The COVID-19 pandemic has hit the world hard, and countries around the globe are anxious to get their hands on a vaccine as soon as possible in the hopes that it will bring a return to normalcy.
Those vaccines are expected to be in short supply when they first hit the market, meaning not everyone will have access initially. Within countries, some groups will be prioritized for vaccination.
But what about globally? Which countries will get the vaccines first?
Many wealthier nations are already making bets on vaccines still in relatively early stages of development, with no guarantee that they will ever perform well enough to gain approval or protect their populations.
That has many concerned about “vaccine nationalism,” where countries look out for their own interests at the expense of others.
Here’s a closer look at what wealthier countries are doing to ensure supplies for their own citizens, how that might affect other countries, how Canada might fare and what efforts are being made to distribute a vaccine more fairly.
What can countries do to obtain a vaccine first?
There are a few different ways wealthier countries can try to ensure their own supplies:
Provide funding for the development and manufacture of their own candidates to help speed it up.
Manufacture a vaccine within their own country and prevent it from being exported.
Make deals to reserve or preorder large numbers of doses.
What impact does that have on other countries?
In previous pandemics, such as an H1N1 outbreak in 2009, wealthier nations were able to buy up the first batches, leaving no supply for lower-income countries.
And even some richer countries, including Canada, weren’t always first in line if they didn’t have their own manufacturing facilities. During the swine flu outbreak in 1976, for example, the U.S. decided to vaccinate its entire population before it would allow vaccine producers to export their products to Canada.
What are countries doing to ensure their own supply?
The U.S. has a program called Operation Warp Speed, which aims to produce a vaccine faster than anyone else. President Donald Trump has said he hoped it would be available before the end of the year.
The program has already announced that it’s providing more than $6 billion US to pay for development, manufacturing and preorders or reservations for hundreds of millions of doses of promising vaccine candidates from U.S.-based Johnson & Johnson, Moderna, Novavax, Pfizer and Merck, along with U.K.-based AstraZeneca.
Dr. Francis Collins, director of the National Institutes of Health, holds up a model of the coronavirus SARS-CoV-2 at a U.S. Senate subcommittee hearing on July 2 in Washington on the plan to research, manufacture and distribute a coronavirus vaccine, known as Operation Warp Speed. (Saul Loeb/Pool via The Associated Press)
Similarly, the European Commission has a plan to use an emergency fund worth €2.4 billion (almost $3.7 billion Cdn) to buy up to six vaccines in advance for 450 million people.
Germany, France, Italy and the Netherlands have also signed a deal with AstraZeneca for over 300 million doses of its vaccine, which they say all EU members can participate in.
Meanwhile, the United Kingdom has preordered nearly 200 million doses from AstraZeneca, BioNTech/Pfizer and France-based Valneva.
There are concerns such preorders could reduce the initial availability of vaccines in the rest of the world, which has happened in previous pandemics
The federal government has created a $600 million fund to support vaccine clinical trials and manufacturing in Canada.
It is also “closely monitoring vaccine development efforts — domestically and internationally — and will work quickly to negotiate advanced purchase agreements with vaccine manufacturer(s) to secure supply for all Canadians as soon as it is feasible,” Geoffroy Legault-Thivierge, a spokesperson for the Public Health Agency of Canada, told CBC News in an email.
However, as of July 30, it hadn’t yet announced any such agreements.
The government has also announced it is ordering enough equipment, such as syringes, alcohol swabs and bandages, to give at least two doses of a vaccine to every Canadian when one becomes available.
Still, experts warn that Canada currently doesn’t have much manufacturing capacity for vaccines, even those developed in this country — many of which would be manufactured elsewhere and some of which would likely be licensed to foreign companies for manufacturing.
Vials used by pharmacists to prepare syringes are used on the first day of a first-stage safety study clinical trial of the potential vaccine for COVID-19 in March. (Ted S. Warren/The Associated Press)
Quebec City-based Medicago is the first Canadian vaccine candidate to begin clinical trials. But CEO Bruce Clark has said that his company’s main manufacturing plant is in the U.S., meaning there’s no guarantee that a supply would reach Canada in a timely manner.
“‘Guarantee’ is a strong word,” Clark told The Canadian Press in July. “Strange things happen to borders in the context of a pandemic.”
Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University and the IWK Health Centre in Halifax, said Canada is a very small market.
“And we will not have a vaccine if the manufacturer doesn’t apply for approval,” said MacDonald, who has done research on ethical issues surrounding vaccines.
