Canada’s COVID-19 Vaccine Procurement Strategy: Comparisons with the United Kingdom and Israel
Mayvis Rebeira, PhD, Affiliated Scholar, Canadian Health Policy Institute
ABSTRACT
Introduction: Canada’s vaccination rollout for the COVID-19 vaccine was slow and protracted in the early months of 2021 and this has been mainly attributed to vaccine supply issues. This commentary article compares the country’s vaccination procurement strategy with that of UK and Israel. In the early months of 2021, Canada had one of the lowest vaccination rates leading to continual economic shutdown and increasing number of COVID-19 cases. As of the beginning of May 2021, Canada had only fully vaccinated (two doses administered) 3% of its population compared to Israel at 58% and UK at 23%. Canada eventually accelerated its vaccine distribution and by the end of August 2021, 66% of the population had been fully vaccinated. Methods and Results: The main drivers of emergency vaccine procurement were identified through review articles, media and government sources. These can be categorized into six key areas: strategic goal of procurement; structural & demographics factors; manufacturing strategy; emergency planning; pricing and contracting strategy; and vaccines ordered. Conclusion: Canada’s COVID-19 vaccine supply seemed unreliable in the early months of 2021 when both UK and Israel were able to procure a steady supply of vaccines for their population. Canada started with some structural disadvantages relative to Israel and the UK, including less centralized emergency planning and lack of local manufacturing capacity. There are, nonetheless, some important insights that Canada can draw from both Israel and the UK which can be considered for future negotiations, including the procurement of variant-specific booster vaccines, manufacturing strategy, pricing strategy or for planning for other health emergencies that may arise in the future.
SUBMITTED: August 2, 2021 | UPDATED: September 1, 2021 | PUBLISHED: September 23, 2021
CITATION: Rebeira, Mayvis (2021). Canada’s COVID-19 Vaccine Procurement Strategy: Comparisons with the United Kingdom and Israel. Canadian Health Policy, September 2021. ISSN 2562-9492 www.canadianhealthpolicy.com https://doi.org/10.54194/PROF8361
[To access the exhibits download the PDF version.]
INTRODUCTION
As of August 27, 2021, there were a total of 1.486 million cases of COVID-19 and 26,890 deaths in Canada (1). The need to vaccinate the population was critical to control the spread of the virus and prevent hospitals from being overwhelmed with patients. Canada’s vaccination rollout seemed protracted with a more fragmented approach than some other countries, notably the UK and Israel. These countries have rolled out vaccines to their population in a seemingly more coordinated and quicker pace resulting in a higher level of vaccinated population and a quicker re-opening of their economies (2). This article reviews the UK and Israel vaccine procurement strategies and draws insights that Canada can gain from these countries.
Immunization Rates
Canada had one of the lowest vaccination rates for a developed nation in the initial few months of 2021. For almost 8 months after the first vaccines were available, Israel and UK were far ahead of Canada according to the number of COVID-19 vaccine doses administered per 100 people. As seen in CHART 1, Canada’s rate remained well below Israel and the UK until the end of August 2021 (3).
By a different metric, Canada was also slow to achieve full vaccination (two doses of the vaccine) in the population. In March 2021, Canada had fully vaccinated only 1.5% of its population, roughly the same as the UK at 1.3%, whereas Israel’s rate had already reached 41%. As of May 1, 2021, Canada had fully vaccinated only 3% of its population compared to the UK at 23%, and Israel at 58%. As of end of June 2021, Canada’s rate rose to 23% compared to UK at 47% and Israel at 60% (3).
Canada eventually closed the gap with the UK and Israel. As of August 31, 2021, 73% of the Canadian population has been vaccinated with at least one dose and 66% were fully vaccinated (received both required doses) (4).
Factors Affecting Vaccines Procurement
This article examines the vaccine procurement strategy factors in Canada, the UK and Israel. In particular, the following six factors are reviewed:
• Strategic Goal of Procurement
• Structural & Demographics Factors
• Manufacturing Strategy
• Emergency Planning
• Pricing and Contracting strategy
• Vaccines Ordered
The article concludes with possible lessons learned from the experiences of these two countries and applicability of these lessons as Canada enters the next phase of procurement and negotiation for vaccines for emerging variants, as well as insights to help plan for health emergencies that may arise in the future.
