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Limited vaccine supply could thwart Canada's efforts to contain monkeypox – CBC News



As an unprecedented global monkeypox outbreak keeps growing, Canada remains opaque about its vaccine stockpile — even as advocates and medical experts warn the country may lack enough supply to meet current demand, with many Canadians being offered just one round of what’s typically a two-dose shot in order to stretch supplies.

Countries are also hastily procuring more vaccine shipments while a key manufacturer is striving to keep up with global orders, all to stop the spread of a virus that has struck more than 14,000 people globally so far this year.

“Every effort must be made to contain this infection,” Dr. Rosamund Lewis, the World Health Organization’s technical lead for monkeypox, told CBC News.

More than 600 cases of monkeypox virus, or MPXV, have been identified in Canada to date. 

An often painful, lengthy illness, which remains contagious until lesions are fully healed, the current MPXV outbreak is overwhelmingly affecting men who have sex with men, though the virus is typically known for infecting people more broadly, including women and children.

Decades after the end of widespread smallpox vaccination — which offered cross-protection against this virus as well — there is now a “large pool of susceptible people all around the world,” Lewis said.

So will enough people gain protection in time to stop these outbreaks and prevent MPXV from taking hold? Some medical experts are hopeful — but given the concern around vaccine supply as cases continue to rise in Canada and the world, others aren’t so sure this virus will be contained.

High early uptake in vaccine rollout 

As MPXV cases rose in Canada in recent weeks, so did the number of vaccines being offered. 

In major cities in Ontario and Quebec, which have experienced roughly 90 per cent of the country’s monkeypox cases, more than 20,000 shots have been doled out so far.

One front-line physician in Toronto told CBC News that while new patients with the virus keep seeking treatment, demand for the shots is starting to slow.

“We did have excellent uptake, right at the start of the vaccine rollout in May and June, but we need to continue to scale it up,” said Dr. Darrell Tan, an infectious disease specialist at St. Michael’s Hospital who is currently treating about 10 MPXV patients.

It’s too early to say if cases will stabilize, and for now vaccine supply appears to be limited, he said, adding it would be “devastating” if these outbreaks aren’t contained and the virus establishes itself long-term within sexual networks.

It’s too early to say if MPXV cases will stabilize, and for now, vaccine supply appears to be limited, said Dr. Darrell Tan, an infectious diseases specialist at St. Michael’s Hospital in Toronto. (Lauren Pelley/CBC News)

In B.C., where there are now 40 confirmed cases and counting, vaccines are being distributed at men’s health clinics and bathhouses in Vancouver. There, local officials warned demand is already far outpacing the supply provided through the federal stockpile.

“We have big outbreaks happening in Toronto and in Montreal, and so they’ve requested big amounts of vaccines,” Dr. Mark Lysyshyn, deputy chief medical health officer with Vancouver Coastal Health, told CBC News in mid-July. “We have a smaller outbreak here, but we want to avoid getting into the situation that they’re seeing there.”

On the East Coast, there are no known MPXV infections. But with cases popping up in more Canadian towns and provinces, far from the original hot spots — including 12 in Alberta and two in Saskatchewan — Halifax resident David Gosine wanted to get vaccinated before the virus spread into his city. He also assumed he could get a shot locally.

“But it was much more difficult than that,” he said.

Gosine tried a local travel clinic, a sexual health facility, and his family physician. None were able to obtain an Imvamune dose. Instead, he flew to Montreal for a nine-hour layover just to visit a vaccination clinic — gaining eligibility for the shot under Quebec’s rules, since he intends to travel back for the city’s Pride festival in early August.

“I wonder why we’re not being proactive in public health on the East Coast and other parts of Canada that are considered, in the greater scheme of Canada, as rural?” he questioned.

‘Limited supply’ behind Ontario’s 1-dose approach

While some regions of the country may have limited vaccine access so far, those doling out the most shots are also using them sparingly.

The vaccine being offered is Imvamune, from Danish vaccine developer Bavarian Nordic. Health Canada first approved the shot in 2013 for immunization against smallpox — a virus long eradicated globally thanks to widespread vaccination campaigns — in case of a future public health emergency. 

Seven years later, Health Canada expanded approval of the vaccine to fight monkeypox as well.

Typically, Imvamune is a two-dose shot, given 28 days apart, with the option for a booster two years later.

But in guidance for health-care professionals released in mid-June, Ontario said it would be using a “ring vaccination approach” and offering just a single dose in areas with confirmed cases — given the “current limited supply” of vaccines.

The province is not looking to expand its vaccination strategy, Ontario’s chief medical officer of health Dr. Kieran Moore said earlier this month, adding that the strategy “appears to be working.”

“We’re reviewing if we have to go back to those … individuals and provide a second dose,” he said at the time.

