Bulk shipments of the main component of the H1N1 vaccine made at a Quebec plant are being exported to other countries, as Canadians line up for hours for the scarce influenza shots.
GlaxoSmithKline, which has the sole contract to supply Canada's flu vaccine, says it can produce more antigen than it can expeditiously put into vials for Canadians, and has been exporting excess amounts overseas.
Meanwhile, Canadians waited in long lines or were turned away Tuesday in the face of dwindling vaccine supplies and a resurgent virus. Alberta shut down its clinics over the weekend, and rolled out a revised vaccination strategy Tuesday. And there is concern in aboriginal communities: In Northern Ontario, they have received less vaccine than promised, while British Columbia's public health officials are unsure how many native people have been vaccinated.
The Globe on H1N1
Health officials and the Harper government faced more criticism of the stalling vaccination effort Tuesday, while the Auditor-General criticized the federal government for a lack of progress on planning for disasters and other pandemics.
The nation's chief public health officer on Tuesday reassured Canadians that they are not being shortchanged: This country has first access to all vaccine filled and packaged at the Quebec facility, David Butler-Jones said.
"The first priority for all of the vaccine is to get filled and distributed here in Canada. And if there's excess vaccine production that can't be filled here, then it goes offshore," Dr. Butler-Jones said.
He said there was a possibility of getting help to fill more vials for the liquid, but it would have affected the delivery of other vaccines. "It also was such a small amount that at the time it was viewed as not likely to help much," he said.
Vaccine is produced in three stages: bulk production and the formulation of the antigen, the active ingredient in vaccines; filling the vials; and quality control and packaging.
A GSK spokeswoman said in an e-mail that the first stage has been completed and the excess bulk antigen is being exported. The company did not indicate an amount or where the shipments are going. "Canada does not need the antigen that is being exported," said Megan Spoore of GSK.
Canada ordered 50 million doses from GSK. Around seven million have been distributed so far to provinces and territories. GSK told the federal government last Thursday that it will ship 436,000 doses to provinces and territories this week, far less than the roughly two million anticipated, because it had to interrupt production at its Ste-Foy, Que., plant to make a version of the vaccine for pregnant women.
The shortage has resulted in immunization clinics temporarily shutting their doors or struggling with long lineups.
In Alberta, clinics opened their doors wide last week, despite agreeing with other provinces weeks ago to give the shots in order of priority. The Calgary Flames quietly set up a private clinic, after contacting Alberta Health Services, to inoculate players and their families on Friday. Many Albertans are upset that the hockey team was able to jump the queue; the province is investigating.
Officials in the province shut down the clinics Saturday for fear of running out of vaccine. The clinics will start up again on Thursday but only accept children between the ages of six months and five years; on Friday, the program will also include pregnant women. No exceptions will be made, officials said.
Gerry Predy, Alberta's senior medical officer of health, said the delay in stepping up the program again resulted from health officials' need to "refocus" and figure out their next steps before administering any more shots.
An outbreak has also been confirmed Thursday evening at a Toronto children's rehabilitation centre.
Golda Milo-Manson, chief of medical staff at the Bloorview Kids Rehab, said they've had confirmed H1N1 cases in four children, and have another seven awaiting test results with similar symptoms.
"We are highly suspecting that they will have H1N1 as well," she said. "Fortunately the symptoms were such that we're able to treat them, and all appear to be recovering."
The 11 kids make up a significant portion of the 65 in-patients at the Centre. The outbreak was first declared on Friday in the Brain Injury Rehabilitation Unit, but the centre announced yesterday its number of confirmed cases had jumped from one to four.
The centre's young patients have complicating health issues, such as neurological impairments and respiratory maladies, that put them in a high-risk group, Dr. Milo-Manson said.
Bloorview has placed a limit on the number of visitors allowed. All the patients who have consented to an H1N1 vaccine (about 90 per cent) have been given one, as have frontline staff, Dr. Milo-Manson said. Inpatients were also offered Tamiflu.
It remains unclear across the country when healthy Canadians will get vaccinated.
"We are doing our very best," said Arlene King, Ontario's chief medical officer of health. In Ontario, many cities opened more clinics to ease the bottleneck.
Dr. King said she does not know at what point the pandemic will peak, but she wants to do everything possible to prevent another wave later on. "I don't have a crystal ball and no one has a crystal ball about when this wave will peak or what the peak will be."
The Liberal opposition this week blasted the decision to hire GSK as the "only supplier for Canada," but CTV News reported last night that the $323-million contract was actually awarded in 2001 by the previous Liberal government. The contract was awarded to Shire BioChem, a company that gave $57,000 to the Liberal Party in 2001 and has since been bought out by GSK.
With a report from Dawn Walton in Calgary and Daniel Leblanc in Ottawa