Why Canada is at the mercy of vaccine nationalism.
IF YOU CREATE AN ENVIRONMENT THAT ENCOURAGES COMPANIES TO MANUFACTURE AND DO RESEARCH IN CANADA, RATHER THAN PUT IT SOMEWHERE ELSE, THEN COMPANIES MAKE THOSE DECISIONS WITHIN THEIR REALM. — ROBERT VAN EXAN
For the better part of a month, Canada’s vaccine effort has plummeted down international rankings, as little vaccine has arrived on our shores.
Americans, Britons and Israelis, along with those living in tiny nations like the Seychelles and Malta, are much more likely to have received a shot than people living in Canada, where as of this week only 2.4 per cent of people have received even one shot of a COVID vaccine.
As Canada scrambles with the rest of the world to secure vaccines, one major issue has been this country’s lack of domestic production. It is an issue that will leave Canada at the mercy of vaccine nationalism until at least the end of 2021.
Israel’s success as the world leader of the vaccine race appears to have been because it paid more for doses and agreed to share health data. Other countries leaving Canada behind are using vaccines from China or Russia that have not even been considered for use here. And some have approved candidates that Canada has purchased, but not yet approved.
The U.K. is using the AstraZeneca vaccine, which has not yet been approved in Canada, and both Britain and the U.S. have another advantage in their plan; they manufacture vaccines on their home soil.
Canada’s Pfizer and Moderna vaccines are manufactured in Europe and both have supply chains that see different components of the vaccine created in different parts of the continent before coming together in so called fill and finish facilities.
When the European Union mused about imposing export restrictions they had the power to shut down Canada’s vaccine deliveries completely. Canada’s only link in the vaccine chain is as a customer for now, giving it no leverage with major companies.
Meanwhile, Pfizer reduced shipments for the last month as it upgraded its belgium manufacturing facility, but the reductions were deeper in Canada with less than half of our expected shipments arriving.
Robert Van Exan, who has decades of experience in Canada’s pharmaceutical industry and is president of his own consultancy, Immunization Policy and Knowledge Translation, said for far too long the country was a hostile space for manufacturers.
“A lot of companies closed down pharmaceutical manufacturing in this country, because the environment was totally toxic to them,” he said.
The strikes against Canada, Van Exan said, included weaker patent protections and price controls that cut into company profit. Prior to the pandemic, the Liberal government moved to reduce pharmaceutical prices further with changes to the pricing system for patented medicines, drawing criticism from industry. The government exempted COVID vaccines from that new process, but it remains in place for other medicines.
Van Exan said manufacturing vaccines in Canada is a challenge because most are sold directly to the federal government and with only one buyer companies have to compete on price.
“Our procurement process does nothing to encourage companies to stay in Canada, to do research in Canada, or to manufacture in Canada.”
All of Canada’s policies have pushed drug prices down compared to international comparisons and fostered a large generic industry, but Van Exan points out the generic industry is not developing the next vaccine.
Van Exan said the government has made reasonable investments over the last year to boost production, but that forces them to pick winners and losers. He said the better approach is to ensure companies want to set up shop here with or without government incentives.
“If you create an environment that encourages companies to manufacture and do research in Canada, rather than put it somewhere else, then companies make those decisions within their realm and if you’re successful at doing it, you get companies manufacturing here.”
He said Canada has the research talent across universities, but needs the support to take ideas from the lab bench to market.
Currently, Canada has two major manufacturing facilities for vaccines, a Sanofi Pasteur facility in Toronto and a GlaxoSmithKline facility in Ste. Foy, Quebec. But both facilities have existing contracts with little spare capacity and aren’t equipped to make the leading COVID-19 candidates.
Mark Lievonen, a former president of Sanofi Pasteur, who now sits on the government’s vaccine task force and its bio-manufacturing committee, said when they looked at the options early in the pandemic they found they had to go overseas if they wanted vaccines before the rest of the world.
“We quickly concluded that would mean going with international candidates. That the fastest vaccines that we would be able to secure for Canadians would come from international candidates,” he said.
The U.K. made major investments in its manufacturing industry to get more facilities ready, but it wasn’t starting from scratch. The British government’s vaccine strategy was about expanding and accelerating facilities that were under construction.
Government officials, speaking on background, said they looked at a host of domestic proposals and were willing to offer some funding to many candidates, but they triaged companies based on their past success and how far along their proposal was.
Companies already in clinical trials with COVID vaccines, with manufacturing capabilities, or past success, got big investments — firms like Medicago in Quebec City, or the VIDO-intervac facility in Saskatoon. Medicago got $173 million for research and to expand manufacturing capacity in Quebec City and on top of that got an order for 76 million doses of its vaccine, which is just now entering the final phase of trials. The company’s vaccine could be ready by summer, if all goes well, but the first doses will be made in a facility the company already owns in the U.S. early in the pandemic, VIDO-intervac received $46 million to build a manufacturing facility that will be capable of producing tens of millions of doses a year, but won’t be ready until early 2022.
Other firms received smaller sums to do early stage clinical trials with a clear understanding they could come back for more funding if their science panned out. That commitment extends beyond the pandemic, as the government is looking to restart the Canadian industry and be ready for future outbreaks.
“It was a matter of investing in each company appropriately, based on where they were in the stage, their stage of developing a vaccine and where they were in terms of their scale,” said Lievonen.
“Nothing we would have done would have been able to get us vaccines now or by the end of September.”
The government did fund construction of a new facility for the National Research Council in Montreal and recently announced Novavax would make their COVID vaccine there, but the first vaccines from that plant won’t come off the line until december at the earliest.
Van exan said one of the flaws in Canada’s pandemic plan was that it only prepared for the concept of a pandemic influenza. The GlaxoSmithKline facility manufactures most of Canada’s flu vaccines and has a contract in place to scale up for a pandemic flu.
He said all the signs were there that the next pandemic could be a coronavirus like COVID-19.
“There was never any plan for any other kind of pandemic. And this is bizarre, because we had SARS in 2003, MERS in 2012 and we had, in 2001, a panic around the world about the potential for a smallpox pandemic.”
Andrew Casey, president of BIOTECanada, said many people have looked at Canada’s existing facilities and asked why they couldn’t be repurposed.
He said that’s like asking why soft drink makers can’t switch to making champagne.
“Both are clear, bubbly liquids that you bottle and you serve in glasses. but that’s where the similarity ends and the manufacturing process of both are vastly different,” he said. “You would never ask Moet to make 7Up and you can’t ask 7Up to make Champagne.”
Pfizer and Moderna are the only approved candidates in Canada so far and they both use the same mrna technology. The technology is new and before the pandemic was unproven. Casey said even if the government knew a year ago that an mrna candidate would work they could not have opened an mrna facility in Canada.
“Let’s say you knew on March 31 that it was going to be an mRNA candidate, that was going to deliver the most promising safe and efficacious vaccine, and you put a shovel in the ground on April 1, to build the facility, that facility would not be producing anything for probably another eight to 12 months.”
Casey points to philanthropist bill Gates’ promise to build multiple vaccine manufacturing facilities, which he announced at the start of the pandemic and are all still months from producing a vaccine. He said he knows Canadians will draw little comfort if we continue to fall down international rankings, but he said the challenge is enormous and global in scale.
“We’re trying to get eight billion vaccines into the arms of the world. And for the most part, vaccines that didn’t exist six months ago.”