and territories in tranches based on various factors such as population size and prioritized peoples. The National Advisory Committee on Immunization (NACI) has also issued recommendations on how vaccines should be distributed.

The National Research Council Canada (NRC) has made investments in the domestic development of vaccine candidates, including candidates by the University of Saskatchewan and Variation Biotechnologies. In May 2020, the NRC announced a planned agreement to conduct clinical trials of a vaccine candidate by Chinese company CanSino Biologics, and plans to manufacture it at its facilities in Montreal once approved. However, the deal collapsed due to strained Canada–China relations, and the federal government later announced commitments to purchase vaccines being produced by AstraZeneca, Moderna, and Pfizer.

From about mid-January until mid-February, both Pfizer–BioNTech and Moderna did not ship the agreed upon quantities of secured vaccines to Canada and other countries, due to manufacturing challenges.[4] By February 18, Major General Dany Fortin, who led vaccine logistics at the Public Health Agency of Canada (PHAC), announced that the vaccine delivery was back on track and that there will now be an "abundance of supplies" which will result in a "significant scaling-up of immunization plans in provinces."[5] Significant increases in manufacturing and delivery of vaccines in conjunction with a recommendation by NACI to extend second dose administration to a maximum of 16 weeks resulted in a larger ramp-up in vaccine delivery across the nation in March - June 2021. By July 2021, Canada's vaccine supply had grown to allow a return to shortened dose intervals.[6]

With Health Canada approving the Pfizer–BioNTech COVID-19 vaccine on December 9, 2020, mass vaccination efforts began across the country on December 14, 2020. The agency later approved the mRNA-1273 vaccine developed by Moderna on December 23, 2020. On February 26, 2021, Health Canada approved the Oxford–AstraZeneca vaccine for use,[7] and its first shipments arrived in Canada on March 3, 2021.[8] Following concerns of blood clotting events, although continuing to be approved, the Oxford-AstraZeneca vaccine has been largely discontinued as a first dose, and those who had already received a first dose are encouraged to receive an mRNA vaccine as their second.[9] The Janssen vaccine was approved on March 5, 2021, to become the fourth vaccine to receive Health Canada approval;[10] However, Canada did not receive a delivery of the Janssen vaccine until April 28, 2021;[11] which was then destroyed due to contamination issues at its factory of origin.[12][13] There are no plans for Canada to use the Janssen vaccine.[14]

Canada became the first country to authorize a COVID-19 vaccine for people younger than 16 after approving Pfizer's vaccine for children aged 12 to 15 on May 5, 2021.[15] In August 2021, the Moderna vaccine was approved for use in children aged 12 and up.[16]

Background and timeline[]

Preparations[]

In March 2020, the federal government announced a CA$275 million investment for "coronavirus research and medical countermeasures"[17] and on April 23, 2020 over CA$1 billion in additional financial support was announced. This funding for "national medical research strategy to fight COVID-19" included "vaccine development, the production of treatments, and tracking of the virus."[17]

Nancy Harrison and Cédric Bisson are co-chairs of the Therapeutics Task Force (TTF), which is tasked with prioritizing "financial support for promising COVID-19 treatment projects."[18] The secretariat of the Therapeutics Task Force is housed at the Department of Innovation, Science and Industry (ISED). Joanne Langley and J. Mark Lievonen are the co-chairs of the Vaccine Task Force (VTF) advising the federal government on "vaccine development, related bio-manufacturing and international partnerships".[18] The secretariat of the VTF is supported by the National Research Council of Canada (NRC).[18] The NRC was tasked with identifying potential vaccine candidates, and helping to expedite clinical trials and approval of them in Canada.[19]

Failed CanSino agreement[]

The NRC signed agreements with several companies that had been developing vaccine candidates, including Variation Biotechnologies (which has a facility in Ottawa), and the University of Saskatchewan Vaccine and Infectious Disease Organization–International Vaccine Centre (VIDO–InterVac). Canada did not have facilities capable of producing COVID-19 vaccines at the outbreak of the pandemic;[20][Notes 1][21][Notes 2][Notes 3][22] the NRC earmarked $45 million to upgrade its laboratories in Montreal in anticipation of vaccine production.[23]

