The largest mass immunization effort in Canadian history began Dec. 14 in Ontario and Quebec after the country received its first COVID-19 vaccine shipment.
Prime Minister Justin Trudeau said Canada has signed a contract to receive up to 168,000 doses of Moderna’s COVID-19 vaccine by the end of December, ahead of their planned January arrival and part of 40 million Moderna doses Ottawa has secured for delivery by the end of 2021.
The Moderna vaccine has not yet been approved by Health Canada, but Trudeau said deliveries could begin within 48 hours of it getting the green light.
Canada is also set to receive about 200,000 of its total early shipment of Pfizer-BioNTech doses this week, on top of 30,000 last week. They are bound for 70 distribution sites across the country — up from 14 now — where the vaccine can be administered.
A vaccine maker said vials may yield more doses than expected.
Pfizer Canada spokeswoman Christina Antoniou said in an email that the amount of any excess vaccine left in the vial can vary based on provider technique and ancillary supplies.
“There may be excess vaccine in the vial after withdrawal of five doses, which in some cases may leave enough volume for an additional dose.”
Health Canada said in a statement that it’s aware vials may contain more than the five doses of 0.3 millilitres indicated on the label.
It said there are safeguards against potential losses in volume that can happen during storage, preparation and administration of the vaccine, and that can result in an extra dose or two.
Alberta’s chief medical officer Dr. Deena Hinshaw said extra vaccine in vials would be given when possible.
The Canadian military is assisting a massive effort to distribute 249,000 doses developed by pharmaceutical giant Pfizer and German partner BioNTech.
Here’s a look at what the various provinces have said about their rollout plans:
Newfoundland and Labrador
A public health nurse in St. John’s, N.L., received the province’s first dose of the Pfizer-BioNTech vaccine at Memorial University on Dec. 16.
Newfoundland and Labrador’s chief medical officer of health, Dr. Janice Fitzgerald, administered the symbolic first vaccine.
Premier Andrew Furey said he anticipated receiving 1,950 doses of the COVID-19 vaccine at the St. John’s receiving site last week.
Furey also said the province expects another shipment of the vaccine later in the month.
Prince Edward Island
In Charlottetown, a physician, a resident-care worker and a registered nurse were among the first people vaccinated on Prince Edward Island on Dec. 16.
Dr. Heather Morrison, the province’s chief medical officer of health, said a few hundred people would be vaccinated each day until Dec. 19.
P.E.I. received 1,950 doses of the vaccine in its first shipment.
The owner of a bluefin tuna exporting company in the eastern part of P.E.I. has offered up two freezers to the provincial government to aid in the effort to store the vaccine.
The province held its first COVID-19 vaccination clinic at the Miramichi Regional Hospital on Saturday (Dec. 19).
Pauline Gauvin, an 84-year-old resident of Shannex Losier Hall in Miramichi, was the province’s first recipient of the vaccine.
New Brunswick’s health minister had said a shipment of 1,950 doses of the Pfizer vaccine would be used to inoculate long-term care residents and staff, staff from rapid COVID-19 response teams, ambulance workers, health-care workers involved in COVID units, seniors 85 and older and First Nations nurses.
Dorothy Shephard said the vaccine plan was being carried out by the provincial Emergency Measures Organization.
The first round of vaccinations were being done at the Miramichi Regional Hospital, starting on Dec. 19 and continuing the following day. The hospital has an ultralow-temperature freezer to store the vaccine.
A nurse who works in a COVID unit at the Halifax Infirmary, was the first recipient in her province of the Pfizer-BioNTech vaccine on Dec. 16.
The province’s chief medical officer of health said 1,950 doses of Pfizer’s vaccine were received on Dec. 15.
Dr. Robert Strang said the first shots in Nova Scotia were destined for 350 front-line health workers in Halifax and would be administered at a clinic close to the Dalhousie University campus, where the province’s first shipment of the vaccine is being stored.
Strang said because the vaccine has specific handling requirements, Pfizer has stipulated that the initial round of immunizations take place near where the doses are stored.
Nova Scotia has one ultralow-temperature freezer to store the vaccine at the tertiary care teaching complex at the Queen Elizabeth II Health Sciences Centre.
Strang said the province is getting another freezer through Ottawa that will operate out of a central depot for vaccines at the public health office in Halifax. The province is also looking at securing freezers from the private sector.
The first doses of Pfizer’s COVID-19 vaccine were administered in the province on Dec. 14.