WATCH | A Toronto man shares his monkeypox recovery:

What it’s like to recover from monkeypox

1 month ago

Duration 1:57

A Toronto resident shares his experience recovering from monkeypox, while officials and advocates say more support is needed for patients during the long weeks of isolation.

Dr. Réjean Thomas, a family physician at l’Actuel, a centre for sexual health in Montreal, is concerned a similar approach in his area may be leaving people at risk if they’re exposed to the virus, since it strays from the typical dosing timeline.

“Because of this lag in vaccines, we’re giving one dose,” he said. “So what will happen with the effectiveness of the vaccine? We’re worried.”

However, recommendations of the Comité d’immunisation du Québec (CIQ) on vaccination against MPXV states that there is still a good immune response from a first dose. Montreal Public Health has asked the province’s ministry of health if the team can offer a second dose to people who request it because their behaviour still puts them at risk, a ministry spokesperson said, but the province is only offering a second round to people who are immunocompromised. 

The company itself isn’t deterring countries from taking a one-dose approach for the time being while supplies are tight. In an interview with Science, Bavarian Nordic CEO Paul Chaplin, an immunologist, said immune memory is strong enough after a single shot that even a booster given two years later leads to the same immune response you’d see on the standard vaccination schedule.

University of Manitoba virologist Jason Kindrachuk agreed data presented so far show a solid immune response even after one dose. 

“As a single dose will provide greater coverage in a time with supply concerns, there is reason to this plan,” he said in an email.

Canada’s vaccine advisory body — the National Advisory Committee on Immunization (NACI) — suggests one shot can be offered for people post-exposure to MPXV, while a second dose “may be offered” after 28 days if an assessment indicates a predictable, ongoing risk of exposure.

But in guidance issued for pre-exposure vaccination, which focuses only on people at a high risk of “occupational exposure in a laboratory research setting,” NACI recommends that Imvamune may be offered and given as two doses.

Deliveries not expected until 2023

Canada’s vaccination efforts to date suggest a rapid response to this emerging crisis, albeit one that could be stymied by limited supply if cases continue creeping up across more parts of the country.

In an email to the Public Health Agency of Canada (PHAC), CBC News asked how many vaccine doses for MPXV have been delivered and received by the provinces; how many doses have been ordered; and whether a one-dose approach is being used everywhere in Canada.

However, Health Canada and PHAC spokesperson Mark Johnson did not provide specific details, including the number of doses ordered, delivered, or received. 

“PHAC does not disclose details concerning medical countermeasures held by the National Emergency Strategic Stockpile, including types or quantities, due to security and confidentiality implications and requirements,” he wrote.

Bavarian Nordic noted in a June news release that PHAC was purchasing an undisclosed number of Imvamune doses under a five-year contract at a value of roughly $56 million US, or $72 million Cdn. 

Deliveries aren’t expected to begin until 2023, a little more than five months from now.

CBC News also posed questions around vaccination efforts to federal Climate and Environment Minister Steven Guilbeault during a funding announcement on Thursday, where he was outlining support for community organizations to address MPXV.

“Some people are getting a second dose of the vaccine — immunosuppressed people are — but we are working hard to acquire more vaccines and we’re confident that we will have enough vaccines to meet the demand to face this outbreak,” he said.

WATCH | Surge in U.S. monkeypox cases spurs demand for more testing, vaccines:

Monkeypox surge prompts growing demand for vaccine, testing in U.S.

3 days ago

Duration 1:51

There is growing frustration in the United States over the government’s response to the monkeypox outbreak, because testing capacity is limited, there are not enough vaccines, and some patients are struggling to find treatment.

‘Expect major shortages’

In the U.S., however, officials say demand for MPXV shots is already outpacing the country’s supply. That country is now ordering millions of doses; so are various countries in Europe.

“In this unprecedented situation, [Bavarian Nordic] is making every possible effort to ensure sufficient availability of vaccines to meet the current demand,” the company said on July 18.

While there may be delays getting shots, Dr. Anu Hazra, program director for the infectious diseases fellowship at the University of Chicago, said it’s important to remember that the world doesn’t have to wait for vaccine development in this case.

“If we can have a concerted effort to do … comprehensive testing, tracing and vaccinations, I do think we can get a hold of this.” Still, he added, the world has “definitely been behind the ball” in terms of trying to catch up to the actual number of cases.

“Expect major shortages of vaccine among frustrated at-risk individuals for many months to come,” wrote Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and Bruce Gellin, chief of global public health strategy at The Rockefeller Foundation, in an editorial for Science.

The pair noted it could take anywhere from 2.4 million to 5.3 million doses to reach the global population of men who have sex with men, an estimate similar to those considered for HIV oral prexposure prophylaxis, or PrEP.

“Unless the world develops and executes an international plan to contain the current outbreak,” their editorial continued, “it will be yet another emerging infectious disease that we will regret not containing.”

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Iran protests: Canada sanctioning 'morality police' – CTV News



Canada will be imposing new sanctions on Iran as a result of a continuing violent crackdown on protesters, Prime Minister Justin Trudeau said Monday.