On May 6, 2020, the NRC reached an agreement with Chinese pharmaceutical company CanSino Biologics to conduct clinical trials for its COVID-19 vaccine candidate Ad5-nCoV at Dalhousie University in Nova Scotia.[24] The NRC cited its "strong collaborative history" with CanSino, and past work on adenovirus vaccines, as part of its decision.[19] CanSino's candidate was the first to enter phase II trials, and was considered by the VTF to be one of the top candidates.[23]

The NRC would have received "a non-exclusive right to use, produce, and reproduce the vaccine for emergency pandemic use", free-of-charge. The agreement was announced by Prime Minister Justin Trudeau on May 12 during a press briefing, and trials were expected to begin within the next two weeks.[24] The trials were formally approved on May 15; the NRC stated that it hoped to produce between 70,000—100,000 doses of the CanSino vaccine per-month.[23]

The CanSino agreement was impacted by Canada's strained relations with China; the shipments of vaccine doses were blocked by Chinese customs, and the State Council of the People's Republic of China refused to authorize the shipment.[24][19] In July 2020, after reports emerged over the delays, the NRC stated that CanSino "[remained] very committed to the Canadian clinical trials."[23]

Agreements with Moderna, Pfizer, and AstraZeneca[]

With the CanSino deal falling through, and the VTF revising its recommendations based on clinical trial data from other countries, Minister of Public Services and Procurement Anita Anand announced on August 5, 2020 that the federal government had committed to purchasing doses of the Moderna and Pfizer–BioNTech vaccines.[23][25] In anticipation of a COVID-19 vaccine, the Canadian government purchased more than 75 million hypodermic needles and syringes.[26]

After the NRC found that its current lab would not meet good manufacturing practices Prime Minister Trudeau announced on August 31 a federal investment of $126 million to "design, construct, commission and qualify a new biomanufacturing facility"—the Biologics Manufacturing Centre, which was projected to be completed by the end of July 2021.[27] It would be built next to the NRC's current Royalmount site in Montreal and have a production capacity of approximately 2 million does per-month".[27]

In September 2020, the federal government committed to purchasing 20 million doses of the Oxford–AstraZeneca vaccine. It also announced that it would make a $440 million investment in the COVAX initiative, to help fund the equitable procurement of COVID-19 vaccines worldwide.[28][28][29]

In November 2020, Conservative Party leader Erin O'Toole criticized the federal government for focusing too heavily on the CanSino agreement, arguing that he "would not have put all our eggs in the basket of China."[30]

Initial approvals and rollout[]

On December 9, 2020, Health Canada approved the Pfizer–BioNTech COVID-19 vaccine. The Public Health Agency of Canada supervises the rollout and administration of the vaccine.[31] By mid-December 2020, Pfizer had agreements to supply 20 million doses to Canada.[32] Healthcare institutions began administering the first 30,000 doses of the Pfizer–BioNTech COVID-19 vaccine in Canada on December 14. A total of 249,000 doses are expected to be delivered by the end of 2020.[33] Because of the cold storage logistics, the initial doses were delivered to 14 distribution sites in the provinces, with none being sent to the Canadian territories since they could not properly store the vaccine. The 14 original distribution sites are located in St. John's, Halifax, Charlottetown, Miramichi, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Regina, Edmonton, Calgary, and two in the Greater Vancouver area.[34] The Canadian government expects the vaccine to be administered to high-priority groups, designated by each province, until the end of March.[33] Most provinces are first prioritizing some subset of healthcare workers, except for Quebec, which is prioritizing residents of long-term care homes, as well as British Columbia, New Brunswick, and Prince Edward Island, which are prioritizing both. Most provinces also have plans to expand priority status to additional groups—such as the elderly, or adults in Indigenous communities—before expanding to the general public.[35]

In the same week as initial vaccinations for the Pfizer–BioNTech COVID-19 vaccine, Health Canada approved the Moderna COVID-19 vaccine, an mRNA-1273 vaccine on December 23, and it was announced that Canada would receive 168,000 doses of the Moderna vaccine before the end of 2020.[36][37] Unlike the Pfizer–BioNTech COVID-19 vaccine, the Moderna vaccine does not require extreme cold temperature storage[37] which meant that as of December 28, Northwest Territories and Yukon had received their first shipments of 7,200 each of the Moderna vaccine.[38] Vaccinations in each territory are not scheduled to occur until mid-January.[39]

