OTTAWA  – Ending COVID-19’s assault on Canada will require an effective vaccine and the government has already decided who will get it first and is looking to set up a massive logistics operation to deliver it across the country.

Earlier this week, the arm’s length National Advisory Committee on Immunization recommended elderly people, specifically those over 70, be first in line for the vaccine, followed by health care professionals and then essential workers like police, firefighters and grocery store employees.

It also suggests making sure the vaccine is available early to people in close quarter facilities, like meat-packing facilities, prisons and homeless shelters where the virus has been able to spread quickly.

In a statement this week, Canada’s chief public health officer Dr. Theresa Tam said she was confident that Canadians will understand that some people have to be at the front of the line.

“Throughout this pandemic, we have seen people come together to protect those most at risk,” she said. “We know Canadians will understand the need to prioritize some groups during the early weeks of COVID-19 vaccine roll-out until there is enough vaccine for everyone who wants it.”

The advisory committee also recommended the government take into account how quickly and where the virus is spreading when the vaccines become available and whether some vaccine candidates may be more effective in certain populations.

Dr. Zain Chagla, an infectious disease specialist in Hamilton, Ont., said given their mortality rates to the virus, putting the elderly first makes sense.

“If you’re gonna put bang for the buck, for the people that are gonna deal with the brunt of the disease that need an intervention now, it’s going to be that,” he said.

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He said vaccinating everyone in long-term care homes for example won’t solve the problem, but it will be a major benefit to the people living there.

“Anything is better than nothing and if you roll it out correctly, even a small supply can have very profound implications for a locked-off population,” he said.

The advisory committee also recommends considering potentially targeting people with specific conditions, like obesity and heart disease, for early vaccination, but says there is still a need for more evidence before settling on a policy like that.

Chagla said they know that older, obese people often do poorly with the virus, but it is not universal.

“We still don’t know why one 50-year-old who’s obese goes to the ICU and the other 50 year old doesn’t,” he said.

He said one thing that could be worth considering as a vaccine rolls out is targeting people that have been identified as potential superspreaders. He said early research has shown most infected people spread the virus in a limited fashion, while others spread it aggressively, so called superspreaders.

Our anticipated delivery schedules are in line with the EU, Japan, Australia, and other jurisdictions

He said prioritizing those people might do a lot to bring down overall cases.

“if you prioritize that group, even though it seems counterintuitive, because they’re the healthiest? Would you get a significant amount more of community control.”

Through one-off deals and the government involvement in the COVAX facility, an international partnership, Canada potentially has access to a dozen vaccine candidates, but no vaccine has so far cleared clinical trials.

The logistical challenge of shipping millions of doses of vaccine are also on the government’s mind and companies have until Monday to respond to a tender for the project with the government planning to award a contract before the end of the month.

Monday’s deadline is for companies to indicate how they will meet the government’s demands, with further negotiations on price to come if the firms can prove they can actually do the job.

The scale of the project is immense with more than 300 million potential vaccine doses set to be sent to the provinces and territories beginning as soon as January and running well into 2022. The rollout of the flu vaccine this month in Ontario has led to shortages as more people than normal seek a shot.

Some of the vaccines will be delivered to Canada, while others have to be picked up from pharmaceutical companies in Europe. The government wants the winning bidder to have warehouse space all over the country, enough to be able to quickly move the vaccine to places where it is needed.

The government said it is confident Canadians will be getting deliveries on the same timeline as our allies provided the vaccines meet Health Canada’s approval.

“Canada’s proactive approach to securing access to a diversity of COVID-19 vaccine candidates has put us in a strong position, with first deliveries on track to arrive during the beginning of 2021,” said Procurement Minister Anita Anand in a statement. “Our anticipated delivery schedules are in line with the EU, Japan, Australia, and other jurisdictions.”

All of the vaccine candidates have to be kept cold adding another layer of complexity to the process. Up to 20 million doses of one Pfizer’s vaccine candidate for example have to be kept below -80C, while the company is handling distribution of that vaccine the government is arranging regular deliveries of dry ice to keep it cold.

Another 56 million doses of vaccine will have to be kept frozen at around -20C and then an additional 200 million doses need to be kept between 2C and 8C. The government is looking for the winning bidder to be able to provide refrigerated warehouses and a detailed inventory tracking system to handle it all.

Prashant Yadav, a senior fellow at the Center for Global Development and an expert on health care logistics, said the challenge of distributing the COVID-19 vaccine will be unlike anything governments have had to deal with.

“It is like setting up Amazon Prime type of daily delivery capabilities nationwide, but not over a four-year planning horizon,” he said.

Proposal documents show the government is looking to have a contract with one entity to handle the full process, leaving the potential for companies to team up into consortiums.

A briefing for the project was attended by airlines like WestJet and Air Canada, shipping firms like FedEx and Purolator and pharmacies like Shoppers Drug Mart. The government wants whoever wins the bid to be ready to go by Dec. 15. and to have systems in place to track deliveries.

Yadav said it will be difficult for a single company to have the tools and expertise for the whole process and he suspects companies will work together.

“Those are the kinds of mixes and matches that need to happen and the combinations of how people will come together to offer the best solution.”

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