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Federal government has plans on how to distribute the COVID-19 vaccine and who gets it first – The Post – Ontario

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The advisory committee recommended those over 70 be first in line for the vaccine, followed by health care professionals and then essential workers

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.”


Canada potentially has access to a dozen vaccine candidates, but no vaccine has so far cleared clinical trials.

Fabrizio Bensch/Reuters

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.”

• Email: rtumilty@postmedia.com | Twitter:

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The 1976 U.S. swine flu vaccinations may offer lessons for the COVID-19 pandemic – CBC.ca

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For Pascal Imperato, a communicable disease epidemiologist who in 1976 was in charge of immunizing New York City against a potential swine flu epidemic, the effort to vaccinate the population against COVID-19 feels like a familiar challenge.

“We were going to vaccinate six million people in six weeks,” he said in a phone interview. “And we were absolutely certain we could pull it off. And we would have.”

Would have, because, ultimately, the largest national immunization program that had ever been undertaken in the U.S. was cut short as the epidemic never materialized, and public skepticism about the program began to mount.

Still, while the COVID-19 pandemic is very real, and the population is much larger, the vaccination program of 1976 may offer some lessons as governments around the world prepare to inoculate the public at large.

“If the program is well organized, mobilizing all of the resources that are capable of administering this vaccine, there [shouldn’t] be any problem whatsoever,” Imperato said. 

In March 1976, the administration of then president Gerald Ford launched a $137 million US nation-wide vaccination program to immunize every American citizen by the end of the year.

The diagnosis of swine flu on a New Jersey army base had led to panic among top U.S. scientists and officials who feared the disease could spread and potentially precipitate a health crisis similar to the deadly Spanish flu outbreak of 1918.

Even though it was cut short, by December 1976 more than 40 million Americans — about one-fifth of the population — had been vaccinated, and about 650,000 in New York City.

Utilizing volunteers, setting up sites

Imperato said that on any given day they had about 900 people who were involved in getting the vaccine out to the general public. That included 500 to 600 volunteers who were recruited each day through the city’s chapter of the American Red Cross.

University graduates, sanitary inspectors and public health nursing assistants were also hired and trained to use automatic jet injectors and to give cardiopulmonary resuscitation. 

Sixty vaccination sites were established in places that included schools and police precincts.

“Anywhere we could,” said Imperato, who is the founding dean and distinguished service professor at SUNY Downstate Medical Center School of Public Health.

Mary O’Brien, 77, resident of the St. Augustine Home, Chicago, winces as she is inoculated against the swine flu in 1976. (Bettmann Archive/Getty Images)

As well, 15 mobile teams were created to vaccinate over 40,000 people in more than 200 nursing homes and about 100,000 people in 150 senior citizen centres.

“This required military organization, if you will, and we were able to put together a team and put into place the people that we needed to bring this about,” he said.

A great deal of administrative and clerical support goes into a program of this kind, he said.

“We have to have people register. We had to have as much information about them as possible, because we needed to know who we were vaccinating and if any of them had any reaction. We had to have teams of people checking on adverse events.”

Local capacity can be the ‘weak link’

Nationwide, however, there  were some logistical problems, said Harvey Fineberg, a physician who was tasked with co-authoring a review into the 1976 Swine flu vaccine program.

The actual immunizations were quite erratic in their frequency in different communities, he said.

“So a lesson that’s still relevant today, whether in different provinces in Canada or different states and counties and the U.S., is the local capacity,” he said.

“That last mile, getting the immunization into the arms of the recipients, that’s the weak link in the chain.”

What made the difference  was the degree of organization and capacity of the public health departments in each community to plan and administer the vaccine, Fineberg said.

“So it wasn’t that it was only cities or only rural, rich or poor, it boiled down to ability to deliver.”

WATCH | Experts discuss strategies for Canada’s COVID-19 vaccine rollout 

As Canada prepares to distribute millions of doses of COVID-19 vaccines in January, Chair of the National Advisory Committee on Immunization Dr. Caroline Quach-Thanh and David Levine, who managed the H1N1 vaccine rollout for Montreal, say this vaccination campaign won’t be without challenges. 3:56

Dealing with ‘coincident events’

But one of the more significant problems of the program was the poor job officials did in communicating to the public when headlines emerged linking potential adverse effects to the vaccine, experts say.

“There are definitely — and this is going to be true this coming year — there will be coincident events,” Fineberg said.

“Preparing the public for expected coincidences simply because stuff happens every day, that’s really, really key,” he said.

During the 1967 vaccination program, three elderly people in Pittsburgh had heart attacks after receiving their vaccine. The publicity and headlines it generated led to a handful of states suspending their vaccination programs while they investigated a potential association, said George Dehner, an associate professor of history at Witchita State Univeristy and authour of Influenza: A Century of Science and Public Health.

While no link to the vaccination was found, polls at the time showed a significant decrease in the number of people who said they would get the vaccine because they feared some adverse effect, Dehner said.

A patient takes part in Pfizer’s COVID-19 vaccine clinical trial in May. On Sunday, a U.S. health official said the country’s first immunizations could begin on Dec. 12. (University of Maryland School of Medicine/File/The Associated Press)

There will be a certain expected death rate of people of a certain age on any given day, Pascal said. And what one has to look at is the death rate above the expected rate when running an immunization program.