On February 2, 2021, Trudeau announced a deal with Novavax to produce COVID-19 vaccines at the Biologics Manufacturing Centre, making it the first to be produced domestically.[40] The Novavax COVID-19 vaccine is currently awaiting approval by Health Canada.[41] This is the first deal signed by Canada that allows a domestic manufacturing of a foreign vaccine. The contract with Novavax is for 52 million doses of the vaccine.[40] Following VTF and TTF recommendations, the federal government announced investment in two biomanufacturing companies—Vancouver-based Precision NanoSystems Incorporated (PNI) and Markham, Ontario-based Edesa Biotech Inc. (Edesa).[42] PNI, biotechnology company, will receive up to $25.1 million to build a "$50.2 million biomanufacturing centre to produce vaccines and therapeutics for the prevention and treatment of diseases such as infectious diseases, rare diseases, cancer and other areas of unmet need". Edesa will receive up to $14 million to Edesa Biotech to "advance work on a monoclonal antibody therapy for acute respiratory distress syndrome, which is the leading cause of COVID-19 deaths.[42]

By February 2021, the NRC and the ISED support for domestically-produced vaccines and therapeutics for COVID-19 included $37 million in stage 1 funding for six vaccine candidates, and seven therapeutics candidates.[43]

Manufacturing delays[]

A mass-vaccination clinic at the Olympic Stadium in Montreal.

In mid to late January, details emerged about manufacturing delays by both approved vaccines made by Pfizer and Moderna affecting the country's vaccine rollout in late January through the month of February.[44][45] On February 3, the European Commission approved delivery of COVID-19 vaccine to Canada, in spite of production constraints in Europe. Canada was one of many countries that applied for delivery and does not have its own manufacturing capacity.[46] By February 4, Major General Fortin said while that Pfizer explained its dramatically lower vaccine shipments—with a decrease of 80% in all Pfizer shipments—as caused by "plant upgrades at a facility in Belgium", Moderna has offered no explanation for similar delays.[4] By early 2021, the speed of Canada's deployment of COVID-19 vaccines had become the topic of widespread public discussion, along with the related question of why the vaccines were not being produced in Canada.[47][48]

Fortin said that 180,000 Moderna doses had arrived in Canada on the morning of February 4 and Canada is "still expecting 2 million Moderna doses by the end of March.[4] On February 4, Fortin said that about 70,000 Pfizer-BioNTech doses will arrive in the next week.[49]

On February 3, COVAX published the country-by-country vaccine distribution forecast to COVAX participants—Canada will receive 1,903,200 doses of the Oxford–AstraZeneca vaccine by the end of the first half of 2021.[50][51]

On February 12, the minister of Public Services and Procurement Canada (PSPC) announced that Canada had "negotiated an accelerated delivery schedule for Pfizer-BioNTech’s COVID-19 vaccine."[52] By the end of September, Canada will receive the 40 million Pfizer-BioNTech doses.[52]

Return to regular shipments[]

A box of ten vials of the Moderna vaccine at a Pharmacy in Quebec

Major General Fortin announced on February 18, that the period in which Canada experienced limited supplies, is now over and there will be an "abundance of supplies" in the spring and summer months. This will result in a "significant scaling-up of immunization plans in provinces."[5] Pfizer's new "locked in" delivery schedule includes 475,000 doses in February and 444,600 per week in March, according to the PHAC's vaccine distribution tracker.[53][5] A February 18, 2021 article in New York Times said that Canadians were concerned about the rollout of the vaccination program.[54] According to the same Times columnist, who had interviewed those involved in "vaccine development, epidemiology, infection control and medical supply chains", they all said it was not surprising that Canada's rollout was not happening as planned. While they could understand why Canadians were frustrated, they said, this is the "nature of new vaccines".[48]

Approval of Oxford-AstraZeneca and Johnson & Johnson[]

On February 26, Health Canada approved the Oxford–AstraZeneca COVID-19 vaccine for use.[7] The agency approved the use of two versions of the same vaccine, one to originate from the United Kingdom and the other produced in India by the Serum Institute of India.[7] The first shipment of 500,000 doses of Oxford-AstraZeneca arrived on March 3, 2021. The doses were marked with an April 2, 2021 expiry date, necessitating speedy administration.[8][55]

