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Mixing coronavirus vaccines without necessary data 'a huge gamble,' experts say – msnNOW

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Different vaccines to protect against the novel coronavirus shouldn’t be mixed-and-matched, despite Britain’s recent decision to allow the practice to be used in rare occasions, health experts say.



The Pfizer-BioNTech COVID-19 vaccine in Edmonton, Alta. on Tuesday, December 15, 2020.


© Chris Schwarz/Government of Alberta
The Pfizer-BioNTech COVID-19 vaccine in Edmonton, Alta. on Tuesday, December 15, 2020.

Mixing different coronavirus vaccines without any data to suggest the safety and efficacy of the practice is “a huge gamble,” Dr. Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto said.

“I think it’s irresponsible … it’s unethical because we don’t know what that does,” he said. “We don’t know what the effectiveness is, we don’t know what the side effects are.”

Dr. Isaac Bogoch, an infectious diseases faculty member at the University of Toronto said while there may be “some theoretical reasons” as to why vaccine mixing “may provide decent protection to COVID-19 infections,” the data is not yet conclusive.

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“Until we see better data to support that, I don’t think we’re going to see any such activity in Canada,” he said.

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The comments come after Britain released new guidelines on New Year’s Eve which will allow people seeking their second dose to be given shots of different COVID-19 vaccines on rare occasions.

“(If) the same vaccine is not available, or if the first product received is unknown, it is reasonable to offer one dose of the locally available product to complete the schedule,” according to the guidelines.

Mary Ramsay, head of immunizations at Public Health England, said this would only happen on extremely rare occasions, and that the government was not recommending the mixing of vaccines, which require at least two doses given several weeks apart.

She said “every effort should be made to give them the same vaccine.

“But where this is not possible it is better to give a second dose of another vaccine than not at all,” she said.

What has Health Canada said?

Health Canada’s National Advisory Committee on Immunization (NACI) currently recommends that the vaccine series “be completed with the same COVID-19 vaccine product.”

“Currently, no data exists on the interchangeability of COVID-19 vaccines,” the agency’s website read.

However, according to NACI, if the vaccine used for a previous dose is “not known, or not available, attempts should be made to complete the vaccine in series with a similar type of COVID-19 vaccine (e.g. mRNA vaccine).”

“In the context of limited COVID-19 vaccine supply and the absence of evidence on interchangeability of COVID-19 vaccines, the previous dose may be counted, and the series need not be restarted,” the website read.

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The agency said “active surveillance of effectiveness and safety of this mixed schedule will be important in these individuals,” adding that “accurate recording of vaccines received will be critical.”

According to the NACI, the agency will “continue to monitor the evidence” and will update its recommendations as needed.

To date, Health Canada has approved two coronavirus vaccines for use across the country. Both are mRNA vaccines, and require two doses to provide around 95 per cent protection from COVID-19.

The Pfizer-BioNTech vaccine requires two shots to be administered 21 days apart, while doses of the Moderna vaccine are to be administered 28 days apart.

Bogoch said we have “good data” on these vaccines, and how they are to be administered.

Asked if there are any circumstances in which Canada should allow different vaccines to be mixed-and-matched before data is available, Bogoch said: “no.”

“I’m not entirely sure outside of a clinical trial what the role would be for conducting this type of activity,” he said.

Video: COVID-19 vaccine committee’s new advice on who should get inoculated first

Furness also said vaccines should not be mixed unless in a lab setting, where participants have given their informed consent.

“If you want to do a trial to try them out, sure,” he said. “But that’s going to take many months.”

Anything else, Furness said, would be “experimental.”

“The human history is really littered with experimenting on people without the understanding that they’re being experimented on,” he said. “And that’s really not OK.”

For now, Bogoch said we should focus on rolling out the approved vaccines as quickly as possible, in the manner in which they are meant to be administered.

“The goal is to have as few vaccines in freezers as possible and get the needles in arms quickly as possible to the highest risk groups and prevent death and suffering,” he said.

–With files from Reuters

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Couche-Tard CEO would love second shot at Carrefour deal – theglobeandmail.com

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A customer pushes her shopping trolley in front of a Carrefour Hypermarket store in Saint-Herblain near Nantes, France on Jan. 15, 2021.

