OTTAWA — Prime Minister Justin Trudeau says Canada is donating another $220 million to the COVAX global vaccine sharing alliance.
The funds will bring Canada’s total monetary donation to COVAX to about $700 million for the purchase, delivery and distribution of COVID-19 vaccines for lower-income nations.
“Our collective aim must be to increase access to COVID-19 vaccines and other medical countermeasures, so that every country has what it needs to protect its people from this virus,” Trudeau said Friday, during a virtual COVAX summit.
COVAX raised another US$1.7 billion from countries like Canada at the event.
The cash is intended to help Canada make good on its commitment to donate at least 200 million doses by the end of the year.
This latest contribution will be targeted at helping recipient countries prepare to receive and distribute the vaccines on offer.
Last month International Development Minister Harjit Sajjan travelled to Senegal and Ghana to meet with local officials overseeing their vaccine programs. He said the issue with vaccine donations is no longer about supply.
Instead it’s limitations on vaccine distribution within recipient countries, including the peripheral supplies like syringes, and high levels of vaccine hesitancy, particularly among younger people. He said his discussions on that trip were useful to helping target Canada’s aid where it is needed most.
“The main challenge right now for us is not about supply,” he said. “It’s about actually getting all the other tools in place.”
Justin McAuley, Canadian spokesman for the global anti-poverty agency ONE Campaign, said the new funds are helpful. For the first year of COVID-19 vaccines, supply was the main constraint in wealthy and low-income countries alike.
McAuley said now COVAX is not wanting for doses. Its own procurement agreements with vaccine makers are starting to bear fruit, and the wealthy countries like Canada that snapped up all the early doses of vaccines have vaccinated most of their populations and have many excess doses available.
“But some countries don’t have the fridges, syringes and health-care workers needed to get doses in arms,” said McAuley. “So when we finance COVAX like we did today, that is going to make sure that the logistical support is there so that our doses don’t end up going bad in warehouses.”
He said the financing can also help COVAX build public awareness campaigns to overcome apathy and hesitancy to getting vaccines.
But McAuley said Canada didn’t start offering up a lot of doses to donate until it no longer had a use for them at home, and in many cases when their expiry dates were looming.
He said Canada needs to provide a stable, predictable supply of vaccine donations so countries that need them can prepare to receive and get them into arms.
Earlier this year, John Nkengasong, director of the Africa Centres for Disease Control and Prevention, asked for a pause on donations because so many were being offered that countries couldn’t keep up with the storage needs or get them to people quickly enough.
He said transporting vaccines and supplies like syringes to remote locations is still a challenge, there is a shortage of health-care workers who can give the shots and vaccine hesitancy is high.
Canada has fully vaccinated 82 per cent of its population and a third dose has been given to 48 per cent. As a group, the wealthiest countries in the world have fully vaccinated 74 per cent and boosted 38 per cent.
The poorest countries have fully vaccinated less than 12 per cent of the population, and only 15 per cent has even one dose.
Canada promised to donate 38 million doses from its own domestic supplies, and another 13 million from doses Canada bought for itself from COVAX but didn’t need.
Thus far Canada has shipped 14.2 million doses to 19 countries via COVAX and another 762,000 directly to six countries through bilateral vaccine donation agreements.
It says another 87 million doses were purchased by COVAX with Canada’s previous financial donations — but that is based on a formula for the cost per dose developed by the United Kingdom, and COVAX itself says it cannot confirm the exact number.
This report by The Canadian Press was first published April 8, 2022.
Mia Rabson, The Canadian Press
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A new study offers a closer look at possible factors that may lead to some hospitalized COVID-19 patients being readmitted within a month of discharge.
At roughly nine per cent, researchers say the readmission rate is similar to that seen for other ailments, but socio-economic factors and sex seem to play a bigger role in predicting which patients are most likely to suffer a downturn when sent home.
Research published Monday in the Canadian Medical Association Journal looked at 46,412 adults hospitalized for COVID-19 in Alberta and Ontario during the first part of the pandemic. About 18 per cent — 8,496 patients — died in hospital between January 2020 and October 2021, which was higher than the norm for other respiratory tract infections.