Strategic Goal of Procurement
It is critical to determine the strategic goal of procurement as this drives the negotiation and contracting strategy and the desired outcomes of vaccine procurement. Both Israel and UK had explicitly stated clear goals and objectives for their procurement strategy. This in turn guided and determined the multiple strategic decisions that needed to be made regarding the type of vaccines to procure, the extent of risk willing to take in procuring these vaccines, the maximum price willing to pay and the expectations from the vaccine manufacturer – all of which would help meet the stated outcomes of procurement.
Both UK and Israel placed speed of delivery of the vaccine (on condition that it is effective and safe) above all other factors. This had guided both countries to focus on vaccine manufacturers that could deliver the vaccines in the soonest possible time, as the longer the wait for the vaccine, the greater the health and economic damages. Prolonged wait for vaccines increases the likelihood that more people will contract COVID, ICU wards and hospital beds will fill up and the economy will continue to be shut down. This results in other unintended consequences such as prolonged social isolation, impact on mental health of children and youths, continual loss of jobs with many of them not returning, closure of business and schools, increased deficits and sharp drop in revenues for the government.
In Israel, the government set a procurement strategy that focussed on getting the population vaccinated as fast as possible in order not to extend the pandemic. Speed of vaccination was a prime strategic goal of the country and vaccine procurement was a key factor in achieving this goal through strategic negotiations and relationship building with manufacturers. (5) Similarly in the UK, speed of getting the population vaccinated was the prime driver of the procurement strategy which was noted in its overall strategic principle. This principle helps drive UK’s procurement strategy as it determines the type of vaccines to procure and the timelines to make this goal a reality. With its single-minded purpose on procuring vaccines as fast as possible, UK became the first country in the world to begin vaccinating its population in early December 2020 (6).
In Canada, the entity overseeing vaccine purchases, Public Services and Procurement Canada, working in conjunction with the COVID-19 Vaccine Task Force, led the negotiations manufacturers. Canada spent over $1 billion as upfront payment to secure access to promising vaccine candidates as it started its negotiation. Future payments were agreed to pending regulatory approval from Health Canada. As part of the procurement strategy however, no explicit goal was publicly noted as driver for the procurement strategy, an important missing piece when compared to UK and Israel (7).
Structural & Demographic Factors
When it came to structural and demographic factors, both Israel and UK have inherent advantages compared to Canada, notably population density and geography. As noted by Marchildon (8) and Rosen and colleagues (5), Israel has a high-density population within a smaller geographic area. Compared to Canada’s population of 37.6 million over 10 million square km, Israel has a population of 9.3 million as of end 2020 within a much smaller geographic area of only 22,000 square km. In addition, Israel also has a relatively younger population (5). The smaller geographic size and high urbanized population enabled faster and easier access to the community-based vaccination sites and reduced vaccine transport and logistic challenges especially with the Pfizer vaccine, which required special extreme cold refrigeration. All these factors helped in the successful early vaccine rollout.
UK has a population of 66.7 million within a smaller geographic area of 0.24 M square kilometers with most of the population residing within relatively high population-density areas. In Canada, though most of the population are in cities near the border (90% live within 150 miles from the US-Canada border), the country still has many small towns in remote and rural areas including indigenous populations that reside in difficult to access areas. Its population in urban centers is diverse, however there seems to be a general acceptance of vaccines in Canada, similar to UK and Israel.
Manufacturing Strategy
Compared to Canada and Israel, the UK is the only comparator country with domestic vaccine manufacturing capability, giving it a strong inherent advantage for procuring the vaccine and having more control over its supply. The big advantage in UK is that the vaccine manufacturer, AstraZeneca working in conjunction with Oxford University, is located in UK. The country also has three manufacturing sites for the AstraZeneca (Cobra Biologics in Keele; Wockhardt facility in Wrexham and Oxford BioMedica in Oxford) in addition to the Serum Institute in India, Pune. The presence of these manufacturing sites enables the government to ensure that the supply commitments can be met, and the vaccines are heading directly for its own use before being exported (13).
In addition, AstraZeneca has ongoing plans to build a new factory in Oxfordshire. This new facility will be capable of manufacturing 70 million doses by the end of the year. The development of the new Vaccines Manufacturing and Innovation Centre was already approved by the UK government, and this was in development with a planned launch in 2022. However, with the onset of COVID-19, the UK government invested a further (C$226m) £131m to bring forward the launch of the site by the end of 2021 instead. UK also has other sources of vaccine doses from outside the country including the Serum Institute of India and the Halix plant in Netherlands (13).