STEPHANE MAHE/Reuters

Alimentation Couche-Tard (ATD-B-T) (ATD-A-T) would revive its $20 billion bid for France’s Carrefour (CRRFY) if the Canadian convenience store operator saw a change in the French government’s stance on the proposed deal, its chief executive said on Monday.

Couche-Tard dropped its surprise bid for the European retailer over the weekend after the plan ran into opposition from the French government. Some French politicians said the issue was a matter of national food safety.

“We’d love to do the transaction …. if we got signals that the environment could change or would change from the French government or other key stakeholders,” Brian Hannasch told an analyst call.

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News of the approach from Couche-Tard, which operates convenience outlets and fuel stations, broke only last week but unravelled swiftly in the face of opposition from French politicians including finance minister Bruno Le Maire.

With a deal effectively blocked, the companies said they had decided instead to examine opportunities for sharing practices on fuel purchases, partnering on private labels and distribution in overlapping networks.

Shares in Carrefour slumped more than 6% in Paris to 15.55 euros on Monday afternoon as the prospect of the 20 euro per share offer evaporated, for now at least. Couche-Tard shares rose 3.4%.

“In terms of politics, I think we went into this with eyes wide open knowing that this was a risk, and I certainly do believe that the pandemic has heightened the food security issue, particularly in France,” Hannasch said.

“And so whether that changes over time, it’s hard to say.”

‘TRUE BARRIER’

In a note to clients on Monday, Bryan, Garnier & Co retail analyst Clément Genelot blamed France’s 2022 presidential elections as the “true barrier to the deal,” amid fears that the sale of the country’s leading private employer could strengthen far-right opposition to incumbent Emmanuel Macron.

Carrefour employs 105,000 people in France and runs around 8,000 convenience stores as well as its traditional hypermarkets and supermarkets.

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One top ten Couche-Tard shareholder, already skeptical about the merits of a tie-up with a grocer, said the company would face questions for moving away from its core business.

“I think in the interim there will continue to be some form of overhang or discount I think applied to the equity just because there will be that concern that the management team has started to get outside what’s considered their area of competence,” he said on condition of anonymity.

Analysts at investment bank Citi said there was still a chance Carrefour and Couche-Tard could revive talks at a later date, while the possibility remained for Carrefour and domestic rival Casino to examine a merger deal.

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Ontario reports 2,578 new coronavirus cases; testing falls to lowest point since early January – CP24 Toronto's Breaking News

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Ontario reported a considerable drop in new COVID-19 cases and deaths on Monday, which could be partially explained by a corresponding fall in testing rates to the lowest point seen in two weeks.

The province reported 2,578 new cases and 24 new deaths on Monday, on the strength of 40,000 test specimens, or 20,000 fewer than what was processed the day before.

Ontario reported 3,422 new cases on Sunday and 3,056 on Saturday.

The seven-day average now stands at 3,074, which is down 10 per cent from this time last week (3,394).

“Locally, there are 815 new cases in Toronto, 507 in Peel, 151 in York Region, 151 in Niagara and 121 in Hamilton,” Health Minister Christine Elliott wrote on Twitter.

Approximately 421 people have died of novel coronavirus infection in the past seven days. Fourteen of the 24 deaths reported on Monday involved residents of the long-term care system.

Monday’s case total is the lowest Ontario has seen since Jan. 1.

There are now 28,621 active cases of infection across the province, down from a peak of 30,141 six days ago.

Provincial labs processed 40,301 test specimens, generating a positivity rate of at least 6.6 per cent. A further 18,481 specimens remained under investigation on Monday.

The number of tests processed is the lowest Ontario labs have completed in a 24-hour period since Jan. 5.

More than 400 patients are receiving care in intensive care for COVID-19 symptoms across the province, with the number of intubated patients climbing by 10 to 303 on Monday.

Toronto’s Chief Medical Officer of Health Dr. Eileen de Villa told the city’s Board of Health Monday that existing intensive care units in the city will reach capacity by the end of January.

There were a total of 1,571 patients admitted to hospitals across Ontario for novel coronavirus infection on Monday, up one from Sunday.

Meanwhile the number of long-term care homes facing an outbreak of COVID-19 grew by 2 to 248 of Ontario’s 626 facilities.