The Janssen COVID-19 vaccine was approved on March 5, 2021 to become the fourth vaccine to receive Health Canada approval.[10] The vaccine is the first to be approved in Canada which only requires one shot to achieve efficacy.[56] Delivery times for the vaccine remain unknown.[57]

After an agreement was reached with Pfizer to move up some deliveries, it was projected a total of 8 million vaccine doses (from three suppliers) will be available in Canada by the end of March 2021.[58] To maximize distribution of first doses, NACI issued a recommendation that second doses be administered up to four months after the first dose.[59]

Minister Anand confirmed on March 26, 2021 that 1.5 million Oxford-AstraZeneca shots would arrive from the United States on March 30, 2021,[60] and that 10 million shots of the Johnson & Johnson vaccine would arrive between April and September 2021.[61]

Vaccination ramp-up and increase in deliveries[]

A man after receiving the Oxford-AstraZeneca vaccine in Nova Scotia.
Vaccine Hunters Canada is an online volunteer group many Canadians have used to find vaccine appointments.

In mid-April 2021, the Government of Canada reached a deal with Pfizer to receive 8 million more vaccines on top of what was already ordered, with more than 2 million vaccines coming into the country per week beginning in the month of May.[62] Moderna however continued to delay deliveries and slashed an order for the end of April from 1.2 million vaccines to 650,000.[63]

Due to public frustration with variable vaccine booking systems across the country, a small volunteer group known as Vaccine Hunters Canada created a website, Twitter and Facebook page to help "eligible Canadians find vaccines." The group posts relevant information on appointments available, eligibility requirements and other tips to the public that might otherwise not be common knowledge.[64][65][66][67] On April 28, 2021 the City of Toronto officially partnered with the group to provide them end of day information in regards to vaccine availability and appointments that are currently unused, as well as information for pop-up vaccine clinics.[68][69][70]

The first shipment of the Johnson & Johnson vaccine arrived in Canada on April 28, 2021. The country received 304,800 doses of the single-shot vaccine in its first shipment.[71] However, Health Canada held the shipment for a safety review, citing production issues at the facilities of Emergent BioSolutions.[72][73]

In May 2021, NACI stated a recommendation that mRNA-based vaccines were preferred over viral vector vaccines such as the AstraZeneca and Johnson & Johnson vaccines due to the rare risk of post-vaccination embolic and thrombotic events, with vice-chairman Shelly Deeks stating that "individuals need to have an informed choice to be vaccinated with the first vaccine that’s available, or to wait for an mRNA vaccine." NACI received criticism for the recommendation, with critics arguing that it contradicted the view that patients should receive the first vaccine they are offered, and that the statement was mixed messaging over the safety of the vaccines that could lead to increased hesitancy.[74][75][76]

On May 5, 2021, Canadian health officials approved Pfizer's vaccine for adolescents 12 to 15 years old, becoming the first country in the world to do so.[15]

On May 11 and 12, multiple provinces, including Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan, announced that they would suspend their use of the AstraZeneca vaccine for first doses, citing supply shortages, with some provinces also citing the blood clot risk.[77][78][79]

Deliveries from manufacturers continued to accelerate in mid-May. In the week of May 16, Canada was expected to receive a record 4.5 million doses of the two mRNA vaccines from Pfizer and Moderna.[80]

In British Columbia, the Vancouver Coastal Health authority apologized on May 31 after accidentally administering the Moderna vaccine to 12 adolescents who were to receive the Pfizer vaccine per the approval.[81]

50% vaccination milestone and second doses[]

An immunization clinic in Surrey, British Columbia
Sign advertising appointments for vaccination at a No Frills grocery store

By May 22, 2021, at least half of the overall population had received at least one vaccine dose, with Canada having administered 20.328 million vaccine doses overall.[82] The country has passed other large countries in coverage like the U.S. vaccination program.[83]

As new arrivals of the Oxford-AstraZeneca vaccine came into the country in late May, provinces chose whether to administer second doses, for example as Ontario is going forward with,[84] or providing people who took a first dose to choose a different second vaccine, as in British Columbia.[85]

The country's percentage of single doses had been disproportionately high in comparison to second doses, due to NACI's earlier recommendations for intervals of up to four months. This led to calls from medical experts for provinces to prioritize second doses, citing the possibility having only one dose would make populations vulnerable to SARS-CoV-2 variants.[86] By late-May, amid an increased supply, several provinces had begun to shorten their intervals for second doses.[87] NACI followed suit on May 28, issuing new guidance that second doses should be administered "as soon as possible", especially to high-risk individuals.[88][89]