UK did not have any internal capability to manufacture mRNA vaccines (such as Pfizer or Moderna). As such, there were efforts to convert an animal vaccine plant to human use, in order to encourage mRNA vaccine production within the country and hence reduce UK’s reliance on external manufacturing of mRNA vaccines. Currently, the mRNA Pfizer-BioNTech vaccine that was approved in December 2020 is imported from Belgium and the Moderna vaccine is imported from Visp, Switzerland and Madrid, Spain, via Belgium (13).
To plan for future manufacturing capacity, the UK ensured that all future vaccines that are purchased by the government will be manufactured within the country if they are approved. This include vaccines from the US firm Novavax that will be manufactured in England and vaccine from the French firm Valneva which will be manufactured in West Lothian and Scotland. Finally, the third vaccine is from Johnson & Johnson which will be manufactured in Netherlands by Janssen. Hence the UK is set up for future delivery of vaccines that are now mostly manufactured within the country ensuring a steady stream of vaccines for future use and for emerging variants and has better prepared the country for any further health scares of this nature (13).
Procurement Emergency Planning
In both the UK and Israel, health is administered and planned centrally through the government (the National Health Service in UK and the Ministry of Health in Israel). Canada’s healthcare system is much more decentralized with health delivery to the population under the care of the provinces and territories rather than the federal government for the majority of the population. This includes ensuring that the population gets vaccinated, setting the criteria for vaccination (e.g. age groups, health risk level, etc.) and overseeing the delivery, storage and distribution of the vaccines. Vaccines procurement, public health advisories and regulatory approval of vaccines are at the federal level. In a pandemic setting, where speed of delivery of vaccines to the people and close coordination is key to success, a decentralized system could be seen as a disadvantage. Procurement and public health policies set centrally at the federal government in the early months did not align seamlessly with the ground-level goal of getting the population vaccinated as fast as possible to stop the spread of the COVID-19 and prevent further deaths.
In Israel, vaccine procurement distribution planning is done centrally for the entire country by the national Ministry of Health. This system is administered through four non-profit health plans which provides a basic set of health services to everyone. As noted by Rosen (5), Israel’s ministry defines the criteria for vaccination at the national level. This means that there is only one set of criteria for the entire country and this responsibility is not delegated downwards to the plans. The health plans in turn, are responsible for vaccinating the general population including seniors and at-risk individuals. However, the responsibility for vaccinating the most vulnerable population group and nursing home residents, was delegated to the national medical emergency services organization called Magen David Adom. No such similar entity exists in Canada. The responsibility for vaccinating front-line healthcare workers was delegated to the hospitals and the health plans which they belong to as part of their work. These clear lines of responsibility ensure minimal confusion and sets the stage to align procurement strategy with vaccination outcomes and aimed to ensure a seamless fit with overall vaccination goals (5).
In the UK, the Department of Health and Social Care started to plan for a national mass vaccination strategy before the first case of COVID-19 was confirmed in the country. UK went through three national lockdowns and experienced a very damaging second wave. This caused UK to focus on a swift vaccination strategy which started earlier than most other countries including Canada. The U.K. also imposed a five-week waiting period between its stages of reopening which enabled more people to get vaccinated. It became the first country in the world to approve a COVID-19 vaccine for emergency use back in early December 2020.
In Canada, the decentralized system of government for health, though advantageous in many situations, had not been optimal in this pandemic emergency crises. The federal government oversees the purchase of the vaccines, determines the type of vaccines to procure, public health messaging and timing of delivery of the vaccines. Other levels of governments determine the criteria for vaccinating their population (for example, priority groups that get the shots first) and ensuring it is delivered to the vaccine clinics. There is also reliance on the federal government for the timing of the first and second doses and the type of vaccines that can be used for both the vaccine shots.
This is especially clear in relation to the AstraZeneca shot where clinics had to wait as they relied on the federal scientific panel to recommend the vaccine of choice for the 2nd shot for those who obtained AstraZeneca as the first shot. Delays in decision-making may have resulted in vaccines sitting in storage in hospitals and clinics as time runs down due to the expiry date (9). This has potentially prolonged the waiting period for millions to get the second dose. This patchwork decision-making and accountability is partly responsible for the slower rate of vaccination in the early months compared to Israel and UK, as well as in most developed countries. Without central responsibility, coordination and quick decision-making in the early months, potential mixed messages were sent out to the public resulting in some degree of confusion at both the health provider level and at the population level.