Elsewhere in the GTA, Hamilton reported 121 new cases, Halton Region reported 79 new cases and Durham Region reported 76 new cases.

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How Couche-Tard’s ambitious bid for France’s Carrefour was cut down – Financial Times

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Every January at the glittering Palace of Versailles, President Emmanuel Macron hosts a conference called “Choose France” to convince the heads of big multinationals that there is no better country to invest in.

Yet when one of Canada’s biggest companies, Alimentation Couche-Tard, made such a choice last week with a €16.2bn bid for French supermarket chain Carrefour, the government moved decisively to extinguish the chance of a deal.

Just 24 hours after the companies revealed they were in talks, French finance minister Bruno Le Maire declared his opposition, calling Carrefour “a key link in the chain that ensures the food security of the French people”. With its grip on a deal slipping, Couche-Tard, a $33bn group which operates convenience stores and petrol stations in North America and Europe, scrambled.

Alain Bouchard, its billionaire founder and chairman, flew into Paris for a meeting to persuade Mr Le Maire that the company would be a good owner for Carrefour, while Canadian politicians, including Quebec’s economy minister, worked the phones. 

It was to no avail. The 72-year-old entrepreneur was sent packing back to Laval, Québec where he founded Couche-Tard, best known for its Circle K chain, in 1980. Late on Saturday, the companies admitted the talks were off, but insisted they would examine operational partnerships.

The shortlived drama riveted the French business elite, while briefly holding out the promise of a payday for some of the top investment banks and law firms in Paris. Couche-Tard was advised by Rothschild, where Mr Macron worked from 2008 to 2010. Rival Lazard advised Carrefour.

The saga has also reignited a debate over whether France is as open for business as Mr Macron once promised. By branding a Couche-Tard takeover as a risk to France’s “food sovereignty”, some executives and bankers are worried the government has done lasting damage to its ability to attract foreign investors.

Breakdown of the retail groups: Carrefour vs Couche-Tard

“How can you tell me France is investor friendly and go and do something like this?” said one person involved in the deal. “Protectionism may be politically popular but it is bad for the country in the long run.”

A far-fetched plan

Despite a reputation for protectionism, it is relatively rare for France to block a foreign takeover. In recent years, steelmaker Arcelor, telecom gear specialist Alcatel-Lucent, cement giant Lafarge, and energy group Technip were all snapped up by buyers from outside France. The country was Europe’s top destination for foreign direct investment in 2019, according to a study by EY.

One longtime ally of Mr Macron and adviser to many French companies said the failure of Couche-Tard’s gambit owed more to bad timing than any fundamental change of approach in the Elysée. France was still attractive for investors, the person argued, pointing to labour reforms and tax cuts passed by Mr Macron’s government. 

Alain Bouchard, Couche-Tard’s billionaire founder and chairman
Alain Bouchard, Couche-Tard founder and chairman, flew into Paris for a meeting to persuade the French finance minister that the group would be a good owner for Carrefour © Canadian Press/Shutterstock

“The idea that the government would stand by while the biggest private employer in France was sold to a foreign buyer in the middle of a pandemic and one year before a presidential election is simply far-fetched,” the person said.

“Carrefour is a very visible asset in France — everyone from the labour unions to the farmers who supply their milk, cheese, and meats would have been up in arms,” they added.

Anticipating such concerns, Couche-Tard had planned to allay them by pitching the deal as a way to forge a French-speaking global retailing powerhouse better armed to compete with Amazon. It pledged to invest €3bn over five years, not cut jobs for two years, and to maintain dual listings in Toronto and Paris, according to people close to the group.

Given how foreign takeovers can quickly turn political in France, companies sometimes quietly run deals by officials to gauge their reaction. In 2005, PepsiCo was rumoured to be weighing up a bid for yoghurt maker Danone, prompting the then Prime Minister Dominique de Villepin to vow to protect the company in the name of “economic patriotism”. A bid never materialised.

Column chart of Revenues (€bn) showing Couche-Tard and Carrefour sales

Months later, France passed a decree giving the government the ability potentially to block takeovers by foreign buyers in sectors deemed strategic, such as defence and security. It is a definition that has steadily broadened to include energy, water and telecoms. In 2019, “food security” was added, creating the legal tool that would eventually thwart Couche-Tard.

