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Canada is 'playing chicken' with COVID-19 by reopening while variants are spreading widely – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Much of Canada is lifting lockdown measures and reopening risky indoor settings while experts warn fast-spreading coronavirus variants threaten to jeopardize recent progress and trigger a brutal third wave.

On the same day Manitoba announced its first case of the variant initially detected in the United Kingdom, the province also said it would reopen restaurants, gyms, places of worship, museums, art galleries, tattoo parlours, nail salons and libraries.  

That variant, also known as B117, is estimated to be at least 50 per cent more transmissible and potentially more deadly and led to strict lockdowns in countries like Denmark, Ireland and the U.K., where it quickly became a dominant strain. 

Alberta, which already has 149 cases of B117 and seven cases of the variant first identified in South Africa, also decided to reopen restaurants, bars and gyms this week despite the rapid rise in variant cases.

“It’s kind of like we’re playing chicken with COVID, which never struck me as being a great idea,” said Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta faculty of medicine in Edmonton. 

“There’s been enough demonstrated risk from the variants being able to become dominant strains over a period of time in multiple jurisdictions that I would have preferred to hold steady and monitor for a period longer.” 

Meanwhile, those variants have caused a surge in cases so rapid in Newfoundland and Labrador, the province has imposed new lockdown measures and cancelled in-person voting for today’s election.

An election campaign sign is shown in St. John’s on Thursday. The outbreak has led to a lockdown of Newfoundland and Labrador, and the suspension of in-person voting across the province. (Paul Daly/The Canadian Press)

Balancing return to ‘normal’ with threat of variants

Saxinger says that while Alberta and other provinces have done an effective job of monitoring for the variants as they emerge, she expects the number of variant cases will no doubt continue to grow as the economy reopens.

“Opening indoor dining is a mistake — plain and simple,” said Dr. Irfan Dhalla, a physician and University of Toronto medical professor who is also a vice-president at Unity Health Toronto. 

“It’s pretty obvious that if we just went back to normal there would be a third wave and it would be absolutely brutal.”

Dhalla says officials are trying to answer the tricky question of how close to normal they can get, while trying to balance keeping cases low in the face of fast-spreading variants. 

“Nobody knows the answer to that question with certainty, but I think everything we’ve seen over the last year tells us it’s better to err on the side of caution,” he said. 

“The prudent thing to do would be to go slow and see what happens after a few weeks.”

Despite keeping its provincewide curfew in place, Quebec has also begun reopening businesses, museums, hair salons and malls — even though gathering in them will not be permitted.

Ontario also began rolling back restrictions this week, lifting stay at home orders in much of the province, allowing for non-essential businesses and even ski hills to reopen, while committing to further loosening measures in the coming weeks. 

“This is not the time to really begin pulling back on restrictions,” Dr. Gerald Evans, chair of infectious disease in the department of medicine at Queen’s University in Kingston, Ont., told The Current this week.

Signs for COVID-19 protocols are displayed as skiers and snowboarders hit the slopes at Mount Pakenham ski hill in Eastern Ontario as the business reopens on Thursday. (Sean Kilpatrick/The Canadian Press)

“Our expectation, when we look at the experience of other countries that have had that variant introduced, is we’re going to see a rise up in numbers and so you don’t want to complicate that by now suddenly rolling back restrictions.” 

The decision to loosen restrictions in Ontario came at the same time health experts warned in a provincial scientific briefing that the spread of variants threatened to trigger a third wave of the pandemic, which could in turn lead to a third lockdown.

“We need to be watching how this unfolds and how it plays out before we make too many changes all at once,” said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto. 

“The overall numbers look to be going down, but these variants are emerging and they will likely emerge rapidly and our ability to control transmission might change with that.” 

Outbreak in Newfoundland sparked by B117

In a cautionary tale for the rest of the country, health officials in Newfoundand and Labrador confirmed late Friday that a massive outbreak of COVID-19 in St. John’s this week was caused by B117, leading strict lockdown measures to be reimposed.

The province reported 50 new cases of COVID-19 Friday, with the vast majority in the St. John’s region. Thousands of people are in isolation, while others faced renewed lockdown measures that shuttered schools and non-essential businesses.