Residents of long-term care homes and health-care workers are being given first priority.
The groups next in line are people living in private seniors residences, followed by residents of isolated communities and then anyone aged 80 and over.
Authorities said that as of Dec. 20 a total of 4,716 inoculations had been administered.
Ontario received 6,000 doses of Pfizer’s COVID-19 vaccine last weekend and began giving them out on Dec. 14.
Retired gen. Rick Hiller, who is leading Ontario’s vaccine task force, said half the shots would be administered last week, and the other half would be intentionally held back to give the same workers a required second dose 21 days later.
“Given the sort of information flow of what we know about the supply, which is very little at this time … we decided it was better to err on the side of caution,” he said.
An additional 90,000 doses of the Pfizer vaccine are expected to arrive later this month and are to be provided to 14 hospitals in COVID-19 hot spots.
Hillier has said the province also expects to receive between 30,000 and 85,000 doses of the Moderna vaccine by the new year, pending its approval by Health Canada.
Ontario’s Solicitor General Sylvia Jones said hospitals receiving the first shots have made security arrangements to ensure the vaccine is safe from theft.
A doctor who works in an intensive care unit became the first person in Manitoba to get the COVID-19 vaccine on Dec 16.
Premier Brian Pallister said some 900 health-care workers in critical care units would be the first to receive the vaccine.
As more shipments come in, priority will be given to other health-care workers, seniors and Indigenous people.
The province plans to vaccinate more than 100,000 people by March — that’s roughly seven per cent of Manitoba’s population.
Officials say they’ve been setting up a large-scale “supersite” to deliver the vaccine. The first freezer able to store the Pfizer vaccine at low temperatures has been delivered and installed, with another four on the way.
The province says the vaccine will become more widely available at a larger number of sites, similar to a conventional vaccination campaign, such as the annual flu shot.
Saskatchewan began its vaccination program on Dec. 15 as two health-care workers got the first shots.
Premier Scott Moe says the province received 1,950 doses of Pfizer’s vaccine.
The first official stage of Saskatchewan’s vaccination program will be in late December when the province receives more doses.
It will target more health-care workers, staff and residents in long-term care, seniors over 80 and people in remote areas who are at least 50.
Some 202,052 doses of the Pfizer vaccine are expected to arrive within the first quarter of next year, and there are to be 10,725 weekly allocations.
Moe says vaccinations for the general population is expected to begin in April.
The first vaccinations in Calgary and Edmonton were given Tuesday to health-care workers.
Alberta Premier Jason Kenney announced in a video released on Dec. 14 and recorded next to a cargo plane at Calgary International Airport that the province’s first 3,900 vaccine doses had arrived.
Alberta Health Minister Tyler Shandro said another 25,000 Pfizer doses would be coming this week and would be given to health workers.
Doses of the Moderna vaccine are expected by the end of the month.
The province says it eventually plans to roll out the vaccine from 30 different locations.
The first COVID-19 vaccination was administered on Dec. 15 in British Columbia. Those working in long-term care facilities and intensive care units were the first people to take part in the province’s immunization program.
Provincial health officer Dr. Bonnie Henry said an initial shipment of 4,000 doses of the Pfizer-BioNTech vaccine would be available at two clinics in the regions covered by the Vancouver Coastal and Fraser health authorities, before immunization is eventually expanded to 30 sites.
Workers in long-term care facilities are at the top of the list to get the vaccine.
A joint statement from Henry and Health Minister Adrian Dix said nearly 2,600 doses of the Pfizer-BioNTech vaccine had been administered to front-line health-care workers as of Dec. 18.
Henry expects about 400,000 people to be vaccinated by March.
The province said it is developing a system so people can register to get the vaccine and receive a formal record of immunization.
Nunavut’s premier says the territory will get the vaccine made by Moderna in the first quarter of 2021.
Joe Savikataaq says Prime Minister Justin Trudeau has told him Nunavut will get enough doses to vaccinate 75 per cent of the population.
Chief public health officer Dr. Michael Patterson says Nunavut will prioritize elders and health-care workers first for the vaccine.
Savikataaq says his government is still working on its plan to roll out the vaccine once it arrives in the territory.
The premier of the Northwest Territories says N.W.T. will receive 51,000 doses of the Moderna vaccine in the new year.
Caroline Cochrane says that’s enough to vaccinate 75 per cent of the population ages 18 and up.
The territory is creating a vaccine team made up of nurses and support staff to travel to smaller communities.
