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Growing 'consensus' provinces should offer COVID-19 vaccine more widely, instead of holding back 2nd dose – CBC.ca

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There’s growing consensus that offering the COVID-19 vaccine to as many people as possible may have more impact than holding back supplies to give recipients their second dose — but in Ontario, officials still plan to maintain the two-dose timeframe to ensure immunity.

The push for a change in approach comes after two vaccines have been approved to roll out in Canada. 

Pfizer-BioNTech’s version, approved first by Health Canada, is already being offered to tens of thousands of health-care workers. 

A second option from Moderna, just approved on Wednesday, is now slated to roll out as well with nearly 170,000 doses expected to arrive in Canada by the end of the year.

Both require a two-dose approach, and original recommendations involved using half the available vaccine supplies while reserving a second dose in case supply chain issues disrupted the timeline, explained Toronto-based infectious disease specialist Dr. Allison McGeer, a member of Canada’s COVID-19 immunity task force.

“That consensus is changing now,” she added.

The two-dose regime involves injections given 21 days apart for the Pfizer-BioNTech vaccine, and 28 days apart for the Moderna version. 

The latest findings suggest a single dose did provide solid protection against COVID-19 “in the short term,” McGeer said.

U.S. FDA data shows 1st shot efficacy

Data released by the U.S. Food and Drug Administration in December showed that some level of protection from the Pfizer-BioNTech vaccine begins quickly after the first shot, with efficacy of a little more than 52 per cent — which spikes to roughly 95 per cent a week after the second dose.

A briefing note on the Moderna vaccine showed around 50 per cent efficacy after a first shot within the first two weeks, and beyond that timeframe, efficacy of more than 92 per cent even before someone received their second dose.

“In a setting in which we are seeing more cases every day, and we really want to do something as quickly as possible, it probably makes more sense to get everybody a dose now — knowing that there’s going to be enough vaccine coming,” said McGeer.

“And if that means some doses come a week late, that’s probably fine.”

Yet-to-be-published modelling from the University of Toronto, first reported by the Globe and Mail and obtained in a draft form by CBC News, shows taking a more flexible approach — by withholding fewer doses to vaccinate more people quickly — could avoid 34 to 42 per cent of symptomatic infections.

WATCH | Some provinces won’t hold back COVID-19 vaccine doses for 2nd shot:

The provinces are taking different approaches to distributing their first COVID-19 vaccine doses, which require two shots. Some will hold back half their allotted doses, to ensure patients get the full amount of vaccine, while others are giving out their whole allotment to double the number of recipients, which some infectious disease experts say is risky. 3:38 

“If we could get more vaccines in the arms of long-term care residents and long-term care workers, this could potentially avert a lot of the potential infections in the coming weeks,” said Ashleigh Tuite, an infectious disease epidemiologist and mathematical modeler at the university’s Dalla Lana School of Public Health.

Ontario’s COVID-19 Science Advisory Table is now preparing to make a formal recommendation to the province on whether to hold back the second doses, based on the research from Tuite and her team, the Globe reported. 

Ontario to monitor, assess vaccine rollout

Ontario, however, isn’t committing to changing its current approach, and officials say no formal recommendation has yet been made.

A spokesperson for the Ministry of Health did say in a statement that the province’s COVID-19 Vaccine Distribution Task Force will continue to closely monitor and assess the vaccine rollout.

“While some individuals may have good COVID-19 immunity after only one dose, it’s not guaranteed and a second dose is necessary,” reads the statement provided to CBC News.

“We will continue to administer second doses to patients, ensuring they have optimal immunity from the vaccine, while continuing to vaccinate a growing number of new patients as additional doses of the vaccine are delivered.”

Several provinces, including Saskatchewan, New Brunswick, and British Columbia, are already aiming to do the opposite by providing available vaccine doses widely.

“We aren’t holding back doses because we want to protect as many people as possible, as quickly as possible,” Dr. Bonnie Henry, B.C.’s chief medical officer of health, recently said.

But Matthew Miller, an infectious disease specialist from McMaster University, cautioned against drifting away from the strict two-dose timeframes before the vaccines’ long-term efficacy is clear — particularly during the early phase of immunization campaigns targeting those at a high-risk of infection.

“I do think it’s imperative to ensure we have the doses on hand to be able to guarantee that they’re to experience the most efficacy possible,” he said.

Prime Minister Justin Trudeau tweeted this photo Thursday as he announced that the first shipment of doses of Moderna’s COVID-19 vaccine had arrived in Canada. (Canada Border Services Agency)

‘We know it can save lives’

Advocates for more widespread vaccinations aren’t calling for an end to the two-dose regimen, but McGeer stressed there’s now less need to hold back doses based on emerging information on the stability of the supply chain.  

The debate is playing out while a growing number of Canadians say they want to get a COVID-19 vaccine as soon as it’s available to them.

Close to half of respondents said they would take the shot if it became available, according to a December online survey from the Angus Reid Institute, up from 40 per cent of respondents the month before.

Eventually, as more doses become available, all provinces will be scaling-up their immunization programs to the broader public, with a federal goal of vaccinating all Canadians who want the shot by the end of 2021.