For the week following the Victoria Day weekend, Canada expected a smaller vaccine shipment than normal, as Pfizer-BioNTech sent more vaccine the previous week.[90]

The government had previously indicated that Canada would have 55 million doses delivered by the end of July 2021, but this mostly included Pfizer distributions. Moderna had now committed to delivering 11 million doses in July 2021, with 5 million of those doses potentially arriving in June. Combined with an expected 9 million Pfizer doses to be delivered, this would be enough to give Canada 68 million doses by the end of July.[91]

Vaccine mandates[]

On August 13, 2021, Minister of Intergovernmental Affairs Dominic LeBlanc and Transport Minister Omar Alghabra announced that the federal government plans to mandate the vaccination of all federal public servants, employees in federally-regulated transport industries, and passengers of commercial air travel, interprovincial rail service, and large marine vessels with overnight accommodations (e.g. cruise ships). The government will also "expect" the vaccination of all employees in industries regulated by the Canada Labour Code.[92][93] At the time of the announcement, the Government of Canada estimated that there are approximately 19,000 employers and 1,235,000 employees (8% of all workers in Canada) subject to the vaccine mandate.[94]

Soon after the announcement by the Government of Canada, some provinces began mandating vaccination for their public servants, starting with the Ontario government, who announced on August 17 that public health services and school boards will be required to have a "vaccination policy" in place that would require an employee to either be fully vaccinated or undergo regularly testing.[95][96] The same day, the Quebec government announced that healthcare workers in both the public and private sector must be fully vaccinated by October 1, 2021.[97] New Brunswick was the next province to follow, mandating vaccination or regular testing for provincial public servants.[98][99]

On August 27, 2021 the Moderna vaccine was approved for use in children aged 12 and up.[100]

Vaccination rollout by province and territory[]

COVID-19 vaccinations in Canada by province and territory, August 30, 2021 (
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)
Province Population People who have at least one dose People fully vaccinated Total population with at least one dose (%) Total population fully vaccinated (%) Ref
British Columbia British Columbia 5,174,724 3,894,230 3,514,485 75.26% 67.92% [101]
Alberta Alberta 4,444,277 2,921,476 2,606,944 65.74% 58.66% [101]
Saskatchewan Saskatchewan 1,179,906 781,247 694,445 66.21% 58.86% [101]
Manitoba Manitoba 1,382,904 984,908 915,357 71.22% 66.19% [101]
Ontario Ontario 14,789,778 10,803,172 9,923,606 73.04% 67.10% [101]
Quebec Quebec 8,585,523 6,505,169 5,894,283 75.77% 68.65% [101]
New Brunswick New Brunswick 783,721 587,882 522,277 75.01% 66.64% [101]
Prince Edward Island Prince Edward Island 160,536 127,917 111,966 79.68% 69.75% [101]
Nova Scotia Nova Scotia 982,326 755,500 687,683 76.91% 70.01% [101]
Newfoundland and Labrador Newfoundland and Labrador 520,286 416,026 360,371 79.96% 69.26% [101]
Yukon Yukon 42,596 33,291 31,848 78.16% 74.77% [101]
Northwest Territories Northwest Territories 44,991 34,636 32,475 76.98% 72.18% [101]
Nunavut Nunavut 39,536 23,484 20,638 59.4% 52.2% [101]
Canada Canada 38,131,139 27,868,938 25,316,378 73.09% 66.39% [101]


Additionally, 198,370 Moderna, 5,850 Pfizer-BioNTech and 460 Oxford-AstraZeneca vaccine doses have been kept for "Federal Application" for use with the Public Health Agency of Canada (PHAC), Canadian Armed Forces and the Correctional Service of Canada.[102]

National vaccination progress and orders[]

Total number of people receiving vaccinations in Canada as of August 27, 2021[1]

  Unvaccinated population: ~10,329,824 people (27.09%)
  Population who has one dose of a vaccine: 2,629,083 people (6.89%)
  Population who has received two doses of a vaccine: 25,172,232 people (66.01%)

Vaccines delivered per pharmaceutical company as of August 19, 2021[102]

  Pfizer-BioNTech (42,655,584) (66.97%)
  Moderna (18,041,170) (28.32%)
  Oxford-AstraZeneca (2,999,180) (4.71%)