Bruce Chaulk, the province’s chief electoral officer, announced during a press conference Friday that in-person voting in all 40 districts across the province had been suspended and the election would be solely by mail due to the outbreak.

“We know that if not controlled, it becomes a predominant strain within weeks of first appearance,” said Dr. Janice Fitzgerald, the province’s chief medical officer of health.

“This is concerning and serious. But we have the ability to overcome it.”

There are 260 active cases in the province, with 244 of those reported in the last five days. In contrast, the province had 395 total cases of COVID-19 in all of 2020.

“I actually worry more about those areas that have been spared through most of the pandemic,” said Hota.

“You don’t know what it’s like to deal with COVID until it hits you — and it hits hard.” 

WATCH | Provinces reach for mix of reopening, COVID-19 precautions:

Three provinces — Ontario, Quebec and Alberta — have announced the easing of restrictions, some immediate, some phased in. Strict measures have reduced COVID-19 caseloads and some experts warn relaxing them could bring another spike in cases. 2:39

‘Mixed messaging’ between health experts, provinces 

All of the provinces that moved toward reopening this week cited reduced caseloads as reasoning for their strategies, despite the fact that cases of the variants continue to rise. 

At least three provinces have confirmed community spread of the variants and there have been more than 450 variant cases in Canada to date.

But at the federal level, dire warnings about reopening amid the spread of variants seems to conflict with what’s happening on the ground.

“Resurgence will happen really fast, so this is the time to be vigilant against the variants,” Canada’s Chief Public Health officer Dr. Theresa Tam said during a press conference Friday. 

“We need to really be very cautious about easing public health measures at this time while vaccination is just beginning to accelerate.” 

Dhalla says there’s a growing disconnect between provincial politicians and medical officers of health across the country, which is only adding to confusion for the public. 

Customers enjoy indoor dining at Hunter’s Country Kitchen in Carstairs, Alta., Monday, as Alberta begins a plan to ease restrictions. (Jeff McIntosh/The Canadian Press)

“I think what we’re also starting to see is a little bit of mixed messaging again,” he said.

For example, in Toronto — where a stay-at-home order is in place until at least Feb. 22 — the medical officer of health said this week the city was on the verge of a “new pandemic” due to the spread of variants in the city, which has already found cases of variants first identified in the U.K., South Africa and Brazil. 

“It was inevitable the variants of concern would emerge in Toronto,” Dr. Eileen de Villa said during a press conference.

“We are in a position of great uncertainty with respect to variants but what we know is alarming. I understand the value of preparing for the time we can lift restrictions. From a public health perspective in Toronto, that time is not now.” 

Threat of variants kept restrictions in some provinces

British Columbia said last week it would be extending its public health restrictions indefinitely, despite recent signs that the province is driving transmission down even with at least 40 cases of variants detected. 

“Right now, we need to stay the path,” Provincial Health Officer Dr. Bonnie Henry said. “We need to protect the progress we have made and not squander our progress.”

A Vancouver waiter delivers wine to masked diners outdoors. In B.C., restrictions on gathering with people outside your household that were imposed in November remain in place with no end date. (Ben Nelms/CBC)

New Brunswick is another province sticking with strict public health measures despite having just four confirmed cases of B117. Parts of the province are under lockdown and non-essential travel discouraged in other regions.

“They are going to come to New Brunswick, if they’re not already here,” said chief medical officer of health Dr. Jennifer Russell of the variants late last month after measures were imposed.

“We are in the middle of the second wave right now, but the third wave is going to be upon us very soon and that third wave is much worse than the first and second combined and this third wave is as a result of these new more transmissible, more contagious variants.”

Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, says Canada is already starting to see the early warnings of a surge driven by variants and his research predicts a third wave could come as early as March.

“[B117] is doing here what it’s done in Denmark and the U.K. — the new strains are starting to outcompete the old strains,” he said. “Even though it’s a small minority of strains, they’re spreading better here than the old variants are spreading.” 

Saxinger says stronger action needs to be taken “extremely early” to prevent a devastating third wave from variants in Canada and hesitating to act could jeopardize our ability to drive case numbers down — even with strict public health measures that have worked in the past. 

“The leash just has to be very, very short,” she said. 

“Because there’s no way we’re going to have enough vaccines into all the vulnerable populations over the next few months to be able to avert preventable deaths if there’s another big surge.” 


