canada needs to understand and master the logistical challenges required for a safe, effective and efficient vaccination program. but it will not be easy.
when will a vaccine be available?
we have heard that with approval of the pfizer vaccine we should expect almost 250,000 doses within the next month and four million by march. this is welcome news, however the timeline may slip. pfizer has already announced a production delay due to supply chain issues that hopefully can be overcome soon. this vaccine is the most difficult to store and deliver — it would appear that it will be distributed from key hubs that are able to deal with ultra-cold refrigeration. the timeline for the moderna and oxford vaccines is not yet public, but hopefully significant quantities will also be available in the next few months. canada has options for 56 million doses of the moderna vaccine which hopefully will obtain regulatory approval soon, along with a distribution timetable. since two doses per person of each vaccine are required for immunity, i would suspect that we will not reach adequate volume of vaccine to immunize all those who are willing until late 2021.
who should be vaccinated first?
it has been reported that 96 per cent of deaths have occurred in people over the age of 60, with a preponderance of men and those with co-morbidities. while there is consensus that those in care homes should be immunized first, this will logistically be more challenging for the pfizer vaccine given the need to centralize distribution. the consensus is to protect those at greatest risk and exposure first with a cascading distribution to those next in priority. it is likely that each province will have their own plan with per capita distribution rates to individual provinces. we should try and build a national consensus.
how do we know vaccination was successful?
ideally we should be testing for developed antibodies in those vaccinated to know that they have relative immunity. this may be key for travel and workplace safety, as well as for plans to shelter those at ongoing risk because vaccination was ineffective in producing protective antibodies. it is not clear that our strategy includes such surveillance or the means to create a national database for those tested and track who responded. after all, we were incredibly ineffective in ramping up testing and tracking for virus detection. can we approach vaccine distribution more effectively?
how do we track complications?
while the pfizer and moderna vaccines will likely get approval and distribution first, canada has seven or more possible vaccines to draw on. it is likely that, in order to speed up access, multiple vaccines will be used as they become available since we can’t get enough of one in a timely enough fashion. again, it will be essential to have a national database to record who was vaccinated, when and with what vaccine and to centralize the reporting of adverse events. there already is concern about two serious allergic reactions to the pfizer vaccine in highly allergic individuals. more issues will surely surface.
electronic vaccination card
ideally, we should all get an electronic vaccination card that tracks the vaccine we received which can be used to determine whether new infections occurred despite vaccination. this will confirm efficacy of any vaccine and also help determine the length of immunity. it is hopeful that immunity will last for at least a year, but it is likely booster doses will be needed. by knowing who received what vaccine, we will be able to determine whether there is decreasing benefit with boosters and if a second — different — vaccine should be used.
how should the vaccine be distributed?
governments, by nature, are neither nimble nor value efficiency. the private sector is expert in distribution and supply chain management and should be partnered with. courier services have already been engaged for delivery. we will also need an army of personnel from public health groups and the private sector — including pharmacies — to inoculate people. we will also need mobile facilities for outreach to smaller or harder-to-reach communities. this is much more complex than distributing annual flu shots.
managing the supply chain
supply chain deficiencies have greatly hampered virus testing and this can’t happen again. delivery and auto companies as well as other businesses are expert in supply chain management — this expertise should be sought and leveraged. we have to anticipate where bottlenecks may occur and actively plan to avoid them.
building self-sufficiency
there will be a worldwide scramble for material needed to complete vaccination and its monitoring. as with ppe, we need to be as self-sufficient as possible. our federal government spent a great deal of money on inefficiently building a vaccine production facility that, to our great comfort, will be ready for the next pandemic — but not this one. let’s not do that again.
governmental collaboration
it will be easy to cast blame for any failures. for this reason, there will need to be effective collaboration and trust between the federal, provincial and regional governments. these governments will need to be transparent, honest and collaborative — something we are not used to. as well, there will need to be sharing of lessons learned from the success and failure of rollout in different regions.
build an effective integrated command structure
there needs to be a central command with multiple divisions whose leaders are responsible for integrating the different needs of procurement, distribution, tracking, safety and communication. while there will be military leaders in charge, we must have the private sector skills and open debate necessary to weigh options critically and to be innovative and nimble in finding solutions.
we were fortunate that hitler failed to appreciate the difficulty in defeating russia. he had the strongest military and great success in rapidly defeating europe, yet he did not appreciate the challenges, time and complex logistics needed to defeat russia and its ability to accept the cost of a scorched earth policy that would further limit resupply. we can’t afford to make the same mistakes in our war against this pandemic. let’s hope we are up to the task.
dr. harry rakowski is an academic cardiologist based in toronto.
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opinion: vaccine logistics depend on 10 things