“And so the CDC in this particular case did not do a good job of anticipating that and explaining that,” Dehner said.

But the vaccination rollout also saw dozens of people come down with the rare neurological disorder Guillain-Barre syndrome at a much higher rate than would be expected. Unlike the heart attacks, where no link was found, a scientific review has found there was an increased risk of Guillain-Barre syndrome after the swine flu vaccinations, according to the CDC. The exact reason for this link remains unknown.

In a 2009 interview with the The Bulletin, the health journal of the World Health Organization, Fineberg said those cases wouldn’t have been “a blip on the screen had there been a pandemic but, in the absence of any swine flu disease, these rare events were sufficient to end the programme.” 

Focus on science, not politics

When Guillain-Barre syndrome increased, some members of the public “became very skeptical and saw the whole thing as politically based, and not science-based,” said Richard Wenzel, emeritus chairman and professor of the Department of Internal Medicine at Virginia Commonwealth University.

“There was a concern that maybe politics was driving some public health responses.”

“One of the things that I would say we’re still trying to learn is policy should be scientifically based. What I mean is that whoever gives the message has to say, ‘Here’s what we know, here’s what we don’t know. And here are the assumptions we’re making currently that guide our policy.

“That sounds simple, but it’s rarely done, even today.”

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Dozens infected after BC hockey team brings COVID-19 back from Alberta | Offside – Daily Hive

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A recent trip to Alberta had unintended consequences for an adult hockey team from British Columbia.

BC Provincial Health Officer Dr. Bonnie Henry highlighted what she called “another cautionary tale” during her media briefing today, as the province reported another 834 new COVID-19 cases. Alberta, by contrast, reported more than double that number today.

“We know that there are sports teams in BC that have travelled to other provinces despite the restrictions that we’ve put in place,” said Henry.

“There’s a hockey team in the interior that travelled to Alberta and has come back and now there are dozens of people who are infected, and it has spread in the community,” said Dr. Henry. “We need to stop right now to protect our communities and our families, and our health care workers. This is avoidable and these are the measures that we need to take.”

While adult hockey was allowed to continue, this team was in clear defiance of the provincial health order, which bans “travel for teams outside of their community.” Dr. Henry said the players who contracted the virus in Alberta have since spread it to their family members, workplaces, and community upon return to BC.

“Making an exception for yourself, or for your team, or for your recreational needs puts a crack in our wall and we see that this virus can exploit that very easily,” she said.

While adult hockey was allowed in the most recent health order, it appears that will be changing very soon.

“We are putting additional restrictions on adult team sports indoors as we are recognizing that these are indeed higher risk activities as well. What we will be focusing on is structured programs or sport for children and youth, recognizing how important those are for our young people.”

Dr. Henry said there have been “several incidents that are similar to this,” and as such, she didn’t want to give away which specific region they came from or where they travelled to.

“I’m asking in the strongest of terms, to stay put,” she said. “To stay in our communities and to protect our communities.”

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Origin of Revelstoke cluster unknown, but some visitors did test positive for COVID-19 – BC News – Castanet.net

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Interior Health has not been able to identify how a large cluster of COVID-19 cases were introduced to the community of Revelstoke, however, the region’s chief medical health officer admits some non-residents have tested positive for the virus.

During a Zoom press conference Wednesday afternoon, Dr. Albert de Villiers said a “patient zero” has not been identified, despite Premier John Horgan stating earlier in the day that the cluster was caused by people travelling for recreation.

“What we can say with the numbers that we have seen that, yes, there are some people that are not residents in Revelstoke that sadly are infected as well,” said Dr. de Villiers.

“But having said that, we have also seen there is no one specific incident that led to the bigger number of cases. There are some that have been household clusters, some people picked it up when they went to a worksite, some people may have gone to a private function. There are rumours out there we haven’t been able to substantiate that someone went to a hot spring somewhere.

“I think there are different pieces of this. It’s not just one person that travelled in and caused all of this, I don’t think it’s as simple as that.”

Dr. de Villiers says people travelling in from other communities has been a factor in cases in other communities, which is why, he says, part of the provincial recommendations are for people not to travel outside their community if they don’t absolutely have to.

“Sadly, skiing is not essential to most people,” he said. “For recreation purposes, try to stick to your own community and stick to your own ski hill.”

Dr. de Villiers also addressed an online post out of Revelstoke where an individual asked to be infected with the virus so he could become immune.

He says they’ve seen it before with chicken pox and the measles, but it’s a bad idea with COVID-19 because people don’t know how they’ll react.

“Most people will have a relatively mild form of the disease…but there are people, relatively healthy people, that can develop complications. We’ve had people throughout Canada of all ages that have passed away,” he said.

“I don’t think we want to put people at risk unnecessarily.”

The doctor also explained why it took two weeks for IH to publicly disclose the cluster in Revelstoke.

He says over a two-week period there were only 10 cases, one every day or second day, which isn’t abnormal within communities.

“But, all of a sudden in one day, there were 12 more cases,” he said. “That’s why when we did announce it, it was 22, because there was one day that had more than usual.”

He said they do expect cases to pop up in communities, but the large one-day jump was reason to believe there may have been an issue.

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