In the past, some manufacturers have not prioritized Canada, she said. For example, the manufacturer of the chicken pox vaccine didn’t apply for approval in Canada until it had already been available in the U.S. for five years.
Why should all countries have access to a vaccine?
Because it’s a global pandemic and our world is interconnected, outbreaks in any country have the potential to travel to other countries and cause outbreaks there, MacDonald said. “For you to be safe … your country needs to be safe and all other countries need to be safe.”
That’s even the case if the entire population is vaccinated, she said, as a given vaccine usually doesn’t work for everyone.
Due to manufacturing and distribution constraints, when a vaccine first becomes available, there isn’t expected to be enough of it to vaccinate the entire populations of even countries wealthy and lucky enough to have preordered it. That means most of their populations could remain at risk for a long time if the pandemic isn’t under control in other parts of the world.
Outbreaks also tend to be worse and harder to control in poorer countries, posing a higher risk to both their own populations and the world.
A volunteer receives an injection of a COVID-19 test vaccine, developed at Oxford University in Britain, at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg, South Africa. (Siphiwe Sibeko/The Associated Press)
Dr. Joel Lexchin, a professor emeritus at York University in Toronto who has studied pharmaceutical policy, said many wealthier countries such as Canada are able to do a pretty good job of controlling the virus without a vaccine through such measures as physical distancing, frequent handwashing, mask wearing and temporarily shutting down certain businesses and services.
Meanwhile, lower-income countries where many people live in crowded conditions — some of them with limited access to things like clean water and soap — are struggling with both controlling the epidemic and treating those who have fallen ill.
“I think you need to look at where the outbreak is still the greatest threat to public health and also where the medical care resources are the lowest,” Lexchin said.
“You can make the case that however much we need a vaccine in Canada, there they need it much more than we do.”
What about global efforts to ensure a fair distribution?
There are some, but perhaps the biggest is the COVAX Facility, an initiative of the World Health Organization; Gavi, the Vaccine Alliance, which is a public-private partnership founded by the Bill & Melinda Gates Foundation that vaccinates children against deadly diseases; and the Coalition for Epidemic Preparedness Innovations, which aims to develop vaccines to stop future epidemics.
COVAX is pooling money from dozens of countries to invest in vaccine candidates around the world, with a goal of delivering two billion vaccine doses globally by 2021.
The program is designed to connect developing and developed nations, with all partners getting enough doses of a successful vaccine for 20 per cent of their populations, initially prioritizing health-care workers. So far, it’s signed on 75 higher-income countries — including Canada but not the U.S. — to partner with 90 lower-income countries that together represent more than 60 per cent of the world’s population. It’s also joining forces with vaccine manufacturers.
Health workers screen residents for COVID-19 symptoms at the Deonar slum in Mumbai, India, on July 11. In just three weeks, India went from being the world’s sixth worst-affected country to the third, according to a tally of coronavirus cases by Johns Hopkins University. (Rajanish Kakade/The Associated Press)
The program includes investment in production facilities and incentives to scale up through preorders.
Because most vaccine candidates are not expected to succeed and make it to market, COVAX is designed to get higher-income countries to participate by improving the chance that they’ll invest in a successful vaccine.
“This is an initial opportunity for a wealthy country to kind of hedge their bets and protect their own interests and also contribute to a global effort to secure vaccine for people living in countries where the resources are not there to do it on their own,” said Prof. Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics in Baltimore.
Gavi, the Vaccine Alliance, says it has raised $600 million US from higher-income countries and the private sector to provide an incentive for manufacturers to make enough vaccine to ensure access for developing countries.
Will efforts for a fair distribution of vaccines work?
York University’s Lexchin said it’s not clear if vaccines will be fairly distributed. He noted in an article in The Conversation that even for COVAX, rich countries will get the vaccine before poorer countries. And all countries will only be able to vaccinate their highest-priority groups, including health-care workers — just 20 per cent of the population through the program, limiting its influence.
Lexchin said in an interview that middle-income countries such as Brazil and Mexico sometimes fall through the cracks, as they’re not poor enough to take advantage of lower prices offered by manufacturers, who set the prices.
He said he thinks leaders, including Canada’s, need to step up as well, by requiring that vaccines and treatments be made available at affordable prices to low- and middle-income countries if government funding was received for their development.
Still, MacDonald of Dalhousie University is cautiously optimistic.
“We’re in better shape to be more equitable about a COVID-19 vaccine globally than we were for the influenza pandemic,” she said.
“Do I think we’re going to get it right? … I hope we’ll get it more right.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