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Canada unveils greenhouse gas reduction credits to boost carbon trading market

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By Nia Williams

CALGARY, Alberta (Reuters) – Canada released draft regulations on Friday aimed at stimulating domestic carbon credit trading, part of the federal government’s push to curb emissions of climate-warming greenhouse gases.

Canada, the world’s fourth-largest oil producer and one of the highest greenhouse gas (GHG) emitters on a per capita basis, has committed to reducing emissions by 2030 to 30% lower than 2005 levels. It is targeting net-zero emissions by 2050.

The new Federal GHG Offset System is designed to support a domestic carbon trading market. Projects that reduce or remove GHGs can generate credits and sell them to industrial facilities – such as cement works or refineries – that exceed emissions limits determined under Canada‘s carbon tax.

Environment Minister Jonathan Wilkinson said the system will create opportunities for farmers, foresters and indigenous communities, among others, to earn revenues from projects that cut GHG emissions.

Ottawa also hopes it will spur innovation and private-sector investment in emissions-reducing technology, and allow Canadian industry to remain competitive by lowering the cost of carbon credits.

“This system will encourage cost-effective emissions reductions right here in Canada and create new economic opportunities, particularly in the forestry, agriculture, and waste sectors,” Wilkinson said in a statement.

Environmental group Greenpeace criticized the plan, saying Canada should focus on cutting emissions in all sectors of the economy.

“If we want to encourage climate action in agriculture or forestry, let’s do that directly rather than turning the work of farmers and forest protectors into a get-out-of-jail-free card for oil and coal companies,” said strategist Keith Stewart.

Projects must achieve permanent GHG reductions beyond what is legally required, and must have started operating no earlier than Jan. 1 2017. Ottawa is still working on rules for project eligibility and developing protocols for advanced refrigeration systems, landfill methane management, forest management and sustainable agricultural land management.

Next up will be protocols for projects including aerobic composting and livestock feed management, the government said.

Final regulations are expected in fall 2021.

Each credit will be equivalent to one tonne of carbon dioxide equivalent removed or reduced. The price will be set in the open market, with the federal carbon tax expected to act as a ceiling.

Last year, Prime Minister Justin Trudeau’s Liberal government said it will ramp up its price on carbon to C$170 ($134.32) a ton by 2030.

($1 = 1.2656 Canadian dollars)

 

(Reporting by Nia Williams; Editing by Leslie Adler, Aurora Ellis and David Gregorio)

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One-on-one with Dr. Bonnie Henry: Where she thinks Canada stands in the fight against COVID-19 – CTV News

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TORONTO —
A year into the COVID-19 pandemic, Health Canada has approved four vaccines to be administered to Canadians. However, continued public health measures, new emerging coronavirus variants and record case numbers in the second wave have some health experts warning that life won’t return to normal anytime soon.

But Provincial Health Officer Dr. Bonnie Henry is hopeful that people in British Columbia could be living in a “post-pandemic world” by the summer.

The province’s top doctor says she is “optimistic” that the recent approval of the AstraZeneca vaccine and the first one-shot immunization from Johnson & Johnson will allow the government to revise its vaccination timeline and have every eligible B.C. resident vaccinated sooner than previously thought.

Henry spoke to CTV’s Chief News Anchor and Senior Editor Lisa LaFlamme from Victoria on Friday to discuss where Canada stands now in the fight against COVID-19, as well as her upcoming book, “Be Kind, Be Calm, Be Safe: Four Weeks that Shaped a Pandemic,” detailing the first four weeks of the pandemic in B.C.

Below is a transcript of the interview, edited for length and clarity:

Lisa LaFlamme: I don’t know how you managed to write a book with your nonstop schedule, but it’s a very interesting read. Why now though, before the pandemic is over, before there is a conclusion?

Dr. Bonnie Henry: Oh, that’s a very good question. This book was actually written during the one week, the five days I had off in early August, and my sister was back out here with us and with me and she had put all this structure together and had this idea and she says she talked to me about it, but I don’t remember.

So she came out and basically sat me down and said, ‘OK these are the bits you need to write’, and it really was, in many ways, for me it was cathartic. It was putting some of the thoughts and feelings that we were going through that very challenging time a year ago now.