Health Minister Julie Green says two specialized freezers for storing the vaccines are on their way from the federal government and will be placed in Yellowknife and Inuvik.
Smaller, portable freezers are also on the way and will be placed in smaller communities.
Yukon says it will get enough of the Moderna vaccine by spring to vaccinate 75 per cent of its residents.
A statement from the Yukon government says the territory’s allocation is in recognition of its large Indigenous populations and remote communities.
Premier Sandy Silver says getting vaccinated is the best thing residents can do to protect themselves and their loved ones.
“Over time, widespread immunization will allow us to return to a life without COVID-19 restrictions.”
This report by The Canadian Press was first published Dec. 21, 2020.
The Canadian Press
In coronavirus vaccine drive, Deep South falls behind – Airdrie Today
ATLANTA — The coronavirus vaccines have been rolled out unevenly across the U.S., but four states in the Deep South have had particularly dismal inoculation rates that have alarmed health experts and frustrated residents.
In Alabama, Georgia, Mississippi and South Carolina, less than 2% of the population had received its first dose of a vaccine at the start of the week, according to data from the states and the U.S. Centers for Disease Control and Prevention.
As in other parts of the country, states in the South face a number of challenges: limited vaccine supplies, health care workers who refuse to get inoculated and bureaucratic systems that are not equipped to schedule the huge number of appointments being sought.
But other states have still managed — at their best — to get the vaccines into the arms of more than 5% of their populations.
Though it’s not clear why the Deep South is falling behind, public health researchers note that it has typically lagged in funding public health and addressing disparities in care for its big rural population.
“When you combine a large percentage of rural residents who tend to be the hard-to-reach populations and have lower numbers of providers with trying to build a vaccine infrastructure on the fly, that’s just a recipe for a not-so-great response,” said Sarah McCool, a professor in public health at Georgia State University.
In Georgia, the state’s rural health system has been decimated in recent years, with nine hospital closures since 2008, including two last year. Local health departments have become the primary vaccine providers in some locations, as officials work to add sites where doses can be administered.
“If we’re the only game in town, this process is going to take a long time,” Lawton Davis, director of a large public health district that includes Savannah, said at a news conference on Monday.
Alabama and Mississippi have also been hit hard by rural hospital closures. Seven hospitals have shut down in Alabama since 2009 and six in Mississippi since 2005, according to researchers at the University of North Carolina’s Sheps Center. Alabama, Georgia and Mississippi ranked in the bottom five of U.S. states in their access to health care, according to a 2020 report from a not-for-profit foundation connected to insurance giant UnitedHealth.
But overall, experts say it’s too early in the vaccine rollout to draw conclusions about the region’s shortcomings, and they can’t easily be attributed to a particular factor or trend.
“We’re sort of building this plane as we’re flying, and there are going to be missteps along the way,” said Amber Schmidtke, a microbiologist who has been following vaccine dissemination in the South.
Officials in the individual states have cited a number of challenges, but also acknowledged shortcomings.
“We have too many vaccines distributed that are not in arms yet,” said Mississippi Gov. Tate Reeves, who noted that some hospitals in the state are not using their vaccine doses. He said that practice “has to stop.”
Georgia Gov. Brian Kemp cited a similar challenge and warned providers holding on to vaccines that the state would take their unused doses even if that required “firing up” his pickup truck and doing it himself.
But in South Carolina, hospital officials say it is the state that has moved too slowly to expand access to the vaccinations, leaving them with unused doses. The state recently did offer the vaccine to those 70 and older.
Mississippi’s Reeves said one of the biggest weaknesses in the state’s vaccination system is the federal partnership with CVS and Walgreens to administer vaccinations in long-term care facilities. The pharmacy chains have been slow in hiring enough people to do the work in Mississippi, the governor said.
CVS Health said in a statement that it has “the appropriate resources to finish the job” at long-term care facilities. Walgreens did not respond to an email.
During an online forum hosted by Jackson State University in Mississippi on Thursday, U.S. Surgeon General Jerome Adams, who is Black, noted the reluctance of many African Americans to be vaccinated. He cited a general mistrust of medical systems stemming back to a now-defunct government study that started in the 1930s and left Black men untreated for syphilis for decades.
So far, only 15% of COVID-19 vaccinations in Mississippi have gone to Black people, who make up about 38% of the population, state health officer Dr. Thomas Dobbs said during the forum.
Officials in all four states also said some health care workers — among the first groups eligible for a vaccine — are choosing not to get inoculated. And some stressed that states were dealing with limited supplies and high demand and implored people to be patient.