In addition, the Federal vaccine task force, though comprised of renowned experts in vaccines, lacked membership from economists and other social scientists (10). Hence the impact of the continuing lockdown on the economy, jobs and many other areas due to slow rollout of the vaccines has likely not been taken into consideration in these deliberations. Though the panel is tasked with evaluating only the scientific clinical evidence, given the real-world situation of lockdown on millions of individuals including their physical and mental health due to social isolation and delayed elective surgeries, such decisions should ideally not be done without consideration of other non-clinical factors including economic factors, impact on mental health, impact on youth and children, impact of social isolation of seniors, impact on children due to school shutdown, impact on small businesses, urban to suburban flight and a host of many other factors that have been impacted with this prolonged and economically painful lockdown.
The immediate solution had been to pour out significant amount of funds (estimated at $765 billion) to soften the impact to individuals and businesses due to the economic shutdown (11, 12). This economic impact could have been lessened to a significant degree if there had been a faster coordinated rollout where procurement decisions are made to accelerate the vaccination of the population in the fastest time possible. This could have reduced case counts and led to an earlier re-opening of the economy.
Pricing and Contracting Strategy
The legal contract which encapsulates the pricing and contracting strategy is the driver that ensured steady supply of the vaccine and are usually based on the explicit goals of procurement. There are many elements in the UK contract that has given key advantages to the country especially compared to the EU (14).
Legal System: The UK contract is written in English law. This means that the contract is judged based on the actual wordings of the contract whereas the EU contract, written in Belgian law, relies on whether both sides tried their best to deliver the vaccines and that both sides acted in good faith. This difference has huge advantage to UK as it enables the government to have greater control of the agreement with more demanding terms.
Expertise: the level of experience of the team that drafted the contract can be critical. The UK contact was written by specialists with expert experience in purchasing agreements specifically with drug-buying deals. The European Commission’s contract, by contrast, seems to show less sophistication and less business understanding of these complex agreements.
Preferential treatment: The UK negotiated deals with all its vaccine manufacturers that include clauses which required the manufacturers to supply vaccines to UK preferentially. This essentially meant that if there are shortages in production, supply has to be diverted from other customers to the UK and any failure to perform this could result in high penalties. This was put in practice in early 2021 when AstraZeneca faced supply issues and informed the EU that it would provide only 100 million doses of the vaccine – a third of what was planned. This resulted in a lawsuit trigged by EU and in June 2021, it was ruled that AstraZeneca was required to provide an additional 50 million doses to the EU (15).
UK was of the view that it has the right to preferential supply since it has heavily invested into the research for the AstraZeneca vaccine which was conducted at the publicly-funded University of Oxford. It also helped that AstraZeneca’s headquarters is based in the UK. On the other hand, the EU contract noted that if there are any manufacturing delays, all of the countries would see a proportional reduction in their vaccine delivery but there should not be any preferential treatment.
Penalties and enforceability: In the UK contract, it states that if any party tries to force or persuade AstraZeneca or its subcontractors to undertake any activity that can slow the supply of the vaccine, UK government was able to terminate the contract and invoke harsh punishment deals. (However, in a fast-evolving pandemic situation, where there is only one UK supplier and the government is reliant on it for the fast delivery of the vaccines, it is unlikely this clause had any major concerns for the manufacturer).
The UK was also explicit in stating that they should be informed thirty-days in advance on the number of doses AstraZeneca will deliver to the UK and that AstraZeneca was expected to ensure “Best Reasonable Efforts to keep as close to the original” committed timeline. It is unclear if Canada has any similar language in its own contracts with AstraZeneca, Pfizer and Moderna. Compare this with the EU contract which does not state the need for this detailed level of notification of delays or shipments but notes that it can appoint another manufacturer if delays persist. However, the EU contract does provide more details into what ‘best reasonable effort’ is and specifically note the urgent need to have the vaccines for the population during the pandemic.
Owning the supply chain: The U.K. contract required AstraZeneca to ensure that the supply chain within UK “will be appropriate and sufficient” for the supply of the purchased vaccine doses and that the manufacturer will be responsible for covering any shortfalls if supply was impacted. It also ensured that the supply chain will cover both the vaccines manufactured within the UK and also the ones manufactured in the other AstraZeneca sites in Europe. This move was done to ensure that supply within UK will not be interrupted if the EU regulators approved the vaccine before the UK regulators.
In order the fully own the supply chain, the UK government had initially committed to provide £65 million back in April 2020 to the University of Oxford for the vaccine manufacturing. AstraZeneca was then able to make an agreement in August 2020 to develop a dedicated supply chain for the UK. By investing in the vaccine manufacturing, the UK become the defacto shareholder in the vaccine development and this enabled the government to have seats on the influential Oxford-AstraZeneca joint liaison committees (13, 14) All of these factors have helped ensured steady supply of the vaccines as fast as possible with minimal disruptions to the UK population.