So we finished it in early August and it’s being released on the anniversary, but I don’t think any of us really knew that we’d be in the place that we are right now so it was one of those — it was just really about that really strange and challenging and difficult period of time that we all went through a year ago now.

LaFlamme: You’ve suggested we could still save the summer. Is it risky to raise people’s hopes after so many setbacks on the vaccine front?

Henry: I think we need hope. We need to know that there’s an end in sight and one of the things that we’ve been saying is this is like a triathlon and we’re in the marathon, but we don’t know where the finish line is or whether it’s an ultra-marathon or a regular 42.2 and those last miles are the hardest, so it is when we need that. We need to know that there’s an end in sight and there’s things that we can do that are going to get us there and I actually believe, from what we have learned about this virus and this year, we’ve seen that there’s a seasonality to it, we’ve seen that the vaccines — and this is the incredible thing that within a year we have now four safe and effective vaccines in Canada — and the thing that really has made it in my mind a possibility that we’re going to get there is the data that has shown how effective the vaccine is at protecting older people.

For those people who haven’t been in the vaccine world for a long time, that is something that is almost miraculous and I don’t use that word lightly. To be able to protect the individuals who are older, is something that makes our ability to get to that place where we can have those important connections together again a very real reality after just one dose of this vaccine.

LaFlamme: And I think everybody is encouraged by that. At the same time this big question — is a third wave inevitable?

Henry: Here in B.C. we’ve been seeing a steady increase in the last two weeks and we’re back to, in some ways, very much where we were at this point last year; relying on the important contact case management and contact tracing that public health does to try and stop those transmissions before they take off widely.

LaFlamme: When you reflect back it’s a little disconcerting to hear you say we’re right back where we were a year ago when you’re seeing numbers rise, when you think of the first wave and those earliest days, given the vast experience you’ve had with SARS and Ebola. Were you out there waving a red flag that there was danger ahead and people were reluctant to believe you or were you also blindsided at just how severe this coronavirus would actually become?

Henry: I was very, very concerned and worried and anxious, much more so than many of my colleagues in public health and in the health system because many of them had not been through this sort of thing, and our last pandemic of influenza, we managed fairly well. So there wasn’t the thought that quarantine was something that we would actually do, closing borders was something we would actually do, closing schools, closing workplaces — these measures that we had talked about in some sense and I have spent a lot of time looking into… There was a sense of disbelief that we would actually have to use them.

LaFlamme: What about accountability in this country for all the preparedness manuals that were clearly sitting on shelves somewhere? It felt for a lot of Canadians we were woefully unprepared — mixed messages, B.C. doing one thing, Alberta doing another, this patchwork across the country and I know that is the reality of a provincial-based health-care system, but for the collective good would you have preferred a more centralized response from the beginning?

Henry: I’ve been thinking a lot of about it for many years and I chair our Canadian Pandemic Influenza Preparedness Planning Task Force that actually had the plan that we used as a basis for this response. And yes, I do wish that we had had a much stronger co-ordinated federal, provincial response. Some of the things that we need to really move and change are having a national information system that allows us to rapidly share information on these critical communicable diseases with us across the country and with the federal government. We don’t have that. We needed that after SARS, we knew that, we spent years building something and then some provinces backed out, the federal government decided they weren’t going to use it and once again we’re here with a patchwork system.

There are so many things that could have been easier had we followed the advice that we’d had, and it is very challenging in times of non pandemics to spend the critical money that’s needed to develop information systems to have a stockpile. One of the things that I’ve been advocating for, as have many of my public health colleagues for many, many years is an onshore vaccination production capacity in Canada, but those things are hard to put forward when you have such urgent issues in our health system on a day-to-day basis. And of course, the tragedy of the reality of how we have neglected our long-term care homes across the country, that is something that we need to change.

LaFlamme: That is the true tragic legacy of this pandemic so far. Do you see that as a public health failure or where’s that responsibility?

Henry: I see it as a failure of multiple different levels. We have commoditized in some ways, we’ve got for-profit, we’ve got not-for-profit, we’ve got religious, but we have to look back on the history of long-term care. It really started as religious orders supporting older members as they aged and so it has been — it has grown up piecemeal. And then the way we’ve treated it as sort of partly in the health-care system and partly not has created a lot of barriers.

