Canada’s vaccination campaign is off to a slow start — and news this week that deliveries of the Pfizer product will be reduced dramatically over the next month has further complicated the national rollout.
Maj.-Gen. Dany Fortin, the military commander leading vaccine logistics at the Public Health Agency of Canada (PHAC), has said Pfizer will not ship a single vial of its highly effective vaccine to Canada next week as the pharmaceutical giant retools its production facility in Puurs, Belgium to boost capacity.
The announcement is already prompting some provinces to warn that they will have to curtail appointments in the weeks ahead as they direct the existing supply of the two-dose Pfizer product to patients who need their second shots.
Why is Canada getting less vaccine than anticipated?
Pfizer is grappling with unprecedented global demand for its vaccine as the world scrambles to inoculate patients against the deadly novel coronavirus.
While the company had projected it could manufacture up to 1.3 billion shots this year alone, it is now shifting gears to pump out even more.
The company is making upgrades to its Belgian plant so that it can manufacture up to 2 billion doses this year to meet the insatiable demand. In order to complete those upgrades, some production lines will have to be idled and Pfizer won’t have enough vials to go around in the short term to meet its previously promised delivery schedule.
“Pfizer and BioNTech are working relentlessly to support the further rollout of the vaccination campaigns worldwide by not only expanding their own manufacturing capacities but also by adding further suppliers as well as contract manufacturers to increase total manufacturing capacity,” the company said in a news release announcing the disruptions.
Fortin has said that, starting next week, Canada’s deliveries will be reduced by up to 50 per cent over a four-week period, punting as many as 400,000 doses to a later date.
While the company has another manufacturing facility in Kalamazoo, Mich., the Belgian plant alone is supplying Canada, the European Union and the United Kingdom. U.S. deliveries will continue uninterrupted.
Will Canada, the EU and the United Kingdom be equally affected by these disruptions?
No. Announcing the delays last week, Public Services and Procurement Minister Anita Anand said she expects Pfizer will treat all countries equally as it reduces shipments with an eye to restoring service in February.
But Pfizer isn’t treating every customer the same way. While Canada will receive zero doses next week, the company said it “will be back to the original schedule of deliveries to the European Union beginning the week of January 25.”
Pfizer has promised the EU that it will then “increase delivery beginning week of February 15, resulting in our ability to deliver the fully committed quantity of vaccine doses in the first quarter and significantly more in the second quarter.”
When asked why Pfizer will not make the same commitment to Canada, Anand said that she expects the company to treat all countries equitably — but could not say why Canada has been singled out.
“This was very disappointing and I spent the weekend on the phone with Pfizer executives and my team. We reiterated firmly the importance for Canada to return to our regular delivery schedule as soon as possible,” she said at a press conference Tuesday.
Pfizer did not respond to specific questions about why it is showing more favourable treatment to the EU. In an emailed statement, the company said the details of its agreements with governments are “confidential.”
“Multiple countries around the world will be impacted in the short term in order for us to quickly enable increased production volumes afterwards,” the spokesperson said.
The U.K. delivery schedule is less clear. The government there has said it is “in close contact” with all suppliers so that it can achieve its target of immunizing all those over age 70 by February 15.
So how many doses will Canada receive over the next number of weeks?
It’s hard to say for sure. Fortin had said Canada would see a 75 per cent drop next week in deliveries — but then had to correct that forecast after learning Canada wouldn’t receive a single dose.
Just last week, Fortin had been expecting delivery of 208,650 doses to the provinces every week for the rest of this month. Fortin also said Canada is expected to receive 366,000 Pfizer doses per week in February.
Speaking to the press this week, Fortin conceded those numbers are no longer accurate.
“Those numbers remain to be confirmed by Pfizer Canada. In fact, we have regular conversations with them and we hope and we expect to have clarity on those numbers,” Fortin told reporters at a public health briefing.
Is Canada still on track to get 4 million doses of the Pfizer product by the end of March?
The government has said yes. While the deliveries may change, the government insists its medium-term targets are more certain.
By the end of the first quarter, Canada is expecting four million doses from Pfizer and another two million doses from Moderna — enough to vaccinate some 3 million Canadians with these two-dose products.
WATCH: Canada affected by Pfizer vaccine production delay in Europe
But these delays mean that many people will be kept waiting much longer for shots than they originally anticipated. While deliveries might return to a more normal flow, it will be difficult for provinces to pump through hundreds of thousands of patients in a short timeframe to reach vaccination targets.
The delivery hiccup also could push off the vaccination campaign for the general population, which had a start date of April 1.