The situation in Israel was different from UK. Israel started procuring vaccines relatively much later than Canada or UK. However, it then moved aggressively with a strategic focus on procuring vaccines as early as possible to control the growth of COVID-19 cases rather than rely on local manufacturing. In order to do this, the Israeli government was thought to have paid a higher price than other countries to get the vaccines quickly with minimal disruption and to secure the delivery of millions of vaccine doses that are either close to completing clinical trials or were moving through regulatory approval. Though the actual price Israel paid for the vaccines is not publicly known, it was reported by unconfirmed sources that Israel could have paid around $30 per dose which could be nearly twice what some other countries paid for similar vaccine dose (16).
In addition, to become a priority country for the manufacturer and ensure the fastest delivery of vaccine supplies for its population, Israel agreed to provide to one of the manufacturers, Pfizer, access to its extensive medical data of its citizens. This essentially made Israel into the first country-wide trial for investigating potential long-term effects of the vaccine. Israel is well-known for having sophisticated electronic medical records of its citizens which goes back nearly three decades. It used this strength to secure sufficient vaccine doses in its first order to cover a majority of its population and it did it earlier than any other country. Privacy issues were naturally raised by the medical ethics board including whether the contract enabled Israel or the manufacturer to delay the publication of any negative or adverse findings (16).
By contrast, Canada had a different strategy from UK or Israel. In June 2020, the National Research Council was tasked with setting up an 18-member COVID-19 Vaccine Task Force whose duties include prioritizing vaccine projects that needed support for activities in Canada and to identify opportunities to “seek support for activities in enhance business connectivity globally to secure access to commercially sponsored vaccines” (17).
It was in August 2020 that the federal government signed deals with the first two vaccine manufacturers – Novavax and Johnson & Johnson to procure millions of doses if the vaccines were proven to be effective and safe. The next month, in September 2020, the federal government signed deals with four other companies -Pfizer, Moderna, GlaxoSmithKline/Sanofi and AstraZeneca.
In total, Canada signed deals with seven manufacturers with options for additional millions of doses. This strategy of spreading its orders to many companies in an effort to reduce risk rather than focussing and risking on the top one or two vaccines in exchange for early, non-interrupted delivery could be considered as a critical factor in its sluggish start towards early and quick, uninterrupted access to approved vaccines.
Vaccines Ordered
The UK set up a vaccine taskforce early on at the onset of the pandemic in May 2020 to specifically assist in the rapid procurement and distribution of the vaccine doses to the population. The taskforce not just included clinical and scientific expertise but also experts in technology and logistics. UK signed orders with eight manufacturers for a total of approximately 670 million doses. The key focus of the procurement order was to focus on vaccines that can be used as early as 2020 in order to control the rapid pace of the spread of COVID-19. The taskforce focused on vaccines that are effective and available as quickly as possible rather than focus on price. UK was also willing to take the risk and fund upfront costs for manufacturing as at that time, though trials were still underway and there were no guarantees of the effectiveness of any of the vaccines. In total, they risked approximately £900m for these upfront costs.
Israel concentrated its orders on the early vaccines that were close to getting clinical results or close to approval. Like the UK, the focus was on getting the vaccine as fast as possible. In total it ordered approximately 53 million doses. Though it paid a higher price for them, it did not commit to spread out its purchases across many manufacturers but instead placed deals with only four vaccine manufacturers.
Canada, as noted earlier, made deals with many vaccine manufacturers with seemingly less focus on getting the vaccines as fast as possible which would have meant focussing on vaccines that are close to trial completion. As such, Canada made deals with seven manufacturers for a total of nearly 254 million doses and received an additional 1.5 million doses of AstraZeneca that was donated by the United States. Looking at doses ordered, no other country in the world has ordered more vaccine doses per resident than Canada. Canada has ordered 10.5 doses per resident compared to UK at 8.2 and Israel at 4.5. (18)
RECOMMENDATIONS
Canada got off with a slow start in securing vaccine supply in the early months of 2021. However, by the end of June, vaccination rates were accelerating and by end August, Canada had managed to vaccinate a significant proportion of its eligible population. Though Canada has recently significantly ramped up the speed of vaccination as supply of vaccines finally came on steady track, there are still notable insights that can be gained from both Israel and the UK on vaccination procurement and public health strategy that can be used as lessons learned in preparation for any further health emergencies (19). These insights highlight the importance of intersectionality between vaccine procurement strategy, public health vaccination strategy and implementation strategy at the regional levels to get people vaccinated in the most expedited manner.
