Canada is rolling out COVID-19 vaccines at a slower pace than some of its peer countries, prompting some doctors to warn that provincial governments must accelerate their immunization campaigns if they hope to save lives in nursing homes and stay ahead of more transmissible variants of the coronavirus.
Canada is falling short not in supplies from vaccine-makers Pfizer-BioNTech and Moderna, but in its ability to move doses from freezers to the upper arms of recipients. No province has administered more than 50 per cent of the doses it has received so far, according to government figures compiled by the COVID-19 Canada Open Data Working Group.
“Why are they not treating the vaccine administration like the emergency that it is?” said Nathan Stall, a geriatrician at Toronto’s Sinai Health System who studies the toll COVID-19 has taken in seniors’ facilities. “That’s reflected in multiple ways, [including] closing vaccine clinics on statutory holidays and a lack of communication about why it’s so slow and what they’re doing to accelerate it.”
Israel, Britain, the United States and Germany have all inoculated a larger share of their populations than Canada, despite Canada being one of the first countries to start authorizing vaccines against the novel coronavirus.
As of Jan. 3, Canada had administered 0.31 vaccines for every 100 residents, a lower number than world-leading Israel (14.14 per 100), Britain (1.39), the U.S. (1.28) and Germany (0.32), but higher than Spain, France and most other European countries, where the first vaccine was not approved until late December.
The pressure to speed up immunizations is growing as Canada discovers more infections caused by a fast-spreading version of the virus first identified in Britain.
The variant, known as B.1.1.7., has contributed to a massive surge of infections in Britain, where Prime Minister Boris Johnson announced on Monday a strict national lockdown that will close nearly all schools and last until at least mid-February.
So far, a handful of cases with the British variant of the virus have turned up in Canada. Ontario announced on Monday that it had identified three new cases of the B.1.1.7 variant in the Greater Toronto Area, all connected to overseas travel, bringing Ontario’s total to six.
The emergence of the British variant and another fast-spreading version identified in South Africa has led to a ramping up of genetic surveillance for changes to the virus in Canada.
Over the holidays, a large-scale virus genome sequencing project that was already underway was redirected toward searching for variants. “The highest priority now for us is to test for the variants in travellers,” said Catalina Lopez-Correa, who is executive director of the effort on behalf of Genome Canada.
Dr. Lopez-Correa said the project has now developed new protocols that include genome sequencing of cases that seem out of the ordinary, such as people who have been reinfected with COVID-19 or infected after receiving a vaccine. Young people with unusually severe cases will also be looked at for signs that the virus is changing.
When it comes to vaccinations, Canada is off to a sluggish start for several reasons. The Pfizer and Moderna shots were approved by Health Canada and shipped to this country earlier than provincial governments expected; most spent the fall planning to start immunizing priority groups in January.
Some provinces, hamstrung by a shortage of health care workers, closed or scaled back vaccination clinics on Christmas and Boxing Day. Others planned to hold in reserve the second of the two doses required for longer-lasting immunity in case of supply disruptions, a position most have reversed.
Alberta’s vaccine rollout is facing significant delays. The province gave initial doses to 14,244 people as of Dec. 31, according to a recent tweet from the province’s Chief Medical Officer of Health Deena Hinshaw, with about 3,000 more expected on New Year’s Day. Those numbers are still far short of the province’s goal of inoculating 29,000 people by the end of 2020.
British Columbia has had more success than some other provinces in rolling out the vaccines it has received. During a briefing Monday, Provincial Health Officer Bonnie Henry said up to the close of clinics on Sunday B.C. had vaccinated a total of 24,139 people, meaning it has injected about 44 per cent of the 54,625 doses it has received so far.
Ontario has administered the most total doses of any province – 41,983, according to the most recent official figure – but the fewest per capita. Ontario received just over 148,000 doses by the end of December.
David Williams, Ontario’s Chief Medical Officer of Health, said the official figure of injected doses was an undercount because it did not include injections of the Moderna vaccine, which Ontario starting administering inside long-term care homes in the Greater Toronto Area on Dec. 31.
Brian Hodges, the chief medical officer of Toronto’s University Health Network, has been leading the first teams of vaccinators into long-term care and retirement homes, an effort he expects will ramp up significantly this week.
On Monday morning, he was at Cedarvale Terrace, where in a matter of hours the team of two primary-care doctors and four nurses vaccinated 148 residents, 36 workers and eight essential family caregivers. The team conducted a blitz at another home in the afternoon.
“This has been a dark time for many people and a real challenge in long-term care,” Dr. Hodges said. “What we are seeing, repeatedly, in home after home, is smiles, tears, shouting, joy and hope.”
Ontario opted to distribute its first doses of the Pfizer shot, which Health Canada authorized on Dec. 9, only through hospitals with access to freezers capable of keeping vials at -70 C, as the vaccine-maker suggested.
By contrast, Quebec began administering the Pfizer vaccine inside long-term care homes as soon as it received its first doses.
Dr. Stall called Ontario’s decision to delay the rollout of the vaccine in long-term care until the Moderna doses arrived “unforgiveable.”
“We could have prevented the cases that are now happening and the deaths that are going to happen of these long-term care residents had we actually used that [Pfizer] product,” he said.
Allison McGeer, an infectious diseases physician at Sinai Health System, said “there is no reason why we shouldn’t have a dose of vaccine into every long-term care resident in [hard-hit] areas of the province by Friday or Saturday. There are volumes of capable people who want to help. We vaccinate people in long-term care all the time.”
Dr. McGeer said that the delay in vaccination in long-term care in Ontario reflects “our societal attitudes toward long-term care.”
“We’re prioritizing long-term care, but we don’t actually, truthfully care about it all that much,” she said. “So it doesn’t feel that urgent to a lot of people. That’s the only logical explanation that I can have.”
With reports from Ian Bailey, James Keller and Jeremy Agius
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