Rhesus monkeys, ‘pizza boxes,’ and armed robbery: Canada’s history shows that, when it comes to vaccination, details matter

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One day in the spring of 1955, Paul Martin Jr. came home from school to find his Dad sitting in the library, clearly in a dark mood. When the boy asked his mother why, she sat him down and explained: “Leave your father alone. He’s got a very big decision to make.”

Paul Martin Sr. was the federal minister of health at the height of the North American polio epidemic, and the fight against the deadly disease was at a crossroads. Two years earlier, Jonas Salk had announced his famous vaccine, and after extensive testing it was finally being adopted on a mass scale, but reports were also emerging from the U.S. of children contracting polio as a result of getting their shots.

Although the infections were eventually traced to a mistake by a pharmaceutical company in California, it was still unclear whether the rash of cases was the result of a bad batch or a problem with the vaccine itself. The U.S. government quickly halted its vaccination program, and Canada was under pressure to do the same. Even Prime Minister Louis St-Laurent wanted to hit pause.

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But for Paul Martin Sr., the issue was personal. He had survived a bout of polio as a boy that left him permanently blind in one eye and with a severely weakened left arm. His son had also contracted the virus, although he made a full recovery.

First-hand experience of the disease had pushed the Liberal grandee into the weeds of the polio fight. He was intimately familiar with and trusted the work of Connaught Medical Research Laboratories at the University of Toronto, which had been a key player in developing and manufacturing the vaccine.

When will Canadians get COVID-19 vaccines? The federal and provincial rollout plans so far

“He was totally involved, probably much more so than a minister of health would be at the time … because of the family connection,” said his son, whom most Canadians know as the former prime minister Paul Martin. “My Dad would do anything to stop kids from getting polio.”

Canada plowed ahead with vaccines that spring and never had a safety crisis like the “Cutter incident” in California, which ultimately killed 10 children. The country’s fight against the disease turned into a Canadian success story.

It also illustrated how attention to detail can be decisive in getting needles into arms safely and quickly, a lesson taught many times over by Canada’s experience with vaccinations.

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When it comes to delivering millions of shots in a short period of time, the fine print matters: personal ties between experts and officials, security, data entry, even packaging. Headlines naturally go to the million-batch orders and urgent timelines – the early stages of COVID-19 vaccination have been no exception – but according to researchers, industry veterans and government studies, Canada’s history in the field shows the unglamorous work of implementation is just as important.

The country’s relatively smooth Salk vaccine rollout was partly a matter of political philosophy – Ottawa committed to providing it for free and testing every batch – but it was also a product of bureaucratic know-how and follow-through. Canada’s approach required researchers and officials to master a wide range of technical details from the procurement of rhesus monkeys used in testing to the recruitment of skilled workers, many of them recent immigrants from Eastern Europe, said Christopher Rutty, a medical historian and adjunct professor at the University of Toronto’s Dalla Lana School of Public Health.

Testing the vaccine as it rolled off the line at Connaught, which manufactured all of Canada’s doses, was obviously the responsible thing to do, but “upscaling the capacity to actually do it” was another story, Prof. Rutty noted. The federal government had to build a state-of-the-art facility in Ottawa that would be used for testing, complete with an in-house monkey colony.

“There was a whole infrastructure necessary,” Prof. Rutty said. “The details are significant. It’s no different than the details with anything else, but there are more.”

Canada hasn’t always mastered the nitty-gritty of vaccine distribution. In 1959, an armed heist made off with 75,000 doses of polio vaccine from the University of Montreal, in the midst of a serious outbreak. No one seems to have foreseen the risks involved in storing large quantities of the life-saving material. Three masked gunmen simply overpowered a lone security guard at the school’s Institute of Microbiology and Hygiene, locked the poor man in a monkey cage, and drove away with the goods. The thieves apparently intended to sell their haul on the black market, but with police on their heels, they abandoned most of the vials in an east-end Montreal apartment where they were recovered within a few days, according to newspaper reports at the time.

Fifty years later, Canada ran into another logistical speedbump with the distribution of the H1N1 vaccine, which protected against an influenza strain causing flu-like symptoms and a relatively high mortality rate. This time the problem was packaging. A Senate report later found that the drug-maker GlaxoSmithKline assumed the shots would mostly be administered at large clinics, so they packaged the vaccine in big, flat “pizza box” containers that held 50 vials of 10 doses each. But many of the shots were ultimately given by family doctors who didn’t have anywhere near 500 patients to vaccinate, which meant thousands of doses sat idle in refrigerators. Some jurisdictions tried to solve the problem by repackaging the vaccine before sending it on to doctors, but that caused more delays.

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Forty per cent of Canadians were ultimately immunized against the respiratory virus, one of the world’s highest rates, but the “fiasco” of its rollout, including the pizza-box issue, meant the country got needles in arms too slowly, argued Robert Van Exan, a former executive at the vaccine manufacturer Sanofi Pasteur. By the time Canada achieved mass immunity, the virus’s infection curve was already trending down.

“We did a good job of immunizing people, but we just did it too late,” he said.

The country’s current effort to provide vaccines against COVID-19 could also be hampered by pesky details. In the late 2000s, Canada started working towards a national vaccination registry called Panorama, but disagreements about jurisdiction led to the program splintering into 10 provincial and three territorial systems, said Mr. Van Exan, who co-chaired a related task force at the time.

The country still has a patchwork of registries that are closed off from each other, meaning if someone got their first dose of the Pfizer COVID vaccine in Ontario and their second in Alberta, neither province would automatically register the other shot, Mr. Van Exan said. The systems “don’t talk to each other … which is the stupidest thing in the world.

“Here was a perfect solution for mass immunization campaigns, and they let it slip through the cracks.”

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The Panorama registry was also meant to include software that would allow it to process barcodes scanned from individual doses of vaccine, to keep track of adverse effects and help flag bad batches. But disagreements between the provinces and Ottawa over the scope and cost of the project scuttled that aspect of the scheme.

“At the time everyone said, ‘Oh, it’ll cost too much, it’ll be too difficult,’” said Mr. Van Exan, who is now an immunization policy consultant. But saying no to the scanning technology was a “missed opportunity” that led to errors and inefficiencies caused by manually inputting complicated vaccine lot numbers that persist to this day, he argued.

The federal government is now reportedly seeking proposals from the private sector to build a new technology platform that will help manage the rollout of the COVID-19 vaccine, with the first doses set to be delivered next week. Not for the first time, a failure to read the fine print – in this case literally – could play an outsize role in Canada’s vaccination plans.

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