Pharmacies have said they could vaccinate as many 2.5 million people per week if all 11,500 community pharmacies in this country are mobilized, but the lack of supply has delayed their participation in the effort.
Data released by PHAC Thursday suggest 10 million more people could be fully vaccinated between April and June, for a cumulative total of 13 million people inoculated since the start of the campaign.
And if other vaccines apart from the Pfizer and Moderna products are approved over that time period, 10 million more patients could complete the vaccine regime by the end of June, for a combined total of 23 million.
The PHAC data also suggest that 36 million Canadians can be vaccinated by the end of September, if all goes well and there aren’t any significant delivery disruptions in the interim.
What is Prime Minister Justin Trudeau doing about this Pfizer delay?
While the prime minister of Israel has had more than a dozen calls with the CEO of Pfizer, and the president of the European Union has personally reached out to the company’s leadership, Trudeau has said that Anand is the lead on this file.
“I can assure you that Minister Anand is talking almost daily with Pfizer and the other vaccine companies to ensure that we get as many doses as possible, as quickly as possible, and that work will continue,” he said. “We will not rest, we will not slow down.”
When pressed by Vassy Kapelos, host of CBC’s Power & Politics, to state whether Trudeau has personally contacted Pfizer to ask for more doses, Anand would only say that she has been in “close communication” with the prime minister.
Some observers have said Trudeau should ask U.S. President Joe Biden to temporarily float Canada some vaccines from the Michigan plant as a sign of goodwill — especially after Biden rescinded the presidential permits for the Keystone XL pipeline.
So how are the provinces reacting to all this?
Not well. Ontario Premier Doug Ford has said the delivery delays will be very disruptive. The province also has said the temporary stoppage could mean its goal of immunizing all long-term care residents in the province by Feb. 15 won’t be achieved.
“If I was in (Trudeau’s) shoes … I’d be on that phone call every single day. I’d be up that guy’s yin-yang so far with a firecracker he wouldn’t know what hit him,” he said of Pfizer’s executives. “I would not stop until we get these vaccines.”
On Wednesday, Ford called Pfizer Canada President Cole Pinnow to discuss the situation.
“He reiterated the serious impact these cancelled shipments will have on Ontario and sought answers as to why Canada isn’t receiving vaccines as quickly as other countries,” Ford’s office said in a media statement after the call.
Ford also has suggested Biden should “help out its neighbour” by releasing some shots to Canada.
Alberta Premier Jason Kenney said Tuesday the province is putting a temporary hold on the first dose of COVID-19 vaccinations to ensure it has enough vaccine to provide a second dose to people who have already received their first shot.
“By pausing first appointments, we can ensure enough vaccine is allocated for committed second-dose appointments,” Kenney said.
How is Canada doing compared to the rest of the world?
Canada has administered some 700,000 shots – roughly 1.7 per cent of the population has received at least one dose of either the Pfizer or Moderna products. In Ontario, about 40,000 people have been fully vaccinated against the virus.
The United States has vaccinated three times more people per capita than Canada.
The U.K., too, has been a world leader in getting shots into the arms of patients. Nearly 7.5 per cent of the British and Northern Irish population has so far received at least one dose.
Canada’s vaccination effort has also been outpaced to date by those in Bahrain, Denmark, Ireland, Israel, Italy, Lithuania, Malta, Slovenia, Spain and the United Arab Emirates, among others.
But according to the latest data collated by the University of Oxford-based Our World in Data, Canada has administered more shots per capita than G7 partners like Germany and France, and middle-income countries like Argentina and Costa Rica.
“I had a lovely conversation with Angela Merkel yesterday morning in which she sort of complained to me that every day she gets it from the German media that they’re not doing as well as Canada,” Trudeau told reporters Tuesday.
“I think a lot of people are comparing stories from country to country and trying to figure out how we can all move quicker.”
The EU authorized the Moderna product for use two weeks after Health Canada regulators gave that vaccine the necessary approvals, which could account for the slower start to vaccination campaigns in countries like Germany.
What about the other promising vaccine candidates?
Health Canada regulators are still reviewing clinical trial data for both the AstraZeneca and Johnson & Johnson products. Canada has placed orders for doses from these companies but a delivery schedule is far from certain, given that the regulatory review is still underway.
The U.K. approved the AstraZeneca vaccine on Dec. 30.
The product from Johnson & Johnson’s pharmaceutical division, Janssen, has not been approved for use anywhere in the world. Some countries are eager to secure doses of this vaccine because it only requires one shot.
The company has not yet presented publicly any final data on its effectiveness, although some early results, published in the prestigious New England Journal of Medicine, are promising.