There are several COVID-19 vaccines at various stages of development around the world. As of 2 December 2020 the Canadian government had invested over $1 billion,[103] including pre-placed orders for seven different vaccines, four of which are now approved by Health Canada. These pre-orders total more than 400 million doses.[104][105][103][106] Six of the seven vaccines require two doses each to be effective, with the exception of the Janssen Pharmaceutica (Johnson & Johnson) vaccine which only requires one dose.[103]

COVID-19 vaccines on order in Canada (
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)
Vaccine Progress Doses ordered Approval Deployment
Pfizer–BioNTech phase III clinical trials 51-76 million[107][108][109] Green check.svg 9 December 2020[110] Green check.svg 14 December 2020
Moderna phase III clinical trials 44 million[111] Green check.svg 23 December 2020[112] Green check.svg 31 December 2020
Oxford–AstraZeneca phase III clinical trials 23.9 million[113] Green check.svg 26 February 2021[114] Green check.svg 10 March 2021[115]
Janssen (Johnson & Johnson) phase III clinical trials 10-38 million Green check.svg 5 March 2021[116] Dark Red x.svg On hold[117]
Novavax phase III clinical trials up to 76 million Pending Pending
Medicago phase III clinical trials[118] up to 76 million Pending Pending
Sanofi–GSK phase III clinical trials up to 72 million Pending Pending



Vaccine policies by Province and Territory[]

On a Federal scale, the Government of Canada has promised to mandate vaccination to all Federally-regulated industries in Canada (including some private industries). As well, anyone wishing to travel on a Federally-regulated transportation method must show proof of vaccination.[119]

The following is a table representing individual provincial measures, policies and mandates for vaccination requirements by Province and Territory:

Vaccine policies by Province or territory
Province or territory Vaccine mandate for Healthcare Workers Vaccine mandate for Provincial employees Vaccine mandate for some or all private industry Provincial vaccine passport
Alberta Alberta No No No No
British Columbia British Columbia Incoming (October 12, 2021)[120] No Yes Incoming (September 13, 2021)[121]
Manitoba Manitoba No No No Incoming (September 3, 2021)[122]
New Brunswick New Brunswick No Incoming (September 13, 2021)[123] No No
Newfoundland and Labrador Newfoundland and Labrador No No No No
Northwest Territories Northwest Territories No No No No
Nova Scotia Nova Scotia No No No No
Nunavut Nunavut No No No No
Ontario Ontario Incoming (September 7, 2021)[124] Incoming[125] Incoming (September 7, 2021)[126] No
Prince Edward Island Prince Edward Island No No Yes[127] No
Quebec Quebec Incoming (September 1, 2021)[128] No No Incoming (September 1, 2021)[129]
Saskatchewan Saskatchewan No No No No
Yukon Yukon No No No No

Pharmacological data and developments[]

As the COVID-19 vaccines are relatively new, certain aspects of delivery and pharmacological care of the products have changed rapidly over the course of the vaccination programme.

Second dose administration[]

Early in the vaccination effort, debate on when to administer the second dose of the approved vaccines appeared medically and politically.[130] Each manufacturer had recommended respectively 21 days apart for Pfizer-BioNTech;[131] 28 days apart for Moderna;[132] and 4–12 weeks apart for Oxford-AstraZeneca.[133] New data suggested the manufacturer's recommendation could be lengthened, in theory allowing for more people to be vaccinated as supply efforts ramped up. Stanley Plotkin and Neal Halsey wrote an article published by Oxford Clinical Infectious Diseases that urged single dose interim use in order to extend vaccination to as many people as possible until vaccine availability improved.[134] Several other articles and media provided evidence for delaying 2nd doses in the same line of reasoning.[135][136][137] The province of Quebec began to withhold second dose administration,[138][139] and eventually adopted a 90-day strategy.[140] The National Advisory Committee on Immunization (NACI) had initially only recommended a maximum of 42 days in between doses.[141] The province of British Columbia had also followed suit and began plans to extend second dose administration to a four month delay.[142]

On March 4, 2021, the National Advisory Committee on Immunization (NACI) recommended that a maximum of four months or 112 days could be achieved effectively between second doses.[143] Other provinces began to adjust their administration programme based on the federal-level recommendation.[142]

Quebec no longer recommends a second dose for those previously infected with COVID-19, as the immunity is considered strong enough.[144] People still wanting to receive a second dose will be allowed to get it.