Tuite said her stance on dispersing available doses more widely doesn’t need to be a long-term strategy, since maintaining the tight two-dose timeframe will become easier as more shipments arrive in the months ahead.

“But right now, when a vaccine is scarce, and when we know it can save lives, I think it’s important to think about how we can maximize that,” she said.

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Ford to make an announcement in Ottawa Monday afternoon – CP24 Toronto's Breaking News

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Premier Doug Ford will be making an announcement in Ottawa Monday afternoon.

Ford will be joined by Ottawa Mayor Jim Watson, MPP for Ottawa West-Nepean Jeremy Roberts and President and CEO of The Ottawa Hospital Cameron Love.

The announcement comes nearly two weeks after the province entered Step 3 of the COVID-19 reopening framework on July 16.

Step 3 allowed for indoor dining to resume and for gyms and theatres to reopen with capacity limits.

The provincial government said Ontario will remain in Step 3 for at least 21 days and until 80 per cent of eligible residents 12 years and older have received at least one dose of a COVID-19 vaccine and 75 per cent have received their second dose.

In addition, at least 70 per cent of eligible residents in all public health units must be fully vaccinated in order for the province to move to the final stage of the framework.

If all of these requirements are met, Ontario could enter so-called Step 4 at the end of next week which would lift the majority of public health and workplace safety measures.

However, last week Ontario’s top doctor recommended that 90 per cent of eligible residents be fully vaccinated before entering the final step, due to the risk of the Delta variant.

“If we remain at around 20 per cent of the population unvaccinated we won’t build a community immunity and you’ll get breakthrough infections in those individuals that are vaccinated because not all individuals, especially those that are elderly or vulnerable or immune suppressed, will get full protection from the vaccine,” Chief Medical Officer of Health Dr. Kieran Moore said to reporters.

Currently, about 80 per cent of those 18-plus in Ontario have had at least one dose and 67 per cent have had two doses. Meanwhile, 64 per cent of youth between the ages of 12 and 17 have had one dose and 40 per cent are fully vaccinated.

The provincial government has not said if it will raise the threshold for fully vaccinated Ontarians before entering the final step of the plan.

Ford is expected to speak at 1:15 p.m. and CP24.com will stream the announcement live.

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Officials say 90% of population needs vaccine to reach herd immunity – CBC.ca

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Like the last leg of a marathon, public health officials say reaching the final segment of the unvaccinated population will be a grind as Ottawa tries to attain herd immunity — when enough of the population is protected against COVID-19.

The city of Ottawa has set a daunting target to fully vaccinate 90 per cent of its population, including those still not eligible to be vaccinated, which has eluded most regions around the world. 

As of July 23, 73 per cent of the city’s entire population had received at least one dose of vaccine, slightly higher than the Ontario rate of 69 per cent, and one of the highest vaccination rates for first doses among cities around the world.

Ontario’s first-shot vaccination rate has dropped from a high of six per cent per week in May to below one per cent in July, and it continues to trend downward. That means it will take longer to inoculate the remaining portion of the unvaccinated population — likely a venture that continues into 2022.

“I think I can’t understate how important it is to get very high levels of vaccination,” said Dr. Trevor Arnason of Ottawa Public Health.

“If we head into the fall with vaccination where it is now, we’re definitely going to see outbreaks.” 

Trevor Arnason of Ottawa Public Health believes Ottawa can be a world leader in its vaccination rate because of its previous success getting the flu shot, and immunizing children. (CBC)

Vaccination targets need to change

Ontario, which has now been in Stage 3 of the reopening plan for 10 days, must reach 80 per cent of its eligible population with at least one dose, and 75 per cent with both doses, to consider removing all public health restrictions.

Some public health experts believe that target is not high enough due to the growing number of cases of the delta variant and the potential for breakthrough cases.

“We need to establish herd immunity, and we would need to be at a higher level: 85, 90 per cent vaccination rates,” explained Dr. Paul Roumeliotis, the medical officer of health for the Eastern Ontario Health Unit, who also heads a group of public health units across Ontario.

Roumeliotis and Arnason say restrictions could return in the fall if delta spreads, even if they’re not as strict as those we’ve seen throughout the pandemic. Ontario public health officials hope to avoid a spike in cases seen during the reopening in the U.K., Israel, and the United States.

A comparable situation exists in the Netherlands, which has a population only slightly larger than Ontario, and similar vaccination rates. There, cases jumped to 10,000 per day only a few weeks after reopening due to the delta variant, which is now responsible for more than 80 per cent of new infections in Ontario.

WATCH: Getting people ‘through the doors’ biggest part of vaccinating holdouts, doctor says:

Dr. Lorne Wiesenfeld says on the last day of the Lansdowne vaccination clinic’s operation, a team of health-care workers ventured into restaurants, grocery stores and businesses to encourage residents to get vaccinated if they hadn’t already. 0:55

‘Get them through the doors’

Officials estimate anywhere from five to 10 per cent of the population will never get the COVID-19 vaccine, but they need to target those who will roll up their sleeves to help avoid a “pandemic of the unvaccinated.”

