It is the largest public health initiative in B.C.’s history. 2021’s COVID-19 vaccination campaign comes with challenges and complications of equal magnitude. Is the province, its medical system and supply chain management up to the task?
Inoculating the 4.3 million people eligible to receive doses of COVID-19 vaccine by the end of September is complicated by a host of logistic challenges. They range from marshalling the army of health-care workers needed to get those doses into the arms of the 4.3 million – not once but twice – to ensuring the supply chain delivers the vaccine according to the schedule needed to hit the inoculation target B.C.’s economy and health-care system are banking on.
If it’s best practice to under-promise and over-deliver during a vaccination campaign, B.C. and Canada may already be heading down the wrong path.
With Pfizer Inc. (NYSE:PFE) and Moderna Inc. (NYSE:MRNA) contracted to deliver as many as 120 million combined COVID-19 vaccine doses this year to Canada, federal and provincial officials have repeatedly declared all Canadians who wish to be vaccinated will get their jabs by the end of September.
“While it is certainly possible that the stated goal could be hit, it doesn’t appear to leave much room for error or contingency,” said Steve Waters, CEO and founder of Contrace Public Health Corps. in Washington, D.C.
He pointed to data from COVID19tracker.ca, which is administered by the University of Saskatchewan, that reveals Canada is currently administering 76% of doses that have been delivered as of late February.
B.C. is doing slightly better at 79%.
“[It] doesn’t lead to confidence that a large increase in delivery of doses will mean a massive increase in the rate of administration. In fact, a large delivery of doses at one time could create logistical issues that could even reduce the administration rate,” Waters said. “Considering there is a global shortage of vaccines, existing production and delivery delays and increasing geopolitical pressures around the most complex logistical challenge in modern history, Canada is certainly at a disadvantage having to depend on other countries for vaccines.”
As the province prepares to vaccinate British Columbians on a scale never before undertaken, BIV tracks supply chain and players involved in ensuring doses reach the 4.3 million people eligible on the West Coast.
While provincial and federal governments frequently cited security concerns over revealing the direct path from manufacturers to communities, BIV reached out to multiple provincial governments and private industry players to piece together how most of the journeys will go.
Pfizer-BioNTech SE
The joint Pfizer-BioNtech vaccines are manufactured at Pfizer’s plant in Belgium before they’re shipped to a distribution centre in Kentucky. After the U.S. sojourn, vials are sent out to “various vaccination sites across Canada,” according to Pfizer spokeswoman Christina Antoniou.
During the Phase 1 rollout that began in mid-December, Pfizer handled the distribution of its own vaccine until the supply chain was proofed.
The Pfizer-BioNTech vaccine is more sensitive to handle than the competing Moderna vaccine, requiring cooling of up to -80C in ultra-cold freezers.
By January, Pfizer had loosened restrictions on the handling of the vaccine.
B.C.’s Ministry of Health would not share whether third parties are assisting with the logistics of Pfizer vaccine deliveries.
An Alberta Ministry of Health spokesman told BIV that Pfizer has contracted United Parcel Services Inc. (NYSE:UPS) to “take care of all the logistics of their vaccine from the manufacturer to the vaccine delivery sites.”
Albert Health Services is using also using its internal courier services to assist in distribution, and B.C.’s Ministry of Health confirmed regional health authorities now use their own transportation to move the vaccine from the initial delivery site to other locations across the province.
Canada has an order for up to 76 million doses.
Moderna Inc.
Although Moderna has manufacturing capacity in Massachusetts, Canada’s supply originates from the company’s facilities in Switzerland. From there, vaccine is sent to Spain for filling and then to Belgium for warehousing and distribution.
After that, Federal Express Canada Corp. delivers the vaccine into B.C. and the other provinces and territories while Innomar Strategies Inc. facilitates the supply chain to ensure the doses are kept cool through its storage and packaging capabilities.
The Moderna vaccine requires cooling of up to -20C.
Because these doses are easier to handle and transport, they are destined mainly for remote regions and Canada’s territories.
Canada has an order for 44 million doses.
AstraZeneca plc
The federal government has not announced what organizations will be handling logistics; however, the U.S. will be a key manufacturing source for deliveries bound for Canada as well as India.
B.C.’s current ambition to vaccinate 4.3 million residents is based on the number of Moderna and Pfizer vaccines allocated to it.
The federal government has an order for 20 million AstraZeneca doses, which could accelerate the timeline for B.C.’s immunization plan based on when they arrive.
With the province now planning on administering first and second doses four months apart, a level of protection will be available to all British Columbians sooner than anticipated.
The private players
While Ottawa has tapped FedEx and Innomar to handle the logistics for Moderna, UPS is also assisting in the Pfizer vaccine delivery.
Closer to home, Fraser Valley Dry Ice Inc., Alberta’s Co2blast Ltd. and Calgary Dry Ice are providing “tens of thousands of kilograms” of dry ice to the province weekly, according to the federal government.
Deloitte Inc. has been awarded a $16 million contract to provide a national vaccine management IT platform (NVMIP) to assist provinces with vaccine rollout, administration and reporting. It isn’t meant to replace B.C.’s system, but the province confirmed that the NVMIP would be used to record all immunizations electronically and track vaccine inventory.
The B.C. Ministry of Health would not share which private sector players it’s been enlisting to assist with the vaccination efforts. Instead, the province said more details about partnerships between businesses and government would be made available as it shifts its focus to mass vaccinations.
The ministry is also examining the potential for large employers to immunize their employees to allow for easy access to a large group to receive a vaccine in one location.
The public players
The federal Public Health Agency of Canada, B.C.’s Ministry of Health, the Office of the Provincial Health Officer and the province’s five regional health authorities are the leading public-sector organizations spearheading the vaccination efforts.
The First Nations Health Authority, Provincial Health Services Authority and the BC Centre for Disease Control are also collaborating in the vaccination effort, along with Metis Nation B.C. and ImmunizeBC.
The response
Waters said there’s a notable lack of urgency in Canada’s vaccination efforts compared with the U.S. and U.K.
“This could stem from the [Donald] Trump administration largely abdicating all responsibility for COVID and dumping it completely on state leaders,” he said.
“So state leaders knew from the early days of the pandemic that they likely couldn’t depend on the U.S. federal government to assist with distribution — or at least while Trump was in office. In Canada that dynamic between federal and provincial government wasn’t as extreme, so that could potentially account for the difference in the sense of urgency between U.S. state leadership and Canadian provincial leadership as it relates to vaccine distribution plans.”
Waters added that it’s likely emerging COVID-19 variants could also disrupt Canada’s plans.
“[It remains to be seen] how large of an effect that would be,” he said. “Regardless of how many doses Canada procured, the global scoreboard is what it is right now and the vaccine strategy that was implemented by the federal government has not fared well compared to Canada’s peers.” •