“Yes, the phone lines will be busy. Yes, the websites will certainly crash,” Kemp said Tuesday. “There are simply vastly more Georgians that want the vaccine than can get it today.”
Mississippi officials said the state’s website and telephone hotline were overwhelmed after the governor announced Tuesday that vaccinations were available to people 65 or older or people who have underlying medical conditions.
Liz Cleveland, a 67-year-old retired state employee who lives in Jackson, waited hours on the website using her cellphone, computer and tablet only to encounter unknown errors.
“It’s like gambling. You may hit or you may bust,” Cleveland said.
About 2 a.m. Wednesday, she was finally able to book appointments for herself and her husband next week in Hattiesburg, which is 90 miles (145 kilometres) away. Mississippi officials said Thursday that they will open an additional drive-thru site for vaccinations soon in the state’s largest county.
Alabama officials also have been inundated with requests for appointments since announcing the state will begin vaccinations for people over 75 next week. A state hotline received more than a million calls the first day it was open.
Celia O’Kelley of Tuscaloosa said she couldn’t get through to anyone to get an appointment for her 95-year-old mother.
“I am scared because Tuscaloosa is a hot spot,” she said.
Associated Press writers Kim Chandler in Montgomery, Alabama; Emily Wagster Pettus in Jackson, Mississippi; and Michelle Liu in Columbia, South Carolina, contributed to this report.
Sudhin Thanawala, The Associated Press
Norway Warns of Vaccination Risks for Sick Patients Over 80 – Bloomberg
Norway said Covid-19 vaccines may be too risky for the very old and terminally ill, the most cautious statement yet from a European health authority as countries assess the real-world side effects of the first shots to gain approval.
Norwegian officials said 23 people had died in the country a short time after receiving their first dose of the vaccine. Of those deaths, 13 have so far been autopsied, with the results suggesting that common side effects may have contributed to severe reactions in frail, elderly people, according to the Norwegian Medicines Agency.
“For those with the most severe frailty, even relatively mild vaccine side effects can have serious consequences,” the Norwegian Institute of Public Health said. “For those who have a very short remaining life span anyway, the benefit of the vaccine may be marginal or irrelevant.”
The recommendation does not mean younger, healthier people should avoid being vaccinated. But it’s an early indication of what to watch as countries begin to issue safety monitoring reports on the vaccines. Emer Cooke, the new head of the European Medicines Agency, has said tracking the safety of Covid vaccines, especially those relying on novel technologies such as messenger RNA, would be one of the biggest challenges once shots are rolled out widely.
Allergic reactions have been uncommon so far. In the U.S., authorities reported 21 cases of severe allergic reactions from Dec. 14-23 after administration of about 1.9 million initial doses of the vaccine developed by Pfizer Inc. and BioNTech SE. That’s an incidence of 11.1 cases per million doses, according to the Centers for Disease Control and Prevention.
Though both Covid-19 vaccines approved so far in Europe were tested in tens of thousands of people — including volunteers in their late 80s and 90s — the average trial participant was in his or her early 50s. The first people to be immunized in many places have been older than that as countries rush to inoculate nursing-home residents at high risk from the virus.
Norway has given at least one dose to about 33,000 people, focusing on those considered to be most at risk if they contract the virus, including the elderly.
In France, one frail patient died in a care home two hours after being vaccinated, but authorities said given the patient’s previous medical history there is no indication the death was linked to the vaccine. The French pharmaceutical safety agency on Thursday reported four cases of severe allergic reactions and two incidents of irregular heartbeat after vaccination.
Representatives for Pfizer and BioNTech didn’t immediately respond to requests for comment.
The Pfizer-BioNTech vaccine approved late last year has been used most broadly, with a similar shot from Moderna Inc. approved earlier this month also now being administered.
— With assistance by Rudy Ruitenberg, and Stephen Treloar
Quebec to allow 90-day delay before second vaccine doses, more than double what national panel advises – CTV Montreal
QUEBEC CITY —
Quebec public health officials said Thursday that provincial advisors have recommended a prolonged COVID-19 vaccination schedule of up to 90 days between the first and second dose — more than double what a national advisory committee recommended a day earlier.
“In our context, that is the best strategy,” said Health Minister Christian Dubé at a Thursday press conference on Quebec’s vaccination progress.
Quebec announced in late December it would be delaying second doses or “booster shots” of the vaccine, but the province hasn’t said until Thursday what kind of delay it had in mind.