Pascal Bine, an M&A specialist at law firm Skadden, Arps, Slate, Meagher & Flom, said the Covid-19 crisis had made the government more willing to block takeovers that could threaten the country’s supply chains. In December, it rejected US group Teledyne’s bid to buy Photonis, a maker of night vision goggles for military use.

Couche-Tard is best known for its Circle K brand
Couche-Tard is best known for its Circle K brand © Chris Helgren/Reuters

“With the health crisis, there is a new doctrine emerging on foreign investment in France. More attention is being paid to ensure that France has supplies of key goods like medical equipment and food, and the proposed Carrefour deal does raise questions about sovereignty,” Mr Bine said.

“Legally nothing has changed but culturally something has . . . do not forget that the 1789 revolution started in part over bread shortages,” he added.

With the pandemic’s disruption hitting share prices, other countries have also been uneasy about potential foreign takeovers. The UK in November expanded its ability to review takeovers of any size in 17 key sectors, while the EU has sought similar new powers and voiced concerns over state-backed Chinese buyers.

Carrefour’s unwanted discount

If the French government could not stomach the Couche-Tard deal, Carrefour’s board and management were open to considering it.

Instead, Carrefour’s chief executive Alexandre Bompard will have to keep cutting costs to improve profits, while trying to stem a multiyear decline in sales at its large-format stores, known in France as hypermarkets. The company’s shares were down 6 per cent on Monday.

Line chart of Forward 12m price-earnings multiple (x) showing Carrefour trades at a discount to peers

Three years into a five-year turnround plan, Mr Bompard has earned credit for selling assets in China and expanding the group’s ecommerce business. But with most cost savings going to pay for restructuring, margins have barely budged.

Carrefour stock has long traded at a discount to those of other big food retailers like Tesco or Walmart, reflecting the intense competition in France, where it still earns half its sales. With a 20 per cent market share, it is the second-largest player in France behind privately owned E Leclerc.

Fabienne Caron, analyst at Kepler Cheuvreux, said that closing the valuation gap will be that much harder now that a foreign takeover is off the table and regulators have previously frowned on domestic consolidation. “The key lessons of this week is that no foreign company can buy a French food retailer, and that Carrefour is up for sale,” she said. 

The lessons have not been lost on Carrefour’s three largest shareholders, who together control about 23 per cent of the stock. The group includes France’s richest man, LVMH founder Bernard Arnault, and the Moulin family behind department store group Galeries Lafayette.

They were open to selling their stakes to help the Couche-Tard deal, according to people familiar with the matter.

They were displeased with the government’s intervention, said one person familiar with their thinking, especially because they have long supported Mr Macron. Spokespeople for Mr Arnault and the Moulin family declined to comment.

Although painful, Couche-Tard’s French snub is unlikely to dent its ambitions. Under Mr Bouchard, the group has completed almost 40 takeovers over the past decade in the fragmented convenience store sector. The relentless dealmaking had, by 2019, made it Canada’s largest publicly traded company by revenue. 

Carrefour chief executive Alexandre Bompard
Carrefour chief Alexandre Bompard has earned credit for selling assets in China and expanding the ecommerce business, but most of the cost savings have gone towards paying for restructuring © Christophe Morin/Bloomberg

Couche-Tard’s move for Carrefour was aimed at cutting its heavy reliance on petrol sales, which are expected to decline in the coming decades as electric vehicles become widespread.

A solid balance sheet certainly gives the company the license to go shopping. According to Barclays analysts, the group’s net debt-to-ebitda ratio for 2020 was 0.9 times and is projected to be 0.5 times this year.

Stephen Groff, a portfolio manager at Cambridge Global Asset Management which owns Couche-Tard shares, said the group’s record has earned it the right to hunt for a major deal — even if the approach for Carrefour came as a big surprise.

“They’re a very effective operator with a decentralised mindset that’s enabled them to adapt to very different market conditions around the world,” he said.

But “shareholders are likely to want to get further clarity on what their long-term ambitions are given this is a different path than what many may have expected.”

Additional reporting by Kaye Wiggins in London

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