We had to take some drastic action very early on because normally, we wouldn’t be providing personal protective equipment and support to private care homes, but early on here in B.C. we said we have to do that because if those people get sick, it’s going to transmit into the community. So we needed to do things like that and overcoming that inertia to get those things done, but it was not easy.

Primary carers who work in our long-term care homes have been mistreated just to be frank for many, many years — underpaid, undervalued, many of them are people who are from racialized communities and that is something that we need to collectively address and change.

LaFlamme: And you were one of the first people in this country to actually be able to put a name and a face to the first Canadian victim of COVID-19. We still don’t know who patient zero is, but how did that experience shape your message so early on and in communicating hard information to Canadians on a daily basis?

Henry: It is really hard, and the backstory of it from the SARS outbreak in Toronto where …I got to know every single one of the families who had people who died in that outbreak. It really became an integral part of my approach to the many different outbreaks that we’ve been involved in; the importance of protecting people’s personal information and making sure that they can’t be linked and found by people who are trying to… It’s challenging, because everybody wants the story and wants to know all the details for families often need privacy, they need time to grieve, to understand what’s happening, and sadly with this virus as we have seen with many other communicable diseases, people can be mistreated, and treated badly.

Even now, we see instances of racism against community members who are COVID positive through no fault of their own, and it started very early on with anti-Asian sentiment that we’re still see. But the importance of getting people the information they needed to take the actions that we knew would protect each other without violating the intense personal privacy that people needed — very difficult balance and I know everybody wants more and more information, but it’s what you need to know as opposed to what people want to know. Finding that balance can be a very difficult challenge sometimes.

LaFlamme: I’m sure personally it was a great challenge too I mean, here you are presenting this message, but you’re also the target. There was a lot of love in the beginning for you, but we all saw that turn. What was that experience like for you and how do you sort of compartmentalize the trolls and the cruelty that is landing on your doorstep?

Henry: I was kind of prepared for that and I said it from the very beginning, I am the face and the voice unwittingly of a really strong, important team and they support me, I support them. That’s one of the things that gets you through the good times and the bad times my fellow chief medical officers of health from across the country, but also my team here in B.C. So that is really important for me.

I knew that over time the longer things go on the more challenging it becomes, the more likely people are to lash out and we know from human behaviour that in a time of crises and anxiety and particularly uncertainty and, I’ve come to learn, nuance creates this feeling of uncertainty that makes some people take it out with acting out and becoming angry. It’s hard, it’s really hard, but I try and balance that, and I can say that I am buoyed every day by positive messages that I get from people all the time from my neighbours, my mother of course…

LaFlamme: There’s so much confusion for Canadians on the role of [vaccine] manufacturers, laid out guidelines, 21 to 28 days between doses. Canadians are suddenly told no, the two doses will have a four month gap because an advisory committee has decided it’s safe. I know you’re a member of that, but do you understand or do you follow the fact that this is what is so confusing and perhaps leading to mistrust in public health in this country?

Henry: Yeah, I understand absolutely that people hear the different messages, but I think what we all need to recognize is that we are learning as we go. We learn more about the virus, we learn how it was transmitted, we learned that in certain conditions indoors, with poor ventilation with lots of people it spread more easily and maybe by aerosols, we learned the importance of masks in certain situations, these are all things that we learn. We get data, it’s a scientific way. You get data, you get more data, you get real-world data, you understand more, and you make changes depending on what you’re learning as you go. Same with these vaccines.

We have to remember that last summer, there was about 150 candidates for vaccines that were in the initial phases of trials. We didn’t know which ones of those were going to work or not. These amazing ones that we have, the Pfizer-BioNTech and the Moderna vaccines, messenger RNA vaccines, brand new vaccine platform, nobody in the world has ever made a vaccine with these before, though there have been little bits of research that have gone back for decades saying that these might be a good idea and people are trying to find a new rabies vaccine, for example. So yeah, the companies wanted and needed to minimize the interval between doses, they needed to figure out if you needed one or two or more, and they needed to minimize the interval between doses so that they could get see if the vaccines worked and we’re safe as rapidly as possible. And that happened, and it happened even before we expected it because we had that surge of cases so the irony is you need more people to get sick to understand that the vaccines are actually protecting people. That is part of how the vaccines were developed and that’s what the manufacturer puts their information into the regulators like Health Canada, and the decision that Health Canada has to make is, does this vaccine work and is it safe? And with the protocols that were used in these clinical trials — so those are very rigid protocols, people are swabbed on a specific date, they’re get blood tests at a specific date, they get vaccines within a specific very narrow timeframe — those are the clinical protocols that help us understand does it work and is it safe.

