Canada's chief public health officer butted heads with the nation's largest association of doctors Tuesday, disputing a Canadian Medical Association Journal editorial that accuses Ottawa of developing an H1N1 vaccine in a way that will result in needless delay.
The editorial this week said Health Canada's decision to fortify the vaccine with an adjuvant – a chemical booster that can increase production by three or four times – will mire the vaccine in a time-consuming regulatory process.
CMAJ's editor-in-chief suggested the sluggish route to approval accounts for the apparent delay Canadians will experience in receiving the vaccine.
The governments of Australia, the United States and several European countries are planning to immunize their citizens with a standard vaccine starting in October. Canadians, on the other hand, will wait until mid-November before the version with adjuvant arrives, according to health officials.
During a press conference in Winnipeg yesterday, David Butler-Jones, Canada's chief public health officer, said the suggestion that a vaccine could reach Canadians a month earlier if Health Canada had adopted the U.S. strategy “is not correct.”
“There isn't actually any delay,” he said. “The adjuvanted vaccine and the non-adjuvanted would be received at the same time.”
But that statement confounded CMAJ editor-in-chief Paul Hébert.
“The question we should ask is why are the Americans able to do this in the first week of October – that's what they've promised – and we are going to take an extra month,” Dr. Hébert said Tuesday. “I can't for the life of me fathom why.”
The U.S. Food and Drug Administration has the same mandate as the regulatory branch of Health Canada in licensing a safe and effective vaccine. Dr. Hébert said he wondered if there were other underlying issues in Canada. “Assuming there isn't, there's no reason not to have this licensed at the same time as others,” he said.
NDP health critic Judy Wasylycia-Leis attended the press conference and suggested another reason for the vaccine holdup.
“There were big issues around when they put the order in,” she said. “It wasn't until the end of July.”
Both Australia and the United States placed vaccine orders by late May.
Adjuvants are in many common vaccines in Canada, but have not previously been approved for influenza vaccines. While other countries are rolling out a non-adjuvanted vaccine for high-risk groups, Canada has decided to blanket the country with a single adjuvant version for anyone who wants it.
“The goal in Canada is to provide as much vaccine as early as possible,” Dr. Butler-Jones said. “We are waiting on the trials as with every country.”
Dr. Butler-Jones joined Health Minister Leona Aglukkaq at the press conference, which was intended to hype $135-million in previously announced funds for building and renovating health facilities in first nations communities.
Aboriginal leaders in attendance welcomed the announcement, but said it failed to address their most pressing concern: the fall resurgence of the virus, which devastated remote aboriginal communities in June. At one point, aboriginals comprised two-thirds of Manitoba flu patients on respirators.
“Our most immediate threat is H1N1,” said Assembly of Manitoba Chiefs Grand Chief Ron Evans. “That's the most pressing concern we have as first nations people.”
He added that any delay in vaccine dispersal “is going be devastating.”
Ms. Aglukkaq and Dr. Butler-Jones said remote communities will receive priority when vaccine shipments begin. Immunization timetables will be firmed up after a Winnipeg influenza conference of more than 200 health-care professionals Wednesday and Thursday.
While other countries will start distributing vaccines before Canada does, Dr. Butler-Jones predicted the country will be well prepared by winter.
“Unlike other countries, we're manufacturing enough vaccine for the whole population,” he said. “So when you get to December and January, the worst part of the flu season, Canada will be quite unique in the world.”
Some public health authorities fear the virus could gain strength even sooner, with classrooms serving as incubators.