Clear Goals of Procurement
One of the key aspects of the vaccine procurement strategy in both Israel and UK is the goal of vaccine procurement strategy. Both countries noted that urgent need to get access to the vaccine doses as fast as possible. Speed is of utmost importance in a time of pandemic and the strategy of procurement hinges around which manufacturers are closest to completing trials and were able to get regulatory approval in order to be priority manufacturers. For example, Israel focused only on three major manufacturers to provide all of the doses to cover its population, and these include Pfizer, AstraZeneca and Moderna.
The second aspect is price. Both UK and Israel noted that price will not be a barrier in order to ensure speed of delivery of the vaccine. UK engaged in complicated deals with AstraZeneca to ensure the supply chain of the AstraZeneca vaccine by investing early on in the at-risk manufacturing of the vaccine. Israel purportedly paid a higher premium to Pfizer to ensure that they are prioritized as the top country for Pfizer and to ensure that doses are received without interruptions as soon as they are approved.
Canada however, made deals with at least seven manufactures, many of them have trials that were still in very early stages where results will not be known until much later. The time critical aspect of vaccine delivery did not seem to be a driving factor initially in either the choice of vaccine manufacturers or the deals itself to ensure supply without interruptions once the vaccines obtained approval.
It is also unclear what Canada will do with millions of doses of future vaccines doses from its deals with the other manufacturers (outside Pfizer, Moderna and AstraZeneca). Vaccines slated for delivery in late 2021 or 2022 would not make a major impact in controlling the spread of the virus as the majority of Canadians would have already been vaccinated. This means that Canada will be left holding millions of doses of vaccines that are slated for delivery later on but will no longer be needed. It is not yet clear if these doses, which seems to be already committed with the manufacturers, will be donated to other countries in greater need of vaccines. Or if they will be donated to COVAX, the multibillion-dollar alliance of governments and non-profits that was set up to increase buying power to procure vaccines for less developed countries but has not yet been very successful in this endeavour. It is also not clear if Canada would be able to cancel these contracts once it deems the supply of existing vaccines is sufficient or if the country has reached herd immunity.
Manufacturing Capability
One of the key strategic advantages for UK is the ability to control the supply chain for the AstraZeneca vaccine which has manufacturing hubs within the country as well as the company being headquartered in the UK. This enabled UK to ensure that vaccine doses from these manufacturing sites are secured and delivered first to UK and enabled UK to have control of the exports of the vaccines to other countries including the EU. Canada neither had the advantage of a manufacturer with headquarters within its country nor did it have the production capability to manufacture any of the millions of doses of COVID-19 vaccine that was developed by international companies. Canada also does not have any home-grown company that was able to develop a COVID-19 vaccine as swiftly as the big three vaccine manufacturers – AstraZeneca, Pfizer and Moderna.
There were opportunities in the past where Canada could have developed this capacity in the face of other population virus outbreaks within the country (21). After the SARS outbreak in 2003, the Federal government commissioned a report “Learning from SARS-Preparing for the Next Disease Outbreak”. The report recommended that Canada develop a ‘national vaccine strategy’ that will help it to prioritize its supply of vaccines. When the H1N1 pandemic hit the world in 2009, Canada experienced supply shortages of the vaccine due to manufacturing issues and missed another opportunity to develop a long-term strategy that would cover future pandemics and epidemics to ensure a secure and steady supply of doses in any such emergency health situations.
When COVID-19 hit the country, Canada tried to resuscitate domestic manufacturing and reached an agreement with CanSino Biologics, a Chinese manufacturer, in May 2020. The deal included conducting trials at the Canadian Centre for Vaccinology at Dalhousie University using the company’s vaccine and then followed by manufacturing of this vaccine. The deal was announced publicly by the National Research Council (NRC) and then days later, the deal was completely dropped as China banned the export of the vaccine to Canada. It is not clear how much Canada lost, if any, through the deal (22).
Soon after the failed deal, the Federal government changed strategy and decided to spend public money to build up Canada’s own manufacturing capacity – this time in the form of a brand-new NRC manufacturing plan in Montreal, Quebec. This was estimated to cost at least $170 million. At that time, it was noted that the manufacturing site will be up and ready by November 2020 and would be able to produce 250,000 doses a month (23). In Feb 2021, the government noted that the manufacturing site will not be ready on time and that it would be open for manufacturing the US-based Novavax vaccine only by the end of 2021. It is unclear at this stage what the update is on this manufacturing and whether consideration was given to the fact that vaccines produced after 2021 would not be useful for the population as it has already signed deals with other manufacturers notably Pfizer and Moderna to supply doses for all the population needs by that time. The deals themselves were made based on advice provided by the 18-member COVID-19 Vaccine Task force that was set up by NRC itself back in June 2020.
