British Columbia’s vaccination plan leaves little ‘room for error’

Glacier Media special report: How the province aims to immunize 4.3 million British Columbians by the end of September

If it’s best practice to under- promise and over-deliver during a vaccination campaign, B.C. and Canada may already be heading down the wrong path.

With Pfizer Inc. and Moderna Inc. contracted to deliver as many as 120 million combined COVID-19 vaccine doses this year, federal and provincial officials have repeatedly declared all Canadians who wish to be vaccinated will get their jabs by the end of September.

“While it is certainly possible that the stated goal could be hit, it doesn’t appear to leave much room for error or contingency,” said Steve Waters, CEO and founder of Contrace Public Health Corps in Washington, D.C.

He pointed to real-time data from COVID19tracker.ca, which is administered by the University of Saskatchewan, that reveals Canada has administered 76% of doses that have been delivered as of late February.

B.C. is doing slightly better at 79%.

“[It] doesn’t lead to confidence that a large increase in delivery of doses will mean a massive increase in the rate of administration. In fact, a large delivery of doses at one time could potentially create logistical issues that could even reduce the administration rate,” Waters said. “Considering there is a global shortage of vaccines, existing production and delivery delays, and increasing geopolitical pressures around the most complex logistical challenge in modern history, Canada is certainly at a disadvantage having to depend on other countries for vaccines.”

Mahesh Nagarajan, a professor at the University of British Columbia’s Sauder School of Business whose focus area is supply chains, said effectively vaccinating a population involves a two-step process: sourcing the vaccine and distributing it.

He commended Canada for quickly acquiring options to buy hundreds of millions of doses of a range of drug makers’ vaccines, and said that had a different drug developer than the Pfizer-BioNTech partnership been able to first get its drug approved for use in Canada, it is “quite likely” that Canada’s vaccine rollout would have been faster.

“The Canadian government has not opened up its books, and shown us the exact nature of these contracts,” he said.

What the Canadian government should have done, he said, was revise its strategy over time.

“You cannot say in June of 2020, ‘We have option agreements for 400 million vaccine doses,’ and then you do nothing after that,” Nagarajan said.

Had the Canadian government swapped its options to buy vaccine doses for concrete commitments to buy those vaccines, backed with top-dollar prices, Nagarajan said, Canada would likely have been a world leader in getting its residents vaccinated.

He pointed to Israel, which has long been the No. 1 country for per-capita vaccinations.

“We know that Israel paid more money,” he said.

Nagarajan added that the federal government, knowing that Canada has little drug-manufacturing capacity, should have done more to ensure sufficient vaccine supply.

Some critics have suggested that were Canada equipped with a robust drug-manufacturing sector, similar to the U.K.’s, its manufacturing companies could have reached agreements with the Pfizer-BioNTech partnership or the second fastest vaccine producer, Moderna, to produce vaccines in Canada.

But Nagarajan said Canadian drug manufacturers would have had to pay the drug developers a significant sum for the right to produce the vaccines and that any such partnership would be feasible for the drug developers only if the prospective manufacturers could produce huge volumes of the vaccines – not merely enough for 38 million Canadians.

Another challenge is that Pfizer-BioNTech’s and Moderna’s mRNA vaccines are more complicated to manufacture than AstraZeneca’s, which is based on double-stranded DNA. As such, established drug manufacturers may have had difficulty producing the vaccine.

“That said, having a large manufacturing capacity can definitely help a country,” Nagarajan said.

With Canada facing sharp vaccine shortages in January and February, Ottawa revealed last month it’s tapping Vancouver-based Precision Nanosystems Inc. (PNI) to boost domestic vaccine manufacturing capacity in the coming years.

Plans for PNI’s new $50 million biomanufacturing facility in Metro Vancouver are now underway after the federal government revealed last month it was earmarking $25 million for the endeavour.

“The government support … has been a great catalyst to be able to bring that to fruition,” he said.

PNI is a provider of technology for the development and manufacturing of genetics medicines that deliver RNA or DNA directly into cells to treat disease at its molecular root cause.

Last fall, Ottawa earmarked $18 million for the company to pursue its own COVID-19 vaccine, which is expected to enter Phase 1 of clinical trials this coming summer.

PNI specializes in a class of vaccines known as self-amplifying RNA vaccines.

These have the potential to create more potent vaccines as they amplify the signal, allowing PNI to manufacture more doses for less volume.

The new 40,000-square-foot facility, expected to be completed in March 2023, would be able to produce up to 240 million of those self-amplifying RNA vaccine doses.

Moderna and Pfizer, meanwhile, have been manufacturing conventional messenger RNA (mRNA) vaccines.

Taylor said PNI’s facility would be able to manufacture two million to 24 million mRNA doses – a significant difference compared with the manufacturing capacity for a self-amplifying RNA vaccine.

With PNI’s facility slated to open in 2023, the Vancouver company’s expanded manufacturing capacity does not fit into the federal government’s timeline for vaccinating all Canadians by September 2021.

Instead, it’s poised to play a part in future responses to health crises.

“This facility will be utilized for the production of both therapeutics and vaccines applied to cancer, infectious disease, rare diseases.… And then in times of pandemic needs, it will be utilized for pandemic response,” Taylor said.