Once we start using them in the real world, we get what we call effectiveness data. So that’s efficacy, that’s the rigid trials. And then once we get them in the real world we start to understand, well who do they work better for, and there wasn’t so many people who were over 65 in this study so we better watch people who are getting it who are over 65 and see if it is what the studies show. And we’ve learned in real life that — and these are studies too, this is scientific method, it’s just a different type of study … So we’re getting great information about how these work in the real world and that’s what drives our decisions now. So the clinical trials are the basis to figure out if they worked, and then we use the real world data to develop where do they work best and how do we make the best use of the vaccines we have and that’s why we made the decision that not only is it good to extend, it is safe to extend the dose interval to four months, but it’s maybe better for people in the long run and that is from vaccine science, from immunology. We know it takes time for our immune system to build up, and for some of these vaccines it may turn out that a single dose is all we need. We don’t know that yet because we haven’t done those, we haven’t followed long enough, but it is likely that we’re going to change again as we get more information. We may need maybe six months, that’s the optimal time to get a second dose, that’s going to help us get through the next two years of COVID circulation with protecting people so those are things that we’re going to learn as we go. So that’s the way science works in the real world, that we take the studies and then we see how it works in reality.

LaFlamme: Well we are all experiencing a harsh dose of the real world over this past year and Dr. Bonnie Henry we thank you so much for your time and valued insight over this year and, again, congratulations on the book.

Henry: Thank you so much.

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Canada approves J&J’s COVID-19 vaccine, moves up some Pfizer deliveries

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By David Ljunggren and Steve Scherer

OTTAWA (Reuters) – Canada‘s drug regulator on Friday approved Johnson & Johnson’s COVID-19 vaccine, the fourth such shot to be given the green light, as Ottawa brought forward deliveries of millions of Pfizer doses.

“To people watching at home right now who are looking forward to getting their shot – your turn is coming,” Prime Minister Justin Trudeau said in a televised briefing.

Trudeau also said Pfizer Inc had agreed to accelerate deliveries, shipping a total of 3.5 million doses ahead of schedule by the end of May.

Deliveries to Canada have been slow – lagging many other developed nations – even though it has ordered more doses per capita than any other country.

With a population of almost 38 million, Canada now expects 36.5 million doses of previously approved vaccines to be delivered by the end of June.

The regulator authorized the Pfizer-BioNTech and Moderna Inc vaccines in December, and AstraZeneca’s in February. Each of these requires two shots.

The government of Ontario, Canada‘s most populous province, said on Friday it would extend the maximum period between first and second doses to four months, speeding up access to a first shot.

In addition to seniors and healthcare workers, Ontario now plans to prioritize shots for those who are unable to work from home, including teachers, and it aims to administer at least one dose of a vaccine to all adults over 60 by early June, officials said.

The J&J vaccine is the first single-dose vaccine approved in Canada and it can be stored in normal fridges, while the Pfizer-BioNTech and Moderna shots must be kept in freezers.

The J&J shot, which has been authorized for adults in Canada, was 66% effective at preventing moderate and severe disease, said Supriya Sharma, a senior health ministry official.

Canada has pre-ordered 10 million doses of the J&J vaccine, with options to order up to 28 million more. In a statement, the Brunswick, New Jersey-based company said it planned to provide the 10 million doses by the end of September.

U.S. President Joe Biden said earlier this week that J&J was behind in manufacturing. The company was due to have shipped 37 million doses to the United States by the end of this month but looks set to fall well short of that.

So far, 4.2% of the Canadian population has received at least one dose of a coronavirus vaccine, according to volunteer-run tracking site COVID-19 Tracker Canada, compared with 16% in the United States.

 

(Reporting by David Ljunggren and Steve Scherer, additional reporting by Moira Warburton; Editing by Giles Elgood and Steve Orlofsky)

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