It should be noted that the strategy of publicly funding homegrown vaccine development and manufacturing essentially socializes the full costs and risks associated with clinical trials and regulatory approval of efficacy and safety. The cost-risk profile of using a public agency to develop a vaccine would therefore need to be compared against simply purchasing the vaccine, from a private sector multinational firm that has already absorbed these costs and risks. This is the approach Israel took in order to get access to the approved vaccines as fast as possible.
Developing homegrown vaccine manufacturing capacity can be achieved without relying solely on a publicly funded government agency. Current policies seemed to have discouraged foreign investments in the pharmaceuticals and vaccines sectors in Canada (24). Reversing recent policy changes on price regulation, improving intellectual property protection, and streamlining marketing approval and health technology assessment processes are some of the ways in which Canada could incentivize foreign multinational companies to invest much-needed private sector risk capital in R&D and manufacturing capacity in this country.
In addition, the pandemic highlights the importance of integrating research and commercialization in the pharma and biotech fields. The World Health Organization has also noted that Canada needs better integration between health care research and commercialization. In the US, clinical research can be setup quickly to lead to the path of regulatory approval. There is close interactions between the drug developers and the FDA which grants regulatory approval (20). Integration between clinical research and Health Canada can be further improved and cultivated with greater transparency in communication especially in a crisis.
Leverage and Recognize Home-Grown Talent
The technology behind the lipid nanoparticle delivery system that was used by the BioNTech/Pfizer COVID-19 vaccine was developed by a biotech firm in Canada; Vancouver-based Acuitas Therapeutics (25). Very little, if any, recognition is given to the firm by the media and government including creating awareness amongst Canadians that a home-grown company was instrumental in developing the technology behind the effective and safe Pfizer COVID-19 vaccine.
Transparency
Transparency of decisions and task force memberships are key elements to gain public trust and execute a successful vaccine strategy including public buy-in of the strategy. Not much is known about the details of the contracts, how vaccine selections were done and principles underpinning the negotiation strategy. Further, the Vaccine Task Force or VTF, which is supported by NRC, had a mandate to accomplish some of the following: prioritize vaccine projects seeking support for activities in Canada; attract to Canada promising non Canadian vaccine candidates, or partner with developers of non Canadian vaccine candidates; optimize the tools needed to develop vaccines; support effective research and development, and supply chain coordination for COVID-19 vaccine projects; facilitate solutions to manufacture the most promising COVID-19 vaccines in Canada and identify opportunities to enhance business connectivity globally to secure access to vaccines with key commercial sponsors. Ideally, the VTF would release a public report as to how many of these goals were accomplished and the activities planned to achieve the remaining goals.
Finally, close coordination amongst the different segments of the federal government is always a challenge but key to a successful vaccine strategy. Israel was able to create a more seamless and coordinated path from vaccine procurement to population immunization. In Canada, there seems to be some degree of lack of communications in the early months especially with regards to vaccine supply shortages or changes in schedules in delivery of vaccines. In addition, there seems to be a disjoint between communications and vaccination campaigns from federal public health authorities to what is occurring on the ground level with the vaccine supply issues.
Conclusion
The federal government will soon be in another round of negotiations as it plans to get potential booster shots for existing and emerging variants and as it procures vaccines through other possible modes of delivery such as nasal sprays and pills. The insights gained from this comparative review could play a useful role as the government enters these future rounds of negotiations with manufacturers. As Canada shifts from a vaccine supply deficit to one of sufficient or excess supply, it is important to recognize the issues in the early phase of the rollout and not lose memory of any lessons learnt from the early days of the vaccine procurement strategy so that key structural changes can be made now in preparation for any other similar health emergencies that may arise in the future.
REFERENCES
1. Health Infobase Canada. http://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html (Accessed September 8, 2021)
2. Mathieu, E., Ritchie, H., Ortiz-Ospina, E. et al. A global database of COVID-19 vaccinations. Nat Hum Behav (2021)
3. “COVID-19 vaccine doses administered” Published online at OurWorldinData.org. Retrieved from: https://ourworldindata.org/grapher/cumulative-covid-vaccinations
4. COVID-19 Vaccination Tracker Canada. Accessed online on 31 Aug 2021: https://covid19tracker.ca/vaccinationtracker.html
5. Rosen B, Waitzberg R, Israeli A. Israel’s rapid rollout of vaccinations for COVID-19. Israel J Health Policy Res. 2020;10(6). https://doi.org/10.1186/s13584-021-00440-6.