Health-care workers at community clinics, including one at Lansdowne in Ottawa, have used lulls in the day to approach people nearby about getting the vaccine.

“The first thing is to get them through the doors, that’s the hardest part,” said Dr. Lorne Wiesenfeld, an emergency physician at The Ottawa Hospital who has also spent time administering the vaccine.

“You want to make it easy. Just remove one barrier that may hinder them, encouraging them in a non-judgmental way.”

Half of Ottawa’s community clinics closed last week as Ottawa Public Health refocused its outreach by offering mobile vaccine clinics at workplaces, community organizations and places of worship, as well as pop-up clinics throughout the city to target young adults.

in Ottawa, only 72 per cent of the population aged 18-29 have the first dose, which is the lowest of any age demographic. That is followed closely by 73 per cent of those aged 30-39 with at least one dose.

Doug Manuel believes public health messaging is difficult when case numbers are low, but that could change quickly if numbers begin to spike again. (Submitted by Dr. Doug Manuel)

Public health messaging difficult with low case numbers

The “receptivity” of public health messaging about the risk of a delta resurgence is non-existent when the number of active cases of COVID-19 remains low and pandemic fatigue persists, according to Doug Manuel, senior scientist at the Ottawa Hospital Research Institute, and a member of Ontario’s COVID-19 Science Advisory Table. 

People may only begin to become more sensitive to messaging if cases begin to rise, as they have in the U.K. and Israel, Manuel said.

Public health officials believe the 90 per cent goal is attainable partly because Ottawa has traditionally reached higher rates of vaccination for the flu and child immunization programs. 

Arnason says once children younger than 12 become eligible, which could happen in the fall, the city could see a bump of about 10 per cent with at least one dose.

“I think Ottawa is one of those places where there’s no reason why we can’t be a world leader,” he said. 

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Inter Pipeline walks away from friendly Pembina merger, will pay $350-million break fee – The Globe and Mail

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Inter Pipeline’s Heartland Petrochemical Complex, in Fort Saskatchewan, Alta., on Jan. 10, 2019.

JASON FRANSON/The Canadian Press

Inter Pipeline Ltd. is abandoning its friendly merger with Pembina Pipeline Corp., opening the door to a deal with rival bidder Brookfield Infrastructure Partners LP.

To walk away, Inter Pipeline will pay Pembina a $350-million termination fee, also known as a break fee. The payment was negotiated when Pembina emerged as a white knight in late May to help block Brookfield’s hostile takeover bid.

Brookfield has since raised its takeover price twice and also given Inter Pipeline shareholders the option to take their payout in cash if they favour Brookfield’s bid. Pembina’s friendly deal was to be paid solely in Pembina shares, and Pembina would not budge on the offer price it had agreed to in May.

Brookfield’s latest offer comes in two forms: Inter Pipeline shareholders can elect for $20 a share in cash, up from its previous bid of $19.50 a share, or they can take some shares of Brookfield Infrastructure Corp. at an elevated price instead of cash.

BIPC was created in 2020 to broaden the company’s investor base and shareholders who are limited in the types of securities they can own; its shares are effectively the same as the Brookfield Infrastructure’s limited partnership units.

When the most recent offer was made, Brookfield’s stock portion was worth $23.85 for every Inter Pipeline share. However, Brookfield is only willing to pay a maximum of 32 per cent of its total purchase price in shares, and BIPC’s shares have also dropped eight per cent since the offer was made.

Two leading proxy advisers, Institutional Shareholder Services and Glass Lewis, both recommended Inter Pipeline investors vote against the Pembina bid.

While Inter Pipeline’s board has scrapped its support for Pembina’s deal, its directors have yet to fully embrace Brookfield’s offer. In a statement Monday, Inter Pipeline said it is “open to engaging with Brookfield in an effort to reach a mutually agreeable transaction in the best interests of shareholders.”

Brookfield’s shareholder vote is set for August 6.

The battle for Inter Pipeline has been heated from the very beginning. Brookfield started building a position in Inter Pipeline in 2020 and privately approached the target’s board about a deal last fall, but was repeatedly rebuffed. Brookfield then went hostile with a bid worth $16.50 in February.

Many analysts believed Brookfield was likely to face little competition in its pursuit of Inter Pipeline, but Pembina emerged as a white knight in May, agreeing to an all-share deal worth $8.3-billion. Brookfield’s original hostile bid was worth $7.1-billion.

Brookfield and Pembina ended up taking each other to court, with both sides filing arguments with the Alberta Securities Commission.

The arguments were heard in early July and the ASC ultimately ruled against Brookfield by raising the percentage of shares that must be tendered to Brookfield’s hostile takeover bid. Pembina had alleged Brookfield was using “coercive tactics” to win the takeover battle.

Before the ruling, Brookfield needed the support of a simple majority of Inter Pipeline’s independent shareholders, but it will now need the support of 55 per cent under a modified tender condition.

The ASC also shot down Brookfield’s request to have the potential $350-million break fee to Pembina scrapped.

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