Beginning May 24, 2021, Saskatchewan became one of the first provinces to offer second dose administration on a shortened interval timeline, allowing people to book second dose appointments based on their age (beginning 80+) or first dose administration date.[145] Meanwhile, Ontario allowed people who received their first dose of the Oxford-AstraZeneca vaccine between March 10 and 19, 2021 to book second dose appointments of the same vaccine.[146]

Pfizer-BioNTech vial capacity[]

In January 2021, the province of Saskatchewan discovered it could draw extra doses of the Pfizer vaccine out of vials labelled as having 5 doses.[147]

As Pfizer prepared for industrial retooling to match international demands for its vaccine, causing a supply slowdown in Canada in January and February 2021, the company announced that their vials indeed contained 6 doses of vaccine, rather than 5.[148] Health Canada accepted the relabelling of the product, however the revelation required the acquisition of millions of low dead space syringes in order to extract the last dose from the vial.[149]

Pfizer-BioNTech storage requirements[]

Initially the Pfizer-BioNTech vaccine was required to be stored at ultra-cold temperatures (between -80 and -60 °C) in perpetuity, until application (in which time after dilution, the vaccine must be used within 6 hours).[150] On February 25, Health Canada recommended that the vaccine could be stored at regular freezer temperatures (between -25 and -15 °C) for up to two weeks.[151]

Oxford-AstraZeneca age range[]

On March 1, 2021, two days after the first delivery of the vaccine, the NACI announced that it would recommend that the Oxford-AstraZeneca vaccine not be given to patients older than 65 due to “the insufficiency of evidence of efficacy in this age group at this time.”[152] This recommendation was based on clinical trial data that only went as far as December 7, 2020.[153] Quebec did not follow this recommendation, but its own Immunization Committee recommended that the Pfizer and Moderna vaccines be given to higher-priority groups in the event of limited vaccine availability (with the AstraZeneca vaccine given to lower-priority groups).[154] On March 16, NACI revised its recommendations based on newly-obtained efficacy data from other countries.[153]

On March 29, 2021, NACI recommended that the Oxford-AstraZeneca vaccine not be given to patients younger than 55, citing reports of a rare, increased risk of blood clots with low levels of blood platelets (post-vaccination embolic and thrombotic events). Most provinces adhered to this recommendation.[155][156][157] In April 2021, due to the third wave of infections, and increased hesitancy towards the vaccine due to these side effects, multiple provinces (including Alberta and Ontario) went against NACI guidance and began to distribute the vaccine to people as young as 40.[158][159][160] On April 23, NACI changed its guidance to recommend the vaccine be offered to patients as young as 30 years old if benefits outweigh the risks, and the patient "does not wish to wait for an mRNA vaccine".[161]

Cessation of Oxford-AstraZeneca in certain provinces[]

Due to increased reports of post-vaccination embolic and thrombotic events, on May 11, 2021, the provinces of Alberta and Ontario decided to cease offering first dose appointments of the Oxford-AstraZeneca vaccine.[162][163] On May 12, Nova Scotia and Manitoba also announced similar restrictions,[164] with Quebec following the next day.[165]

Mixing of vaccines[]

Health Canada and NACI began looking into the possibility of mixing different vaccines in about April 2021.[166] As the future of AstraZeneca vaccines in Canada became increasingly uncertain, due to both shipment delays and the risk of rare blood clots, and preliminary data on the subject became increasingly available,[167][168][169] provincial governments' interest in the proposal grew. In early May, Quebec became the first province to approve of the mixing of an adenovirus vaccine (AstraZeneca) with an mRNA vaccine (Pfizer-BioNTech or Moderna), albeit only under certain circumstances: only people under 45 who have received a first dose of the AstraZeneca vaccine would be able to receive one of the mRNA vaccines as their second dose.[170][165] A couple of weeks earlier, Quebec had exceptionally allowed for the mixing of Moderna and Pfizer vaccines to go ahead in long-term care homes, as the supply of Moderna doses was low.[171]

On May 20, it was announced that Canada would be performing its own country-wide study on the effectiveness of mixing vaccines.[172]

