BC's vaccination schedule leaves slim margin for error

Little room for error

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,” says 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.

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.”

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