The sanctions will be levelled on “dozens of individuals and entities, including Iran’s so-called morality police,” the prime minister said.

“We’ve seen Iran disregarding human rights time and time again, and now we see with the death of Mahsa Amini and the crackdown on protests,” Trudeau said, referencing the death of a 22-year-old who was detained for allegedly violating the country’s forced veiling laws. Her death has sparked outrage and has prompted a wave of international demonstrations, seeing some women cut their hair or burn their hijabs in revolt.

“To the women in Iran who are protesting and to those who are supporting you, we stand with you. We join our voices, the voices of all Canadians, to the millions of people around the world demanding that the Iranian government listen to their people, end their repression of freedoms and rights, and let women and all Iranians live their lives and express themselves peacefully,” Trudeau said.

While no official notice of the new sanctions has been published by Global Affairs Canada, the prime minister noted they come in addition to outstanding measures Canada has taken against Iran.

In an email to CTV News, Adrien Blanchard, press secretary to Foreign Affairs Minister Melanie Joly said that Trudeau “announced Canada’s intention” to issue these sanctions, pledging more details “in due course.” 

Joly, as well as MPs from all parties, have spoken out about the escalating tensions and use of force against civilians in Iran, with the House of Commons unanimously passing a motion last week offering “solidarity to the women of Iran who are fighting for their rights and freedoms.”

With files from CTV News’ Michael Lee 

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Maine power workers cross border without incident to help in Nova Scotia



OTTAWA — Nova Scotia Power says there were no issues delaying American power crews from crossing the border to help repair the electrical grid from the devastation of hurricane Fiona.

On Sunday, the utility company and Nova Scotia Premier Tim Houston had both said an issue related to the controversial ArriveCan app was delaying power crews from crossing into Canada.

Health Minister Jean-Yves Duclos said this morning that the order making the app mandatory and requiring that foreign citizens be vaccinated to come to Canada will expire on Friday.

Power crews helping to restore electricity are considered essential workers and are exempt from the border measures.

In a new statement Monday afternoon, Nova Scotia Power spokeswoman Jacqueline Foster says there was some confusion about the app but it is now confirmed there were no problems.

Versant Power says 15 line workers and two mechanics left Bangor, Maine, for Canada early Monday morning without issue, and Central Maine Power reports more than a dozen two-person crews and 10 support workers crossed the border without incident at around 7 a.m. Monday.

“We now know there were not any issues with ArriveCan,” said Foster. “Our contractor crews have made their way over the border and we are grateful to have them as part of our restoration efforts here in Nova Scotia.”

The Canada Border Services Agency reported that it cleared 19 power trucks at the Third Bridge border crossing in St. Stephen, N.B., just after 7 a.m. Monday. The CBSA said the average processing time was between 30 and 60 seconds per vehicle.

The ArriveCan app has been fodder for heated political debates for months and Conservatives have repeatedly demanded that the government shut it down.

During question period on Monday, Conservative Leader Pierre Poilievre cited the allegations that ArriveCan delayed power crews to demand that the app be scrapped ahead of schedule.

He asked, “Will the prime minister suspend the ArriveCan app today, not Saturday, so that no more holdups happen at the border for those who are trying to help those in desperate need?”

Trudeau said he can “confirm that there were no delays at any border because of ArriveCan or otherwise.”

The utility company had said Sunday that crews were physically stuck at the border, but confirmed a few hours after question period on Monday that this had never been the case.

Foster suggested the error was a result of “confusion” after a concern arose Friday — before the storm actually hit — that crews from Maine might not be able to cross the border because of ArriveCan.

No New Brunswick border crossings reported issues over the weekend.

This report by The Canadian Press was first published Sept. 26, 2022.


Mia Rabson, The Canadian Press


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Former top civil servant, medical association president appointed as senators



OTTAWA — Ian Shugart, a longtime bureaucrat and the country’s top civil servant during the first part of the COVID-19 pandemic, has been tapped for a seat in the Senate.

Dr. Gigi Osler, a Winnipeg surgeon, University of Manitoba professor and president of the Federation of Medical Women in Canada, is also set to become a senator.

Prime Minister Justin Trudeau announced the picks today after the two were recommended to him by the independent advisory board for appointments to the upper chamber.

Shugart, who will represent Ontario, stepped down as the clerk of the Privy Council in early 2021 to undergo cancer treatments and formally retired in May after a long public service career.

Trudeau also appointed him to the King’s Privy Council today, adding his name to a list that includes past and present cabinet ministers and people “honoured for their contributions to Canada,” according to the Prime Minister’s Office.

Osler, who will represent Manitoba, became the first female surgeon and the first racialized woman to hold the presidency at the Canadian Medical Association in 2018.

This report by The Canadian Press was first published Sept. 26, 2022.


The Canadian Press

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