The Coronavirus disease (COVID-19) is a global pandemic as announced by World Health Organization (WHO, March 11th 2020). It is caused by SARS-COV-2 coronavirus, a virus strain never previously identified in humans. As of Jan.11, 2021, COVID-19 has infected 90.9 million people, and caused the death of 1.95 million people globally. In Canada, 672,931 people have been infected, and 17,096 have died.
Vaccine development
There are numerous candidate vaccines for COVID-19, at various stages of clinical trials, and five in active use: the Pfizer BioNTech vaccine, the Moderna vaccine, the Gamalaya Sputnik V vaccine, the Sinopharm vaccine, and the Sinovac vaccine. China also is the sole user of the CNBG vaccine, which was approved there at the end of 2020. The WHO provides a regularly updated summary of COVID-19 vaccine candidates in clinical and pre-clinical development here.
Two vaccines have been approved for use in Canada: the Pfizer BioNTech vaccine, which was approved December 9th, 2020, and the Moderna vaccine, which was approved December 23rd, 2020. The Pfizer BioNTech vaccine is administered by intramuscular injection, as a series of two doses twenty-one days apart. The Moderna vaccine is administered by intramuscular injection, as a series of two doses one month apart. Three additional vaccines are currently under review for use in Canada, made by AstraZeneca, Janssen Inc., and Johnson & Johnson. A current list of drugs and vaccines that have been authorized by Health Canada for use in relation to the COVID-19 pandemic is available here.
Global vaccine rollout
The Our World in Data website, created by the Oxford Martin School of the University of Oxford, monitors statistics on COVID-19, including those related to global vaccine rollout. Because aggregate global or regional databases on vaccine rollout are not currently available, the database tracks announcements of vaccine rollout by country. The information from the database provided below uses a metric of number of vaccination doses administered per 100 people; as such, it may not equal the total number of people vaccinated, since both the Pfizer BioNTech and Moderna vaccines have a two dose regime. All data is current as of Jan. 11, 2021 unless otherwise stated.
Israel is the global leader at vaccine rollout, with 21.42/100 people vaccinated (Jan. 12 2021). The country was one of the first to secure purchase agreements with Moderna, Pfizer, and AstraZeneca, and so received the Pfizer BioNTech vaccine when it was first available. With the approval of Pfizer, SLE, the logistics unit of Teva Pharmaceutical Industries, facilitated distribution by repackaging the large frozen pallets of vaccines into smaller insulated boxes. By doing so, quantities of vaccines as small as 100 doses could be delivered to clinics and remote areas. This facilitated parallel distribution of vaccines, rather than centralizing distribution in hospitals in large urban centres. Israel has a healthcare data system that facilitates outreach to those needing vaccination: every resident is covered by a healthcare maintenance organization, which has current digital information for all patients. This system provides text message reminders to those in need of vaccination, facilitates appointment booking, and manages data on current vaccine distribution. Israel has also been able to get additional doses from each vial that has been provided; this has been done effectively in various countries.
The other most efficacious countries at vaccine rollout per population are: United Arab Emirates, which has also had significant success, with 11.8 doses per 100 people administered; Bahrain, with 5.44 doses per 100 people; the United Kingdom, with 3.94 doses per 100 people; the United States of America with 2.72 doses per 100 people; Denmark with 2.02 doses per 100 people; Iceland with 1.43 doses per 100 people; Italy with 1.19 doses per 100 people; Slovenia with 1.08 doses per 100 people; Canada with 0.95 doses administered per 100 people; and Estonia with 0.9 doses administered per 100 people.
When considering total number of vaccines administered, China and the United States of America are leading, with 9 million (Jan. 9 2021) and 8.99 million doses administered respectively. The United Kingdom has administered 2.68 million total doses; Israel has administered 1.85 million total doses (Jan. 12 2021); the UAE 1.17 million total doses; Russia 800,000 total doses (Jan. 2 2021); Italy 718,797 total doses; Germany 688,782 total doses; Spain 406,091 total doses, and Canada 359,054 total doses.
Vaccine prioritization
At present, vaccine production is not sufficient for universal rollout in all countries. As such, most countries have developed guidelines for prioritizing the immunization of vulnerable groups. In Canada, this work has been done by the National Advisory Committee on Immunization, which has recommended that vaccines should initially be administered to: “residents and staff of congregate living settings that provide care for seniors; adults 70 years of age and older, beginning with adults 80 years of age and older, then decreasing the age limit by 5-year increments to age 70 years as supply becomes available; health care workers (including all those who work in health care settings and personal support workers whose work involves direct contact with patients); and adults in Indigenous communities where infection can have disproportionate consequences” (2020).
At present, only Israel, Bahrain, Qatar, and Saudi Arabia have universal access to COVID-19 vaccination. Greece and Iceland vaccinate all vulnerable groups and some others; and Canada and the United Kingdom are vaccinating all vulnerable groups: key workers, clinically vulnerable people, and the elderly. The United States and Italy are vaccinating two of three vulnerable groups. Vaccine rollout policies are not available for Russia or China.
Vaccine rollout in Canada
In Canada, vaccine rollout is done at the provincial or territorial level, and approaches have differed across the country. As of Jan. 11 2021, 359,054 vaccine doses have been administered in Canada. However, this represents only 65.4% of the total number of both approved vaccines distributed to provinces and territories within Canada (548,950 total doses). This discrepancy is due in part to different provincial policies relating to vaccine distribution. Due to concern about the supply chain, some provinces have stored enough vaccine to ensure that all those who receive a first dose will be guaranteed a second dose. Others have chosen to administer as many doses as possible based on the assumption that subsequent doses will be available.
The nature of the Pfizer BioNTech vaccine, which requires ultra-cold storage, has meant that it cannot be used in the territories, which do not have adequate storage facilities. In other parts of Canada, this requirement has restricted Pfizer BioNTech vaccine distribution centres to hospitals in urban areas, some of which have had to collaborate with private sector industries to secure appropriate storage facilities. The Moderna vaccine does not require ultra-cold storage and so can be more easily distributed to rural and remote areas: as such it will be used as the vaccine of choice in the territories.
Provinces have used various methods to notify those eligible for vaccination: from asking those meeting certain criteria to call a hotline to book an appointment, to sending email notifications that direct eligible candidates to make an appointment using an online booking system. As the criteria for vaccination expand from priority groups, these notification processes will have a greater impact on the rollout of vaccines.