“If [PNI’s COVID-19 vaccine] came earlier than [when] the facility was ready for us, our company already partners and provides our technology to contract manufacturing organizations all over the world.”

Upon announcing the $25 million earmarked for PNI’s facility, Trudeau said the arrangement will offer the country more domestic manufacturing certainty for years to come.

“We don’t know what the future looks like a year from now, two years from now, three years from now,” he said.

“What we’re very clear on is Canada will be developing domestic manufacturing, so regardless of what could happen in the future, we will have domestic production.”

In the short term, one potential bottleneck could be scheduling.

Once people have registered online – likely through the BC Centre for Disease Control website or health authority websites – they will need to be notified when and where they can get their first shot. Once they’ve had their first shot, they will need to be scheduled for a second shot a few weeks later.

“There is a very strong likelihood we will not get it done by September,” said Nagarajan. “Actually, I think the chances are very, very high we won’t get it done by September.”

He’s not convinced the province will be able to secure all the vaccines it will need on schedule. Even if the province is able to secure all the vaccines it will need on schedule, he fears there could be problems getting the provincial Panorama health-care data system synced with the IT systems of five health authorities.

“One of the issues is that each health-care authority has its own IT system,” Nagarajan said. “What is needed is a way to get these systems communicating with each other. This needs to be pretty seamless. You do not want citizens showing up to a vaccination centre where the bottleneck is the IT system trying to record the citizens’ information and then cross-checking it.

“You need to have a very smooth process where all of these transactions get recorded so fast and so seamlessly that the focus is unrelentingly on getting the vaccine in somebody’s arm and getting them out.”

The federal government awarded Deloitte Inc. a $16 million contract late last year to provide a national vaccine management IT platform (NVMIP) meant to assist provinces with vaccine rollout, administration and reporting.

The NVMIP isn’t meant to replace B.C.’s existing system, but the province confirmed it would be used to record all immunizations electronically and track vaccine inventory.

“I know that there’s going to be glitches, there’s going to be bumps,” B.C. provincial health officer Dr. Bonnie Henry told reporters in late February. “We will not let people be left behind.”

Bill Tam, chief operating officer for the B.C. Digital Technology Supercluster, said he thinks a new purpose-built scheduling system, called Project ABC, can be in place by the time Phase 3 starts in April.

With the help of the Digital Supercluster, Cambian, a B.C. software company specializing in health care, developed the Project ABC software, which stands for “authorization, booking and confirmation.”

“We’ve got the scheduling software that allows people to book these appointments,” said Cambian CEO Bruce Forde.

Project ABC was originally designed to manage COVID-19 serology testing, but has since pivoted to scheduling vaccinations on a large scale.

“Think of it as a bit of a rules engine that will ensure the right population demographics have the access they need to go ahead and book their vaccinations,” Tam said.

The Project ABC software, which will likely be embedded as a widget in the BC Centre for Disease Control or health authority websites, will confirm a person is eligible for a vaccine according to age, occupation and other criteria.

“You get an email, or text, if you’ve chosen text,” Forde explains. “It brings you to a website – same place where you registered – then you choose a site that is convenient for you. So if you’re within a certain area, maybe you have like three or four or five options to choose from, you can look at a time, pick the location, and when you’re finished you get a QR code.”

Using their smartphones, people can simply flash their QR code when they arrive at the clinic at the designated time, which will allow them to move quickly through the queue without having to fill anything out.

“We don’t know where the bottlenecks will be until we actually run through the system,” said Nagarajan.

Another integral facet in the vaccine rollout will be a public-awareness campaign never seen before in B.C. and Canada.

Valorie Crooks, professor of geography at Simon Fraser University and the current Canada Research Chair in Health Service Geography, noted that – at least in northern, remote communities where vaccination clinics are likely limited – the opportunity is there for the province to deploy targeted marketing to achieve a better result.

The rise of anti-vaxxer sentiment in North America and throughout the world in the last few years has raised concerns from many experts that a COVID vaccination drive may be impeded by misinformation.

That is why, Crooks said, the key will be avoiding a one-size-fit-all public awareness campaign. The priority should be to identify trusted message-carriers – whether that be local newspapers, community leaders, online platforms or other individuals – whose delivery of vaccination information would be more easily accepted at the micro-local level, she noted.

“We need public health communication strategies that make sense in the places where people live,” Crooks said. “People who are health authority liaisons or on-site providers need to involved in leadership in how information is shared. It may involve turning over the messaging to people who are members of the community who are reliable relaters of key information.”

Rhea Dubois-Phillips, Vancouver general manager of public relations firm Edelman, agreed.

She said relying on daily news conferences will not by itself lead to a successful public awareness rollout.

Dubois-Phillips noted examples during the early days of COVID-19 where provincial news conferences aimed at urging people to stay home and flatten the curve; some of these efforts, she said, were unsuccessful because the information wasn’t readily available in the languages of certain ethnic and religious communities – meaning the messaging did not reach all of its intended target.

“You have to figure out what barriers are there that would prevent certain stakeholders from getting the vaccine,” Dubois-Phillips said.  •




 

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