6. First Britons receive Covid-19 vaccine, a landmark moment in the pandemic. CNN. https://www.cnn.com/2020/12/08/europe/uk-pfizer-biontech-covid-vaccination-intl/index.html
7. Procuring Vaccines for COVID-19. https://www.canada.ca/en/public-services-procurement/services/procuring-vaccines-covid19.html#agreements
8. G P Marchildon, The rollout of the COVID-19 vaccination: what can Canada learn from Israel? Isr J Health Policy Res, volume 10, issue 1, Posted: 2021
9. Experts fear AstraZeneca COVID-19 vaccine wastage after NACI recommends mixing doses. Global News. https://globalnews.ca/news/7914946/astrazeneca-vaccine-wastage-naci-mixing-doses/
10. COVID-19 Vaccine Task Force. https://nrc.canada.ca/en/corporate/covid-19-vaccine-task-force
11. Ramirez M (2021).Infographic-Canada’s COVID-19 Economic Response Plan https://www.wilsoncenter.org/article/infographic-canadas-covid-19-economic-response-plan
12. Canada’s COVID-19 Economic Response Plan. http://www.canada.ca/en/department-finance/economic-response-plan.html
13. Beraniuk. Covid-19: How the UK vaccine rollout delivered success, so far. BMJ 2021;372:n421, http://dx.doi.org/10.1136/bmj.n421. https://www.bmj.com/content/bmj/372/bmj.n421.full.pdf
14. How the UK gained an edge with AstraZeneca’s vaccine commitments. http://www.politico.eu/article/the-key-differences-between-the-eu-and-uk-astrazeneca-contracts/
15. AstraZeneca official ‘hopeful’ to settle EU court case on vaccines contract in ‘weeks. Politico http://www.politico.eu/article/astrazeneca-official-hopeful-to-settle-eu-court-case-on-vaccines-contract-in-weeks/
16. Pizza-sized boxes and paying a premium: Israel’s COVID-19 vaccine rollout, Reuters, https://www.reuters.com/article/us-health-coronavirus-israel-vaccination-idUSKBN29B0KJ
17. COVID-19 Advisory Groups and Task Forces Fact Sheet. https://www.canada.ca/en/public-health/news/2020/12/covid-19-advisory-groups-and-task-forces-fact-sheet.html
18. COVID-19 vaccine tracker: tracing every dose of the coronavirus vaccine administered in Canada. Toronto Star. https://www.thestar.com/news/canada/2021/01/07/covid-19-vaccine-tracker-tracing-every-dose-of-the-coronavirus-vaccine-administered-in-canada.html
19. What Canada can learn from US, UK about COVID-19 vaccinations and reopenings. CBC News. https://www.cbc.ca/news/canada/canada-covid-reopening-lessons-uk-us-1.6017119
20. Canada home to health research successes, but needs culture shift: expert. CTV News. https://www.ctvnews.ca/health/canada-home-to-health-research-successes-but-needs-culture-shift-expert-1.5313814
21. The roots of Canada’s COVID-19 vaccine shortage go back decades. https://theconversation.com/the-roots-of-canadas-covid-19-vaccine-shortage-go-back-decades-154792
22. The National Research Council of Canada and CanSino Biologics Inc. announce collaboration to advance vaccine against COVID-19. https://www.canada.ca/en/national-research-council/news/2020/05/the-national-research-council-of-canada-and-cansino-biologics-inc-announce-collaboration-to-advance-vaccine-against-covid-19.html
23. Biologics Manufacturing Centre. https://nrc.canada.ca/en/research-development/nrc-facilities/biologics-manufacturing-centre
24. Paul Lucas (2020). Canada’s Vaccine Development Capacity and the Federal Government’s Management of COVID-19. Canadian Health Policy, December 2020. https://fko.wzo.mybluehost.me/products/canada—s-vaccine-development-capacity-and-the-federal-government—s-management-of-covid-19.html
25. Canadian Firm Plays Key Role in COVID-19 Vaccine Development Project with BioNTech and Pfizer. http://acuitastx.com/wp-content/uploads/2020/07/Acuitas-News-Release-July-1-2020-1.pdf
