VACCINATION PLANNING

Rollout will be major undertaking

It is the final leg of a marathon that began when Chinese scientists released genetic information about the COVID-19 genome back in early January, allowing work to begin on vaccines.

Like everything involving COVID-19, the campaign to vaccinate people against the virus is coming at breakneck speed, has huge implications, and is full of potential road bumps.

This week, immunization became more real when Health Minister Christine Elliott announced that Ontario expects to receive 2.4 million doses of COVID-19 vaccines from Pfizer and Moderna in the first quarter of 2021, just weeks away. Other vaccines are likely coming soon.

The effort to immunize Canadians in the midst of a devastating global pandemic is unprecedented. And even if high-priority groups get immunized early in 2021, those at lower risk will likely have to wait until at least summer. Life is not expected to return to any semblance of normal until closer to the end of the year.

“I fully expect the winter of 2021 to be fine,” said uOttawa epidemiologist Raywat Deonandan. “We probably will still be wearing masks and having some restrictions, but we are going to have a somewhat regular Christmas next year.”

There is plenty to be optimistic about, starting with the speed and efficacy of the first vaccines, from Pfizer/BioNTech and Moderna.

But experts warn the immunization campaign will be complex — especially with some vaccines requiring more than one dose — and full of potential pitfalls. Among other things, the Pfizer vaccine must be stored at -70C, which requires special super freezers and dry ice.

“This is going to be an incredibly complicated and important rollout compared to others,” said Dr. Kumanon Wilson, a physician at The Ottawa Hospital and researcher at the University of Ottawa. Wilson helped develop the CANImmunize app and digital platform to track vaccines. The app is now being tested as a means of tracking vaccine safety, something that will be crucial with the COVID-19 vaccine, he said.

As in a military campaign, advance planning and clear communications will be keys to making sure things go as quickly and smoothly as possible.

Some of that advance planning is already paying off. Canada has secured more than 400 million doses of vaccine with multiple manufacturers — more per capita than any other country in the world. It has also secured tends of millions of syringes and swabs, and enough freezers to store 33.5 million doses of ultra-frozen and frozen vaccines.

Canada's National Advisory Committee on Immunization has made preliminary recommendations about who should get vaccinated first, subject to specifics of each vaccine. That includes the elderly and those whose health complications put them at highest risk, as well as front-line and essential workers.

Work is already underway to plan for big and small details of the immunization campaign, from transporting and storing vaccines, to keeping track of adverse effects and understanding the ethical implications of the strategy.

That planning involves multiple levels of government and health agencies.

In the City of Ottawa, a newly formed COVID-19 vaccine distribution task force will look at everything from where and how immunization clinics should be held, to how to ensure the city's most vulnerable populations are immunized.

The task force will develop strategies “for the orderly and co-ordinated distribution of possible vaccines,” wrote Anthony Di Monte, general manager of emergency and protective services for the City of Ottawa.

Ottawa Medical Officer of Health Dr. Vera Etches said this week that the city does not need the help of the military with COVID-19 immunization. What the city needs is a system allowing people to register for an appointment based on their risk level; access to locations for clinics; and adequate infection-prevention measures in place.

“I don't think we would need to rely on the military. We have hundreds of immunizers and the experience of immunizing hundreds of thousands of people.”

The provincial government has, among other things, established a committee to work closely with local health units on COVID-19 immunization logistics, said Eastern Ontario Medical Officer of Health Dr. Paul Roumeliotis.

Those logistics will include how to secure an extreme-cold chain for the Pfizer vaccine. Those discussions are underway, he said.

Among Roumeliotis's concerns are having the ability to run up to six vaccination clinics at the same time — not easy in a rural health region that covers a broad geographic area

“We don't want to do Cornwall first and then Casselman a week later.”

Beyond on-the-ground logistics are questions about how to keep track of multiple vaccines requiring more than one dose, possible adverse effects, and the possibility of vaccine access worsening socio-economic gaps.

Dr. Kumanon Wilson said systems will be needed to keep track of who gets which vaccine to ensure that those who need a second dose get the correct one. Proof of vaccination may also be needed for people to travel or even for work, in some cases.

“The case with COVID-19 is going to be really compelling that people need to know which vaccine they got.”

And there has to be a real-time system of tracking any adverse reactions to the vaccine, he said.

He said communications will be key to how smoothly the rollout goes, but complicated by the fact that the immunization campaign will be “dynamic.” Among other things, he said, there could be changing advice about who should get which vaccine as information becomes available.

Communications will also be essential to maintaining public acceptance of the vaccine, which is currently relatively high in Canada.

He advises that government and health officials should avoid publicly shaming people who are hesitant about getting the vaccine. It doesn't work and can turn off other people.

More questions need to be answered to fully understand how the vaccine will work, he said, including how long immunity will last.

“This may end up being a seasonal vaccine after this, like the flu.”

University of Ottawa virologist Earl Brown noted that there is still no understanding of whether the vaccines prevent actual infection, or just illness — meaning people might not get sick but can still shed virus and spread COVID-19.

Still, he said the speed and promise of the two leading vaccines is remarkable, considering that they were developed using a fairly new platform — mRNA.

“Everything is falling into place. Unless there is something that comes out of left field, there are no concerns at this point.” It is still early on, and more data will be revealed, he added.

Deonandan, meanwhile, said people need to continue to follow public health advice while they wait for enough people to be vaccinated.

“There is light at the end of the tunnel, but the tunnel is long and dark. Stay in you car with your seatbelt on until we get there together.”