Provincial officials now say the second dose should come between 42 and 90 days after the first.
Such a schedule would allow the province to give the vaccine to more people who would otherwise have to wait for their first dose, said the health officials.
A delay of 90 days is much longer than what’s been recommended by Pfizer (21 days, for its vaccine), Moderna (28 days, for its vaccine), and federal public health advisors in their recommendation on Wednesday (up to 42 days for both vaccines).
However, that national advisory panel, called NACI, said Thursday that provinces have some leeway to make their own decisions and they aren’t opposing Quebec’s 90-day timeline.
Canada’s Deputy Chief Public Health Officer, Dr. Howard Njoo, said that certain provinces’ “exceptional circumstances” may mean they need to depart from federal recommendations.
“It is sort of the interplay between the actual epidemiology, on the ground, the fact that there is a obviously increased rate of cases, hospitalizations,” said Njoo, and the vaccine guidelines.
EXTENSION BASED ON ‘EXPERIENCE,’ NOT DATA, SAYS QUEBEC
So why is the province talking about 90 days?
Health Ministry advisor Dr. Richard Massé said Quebec experts believe it’s likely that immunity will last longer than 42 days, as recommended by the NACI panel, but clinical trials have not extended past that.
What they’re relying on instead is past experience with other vaccines.
“What we have is the experience working with many vaccines,” said Massé. “Immunity is not something that is ‘on’ or ‘off.’”
While Quebec’s Ministry of Health has said that a single dose can provide up to about 90 per cent efficacy against the virus, Pfizer says that one dose alone is just 52.4 per cent effective.
Massé told reporters the discrepancy comes from different and more specific analysis of Pfizer’s trial data.
He said that Pfizer, when studying the issue, had been including people who had gotten their first dose but hadn’t had time to build up immunity.
“It takes 12 to 14 days to have immunity,” said Massé. “If you count people who get the disease two, three, five days after getting the vaccine, it’s not really a failure of vaccination because immunity [hasn’t been built up].”
One expert told CTV News this week that there are big variations in the efficacy estimates because of the small sample size of people who got only the first shot in the Pfizer trial. That expert, Dr. Donald Vinh, said that in his opinion the efficacy is likely somewhere in the range of 60 to 69 per cent.
In a statement to CTV News, Pfizer Canada spokeperson Christina Antoniou reiterated earlier statements that Pfizer has not evaluated the efficacy of its vaccine on alternative dosing schedules.
“There are no data to demonstrate that protection after the first dose is sustained after 21 days,” she said.
“We recognize that recommendations on alternative dosing intervals reside with health authorities and may include adapting public health recommendations in reaction to evolving circumstances during a pandemic,” she wrote.
But for Pfizer, “as a biopharmaceutical company working in a highly regulated industry, our position is supported by the label and indication agreed upon with Health Canada and informed by data from our Phase 3 study.”
Minister Dubé said the province has been talking to Pfizer. On Jan. 5, Pfizer told CTV News that Quebec had not informed the company before deciding to delay the second dose.
“We’ve had conversations with Pfizer,” said Dube, “to inform them as to why we were making those decisions.”
Earlier this week, Premier François Legault said that in discussions with the federal government, the province learned there may be a risk of losing Quebec’s vaccine supply if Pfizer isn’t happy with its dosing regime.
On Thursday, Pfizer’s statement said the company “remain[s] committed to our ongoing dialogue with regulators, health authorities and governments, and to our continued data-sharing efforts to help inform any public health decisions aimed at defeating this devastating pandemic.”
Both Massé and Dubé said they are hoping for an increased supply, since they would favour a shorter delay before the second dose if the province’s deliveries of vaccine increase.
“Saving lives is a moral imperative,” said Dubé.
“The more doses we have, the more we’re going to be able to decrease the time between the first and second dose.”
NEXT STEPS FOR QUEBEC’S VACCINATION
With about 65 per cent of CHSLD residents already given a first dose, Dubé said Quebec will begin vaccinating residents of private seniors’ homes (RPAs) on Jan. 25.
He said that with a prolonged schedule between the first and second doses, the province can also consider vaccinating the general senior population sooner.
With new vaccine shipments arriving in the province this week, Dubé said 115,000 people have now been vaccinated.
In total, the province has received 162,000 doses so far. Dubé says Quebec is on track to increase that total to 250,000 in February.
–With files from CTV’s Kelly Greig
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