Among those sent home, about nine per cent — 2,759 patients — returned to hospital within 30 days of leaving, while two per cent — 712 patients — died. The deaths include patients who returned to hospital.
The combined rate of readmission or death was similar in each province, at 9.9 per cent or 783 patients in Alberta, and 10.6 per cent or 2,390 patients in Ontario.
For those wondering if the patients were discharged too soon, the report found most spent less than a month in hospital and patients who stayed longer were actually readmitted at a slightly higher rate.
“We initially wondered, ‘Were people being sent home too early?’ … and there was no association between length of stay in hospital and readmission rates, which is reassuring,” co-author Dr. Finlay McAlister, a professor of general internal medicine at the University of Alberta, said from Edmonton.
“So it looked like clinicians were identifying the right patients to send home.”
Examining the peaks
Craig Jenne, an associate professor of microbiology, immunology and infectious diseases at the University of Calgary who was not involved in the research, said the study suggests that the health-care system was able to withstand the pressures of the pandemic.
“We’ve heard a lot about how severe this disease can be and there was always a little bit of fear that, because of health-care capacity, that people were perhaps rushed out of the system,” Jenne said. “There was a significant increase in loss of life but this wasn’t due to system processing of patients.
“Care was not sacrificed despite the really unprecedented pressure put on staff and systems during the peaks of those early waves.”
The study also provides important insight on the power of vaccines in preventing severe outcomes, Jenne said.
Of all the patients admitted with COVID-19 in both provinces, 91 per cent in Alberta and 95 per cent in Ontario were unvaccinated, the study found.
The report found readmitted patients tended to be male, older, and have multiple comorbidities and previous hospital visits and admissions. They were also more likely to be discharged with home care or to a long-term care facility.
McAlister also found socio-economic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and past emergency room visits, but “that wasn’t as good a predictor for post-COVID patients.”
“Including things like socio-economic status, male sex and where they were actually being discharged to were also big influences. It comes back to the whole message that we’re seeing over and over with COVID: that socio-economic deprivation seems to be even more important for COVID than for other medical conditions.”
McAlister said knowing this could help transition co-ordinators and family doctors decide which patients need extra help when they leave the hospital.
On its own, LACE had only a modest ability to predict readmission or death but adding variables including the patient’s neighbourhood and sex improved accuracy by 12 per cent, adds supporting co-author Dr. Amol Verma, an internal medicine physician at St. Michael’s Hospital in Toronto.
The study did not tease out how much socio-economic status itself was a factor, but did look at postal codes associated with so-called “deprivation” indicators like lower education and income among residents.
Readmission was about the same regardless of neighbourhood, but patients from postal codes that scored high on the deprivation index were more likely to be admitted for COVID-19 to begin with, notes Verma.
Verma adds that relying on postal codes does have limitations in assessing socio-economic status since urban postal codes can have wide variation in their demographic. He also notes the study did not include patients without a postal code.
McAlister said about half of the patients returned because of breathing difficulties, which is the most common diagnosis for readmissions of any type.
He suspected many of those problems would have been difficult to prevent, suggesting “it may just be progression of the underlying disease.”
Looking at readmissions is just the tip of the iceberg.-Dr. Finlay McAlister-Dr. Finlay McAlister
It’s clear, however, that many people who appear to survive COVID are not able to fully put the illness behind them, he added.
“Looking at readmissions is just the tip of the iceberg. There’s some data from the [World Health Organization] that maybe half to two-thirds of individuals who have had COVID severe enough to be hospitalized end up with lung problems or heart problems afterwards, if you do detailed enough testing,” he said.
“If you give patients quality of life scores and symptom questionnaires, they’re reporting much more levels of disability than we’re picking up in analyses of hospitalizations or emergency room visits.”
The research period pre-dates the Omicron surge that appeared in late 2021 but McAlister said there’s no reason to suspect much difference among today’s patients.
He said that while Omicron outcomes have been shown to be less severe than the Delta variant, they are comparable to the wild type of the novel coronavirus that started the pandemic.
“If you’re unvaccinated and you catch Omicron it’s still not a walk in the park,” he said.
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