On June 1, NACI approved the mixing of the three approved vaccines in Canada (Pfizer-BioNTech, Moderna, and AstraZeneca-Oxford). Specifically, they recommended mixing a first dose of the AstraZeneca vaccine with a second dose of one of the mRNA vaccines and mixing a first dose of a Pfizer or Moderna vaccine with a second dose of either mRNA vaccine.[173][174] Two weeks later, they changed their recommendations to suggest that a second dose of one of the mRNA vaccines after a first shot of AstraZeneca is "preferred", due to new evidence that seems to demonstrate an improved immune response on a mixed vaccine schedule.[175][176]

Rollout strategies[]

In December 2020, the NACI issued initial recommendations for a multi-stage rollout of vaccines that would prioritize specific populations in sequence, beginning with residents 70 and older, health care workers, and the employees and residents of long-term care facilities (due to the pandemic's disproportionate impact on them); and progressing towards wider age ranges, first responders, essential workers, and residents with comorbidities, before progressing towards the wider general public.[177][178]

Stage Recommended prioritization
1
  • Residents and staff of long-term care facilities.
  • Frontline health care and personal support workers who interact with patients.
  • Adults 70 and older, beginning with those who are 80 years and older, and decreasing in five-year increments as vaccine supply increases.
  • Adults who live in indigenous communities where they may be at a high risk of impact from COVID-19 due to a number of equity factors.
2
  • Essential primary caregivers of an advanced age.
  • Other adult residents of indigenous communities who did not receive vaccine during phase 1.
  • Adults 60–69, beginning with those who are 65 and older, and then decreasing.
  • Residents of "racialized and marginalized communities disproportionately affected by COVID-19". (i.e. Black Canadians, Filipino Canadians, Indo-Canadians)
  • Residents and staff of other communal living settings (i.e. group homes, homeless shelters, correctional facilities, etc.).
  • First responders (i.e. Police, Firefighters)
  • Frontline essential workers (direct close physical contact with the public) (i.e. workers in grocery stores, self-storage, hotels, restaurants, and airlines)
3
  • Adults 16–59 with co-morbidities.
  • Adults 50–59 with no co-morbidities, beginning with those who are 55 and older, and then decreasing.
  • Non-frontline essential workers.
  • Non-frontline health care workers.
  • University students living on-campus.
  • Professional & collegiate athletes.
  • Professional touring musicians and their staff.
NACI recommendations for the prioritization of vaccine doses[178]

Key people[]

Former[]

  • Major-General Dany Fortin, Vice President Logistics and Operations, PHAC (left the role on May 14, 2021 due to an unspecified military investigation[179])

See also[]

  • COVID-19 vaccination in Quebec
  • Deployment of COVID-19 vaccines

Notes[]

  1. ^ In an article in the Financial Post on January 14, 2021, responding to the delay in rolling out of Canada's vaccination program, GlaxoSmithKline Canada's Paul Lucas—who served as CEO from 1995 to 2012—said that, fifty years ago, during the Liberal premiership of Pierre Trudeau, there was little interest in chemical patents. Lucas said that this policy discouraged private investment in pharmaceutical innovations in Canada and caused the Canadian pharmaceutical industry to become focused on generic drugs.
  2. ^ Health policy professor emeritus Joel Lexchin said that the publicly-owned vaccine manufacturer Connaught Laboratories was privatized under the Conservative government of prime minister Brian Mulroney (1984-1993). Connaught was then part of Sanofi Pasteur. GSK acquired the Quebec-based vaccine manufacturer IAF BioChem. Sanofi and GSK—corporations outside Canada controlled decision-making about production. The three biggest vaccine makers Archived February 22, 2021, at the Wayback Machine—GlaxoSmithKline, Merck and Sanofi—lacked the new technologies essential for the production of newer forms of vaccine, that upstarts—such as Moderna and BioNTech—had mastered and by December it was evident that they were incapable of producing an effective COVID-19 vaccine.
  3. ^ According to Lexchin, newly-elected U.S. President Joe Biden reportedly continued the controversial America First policy of predecessor Donald Trump with respect to vaccine distribution. Canada was unable to obtain vaccine doses from the United States, even though the relevant American vaccine manufacturing facilities are relatively close to the Canada–United States border: Pfizer's facility in Kalamazoo, Michigan and Moderna's facility in Portsmouth, New Hampshire (actually a Lonza Group facility producing under contract).

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