The Northwest Territories is firmly in phase two of its plan to ease Covid-19 restrictions. Borders have loosened and a “travel bubble” with Nunavut is in place.
Yet as measures lift, the NWT government has firmly stated things can’t fully return to normal until a Covid-19 vaccine or effective treatment exists.
Scientists and pharmaceutical companies around the world are currently working on those vaccines and treatments. For example, clinical trials for a potential vaccine candidate began at Nova Scotia’s Dalhousie University last month.
But making and distributing vaccines involves a complex web of science, politics, and medical ethics.
Dr Stephanie Yanow is an associate professor of global health at the University of Alberta in Edmonton. For the past five years, she has been working to develop a malaria vaccine.
As she describes it, vaccine development is an incredibly lengthy process. It begins in a lab, choosing how you want to produce the antibodies to fight to disease, and testing whether or not they can kill the virus in a petri dish.
Next, there’s testing on smaller, then larger animals to see if it works on them. Only after it’s deemed safe at this level does a vaccine candidate move to human test subjects, where clinical trial volunteers are exposed to the virus, receive the vaccine, and are monitored for its effectiveness and safety.
According to Yanow, vaccine development under normal circumstances can take five to 10 years from start to finish – sometimes even 20.
“I would say the very least would be six months for a phase-one trial and then, when you get to more advanced phases, they’re usually several years,” she says.
Given the urgency of the Covid-19 pandemic, Yanow concedes the search has been incredibly fast-tracked. It appears trial periods have been shortened to get to the stages with human subjects as quickly as possible.
Estimates from health authorities say a vaccine could be developed in 12 to 18 months, but even that would be lightning speed and a best-case scenario.
Covid-19: an unknown problem
This is where vaccine development hits another snag, both Yanow and microbiologist Dr Claire Cupples warn.
“One of the biggest challenges is we don’t know a lot about the disease because it’s new,” says Cupples, a microbiologist at Simon Fraser University in BC, who has been working in the field since 1989.
In other words, trying to develop a vaccine for a virus that isn’t yet fully understood can be very difficult.
“When they developed the vaccines against polio in the ‘50s and ‘60s – or even back in the 1800s when they were developing vaccines against other diseases like cholera and smallpox – people already knew an awful lot about those diseases,” Cupples says.
“And so it was easier to make a vaccine, because you were working with a known problem.
“But [Covid-19] is a brand-new disease and we don’t really know that much about it. So while we’re trying to treat it, we’re also trying to learn about it, and I think that’s one of the things that makes life really complicated.”
For ethical purposes, vaccine development typically relies on pre-existing treatments. When you expose a human test subject to a virus to see whether the vaccine works, the pre-existing treatment is a failsafe in case it doesn’t.
“With Covid, we don’t have that luxury because we don’t have any drugs that reliably work to kill the virus,” Yanow says.
“This is a big unknown with the Covid vaccine plans because we can probably only go so far in evaluating vaccines without really knowing how effective they would be in a real-life scenario where someone gets exposed to the virus.”
Vaccine ‘not the be-all and end-all’
There are several ongoing drug trials in Canada testing the effectiveness of pre-existing medications in treating Covid. They include hydroxychloroquine, which is used for malaria, and Tocilizumab, which is used for rheumatoid arthritis.
Since the development of a vaccine soon is not guaranteed, Cupples says, investment in potential treatments like those is a good and usually faster option.
“I mean, we don’t have a vaccine for AIDS, but we know now how to keep people alive almost for their natural lifespan because we have treatments,” she says.
The NWT government is keeping all of this in mind as it regularly adapts its plan, says Dr Andy Delli Pizzi, the territory’s deputy chief public health officer.
While the availability of a vaccine will provide guidance in how to relax restrictions, it’s not the “be-all and end-all” of how the territory will proceed, Delli Pizzi says.
He explains the NWT government will “continuously reassess” its public health measures based not only on whether a vaccine exists, but on the pandemic’s broader impact and whether those measures are having the desired effect.
Still, he adds, the territory is keeping a “close eye” on vaccine trials.
If one or more of those trials is ultimately successful, creating a vaccine is just the first part of the battle. The second is distribution and accessibility.
Elders and remote communities first?
Vaccine candidates are being developed around the world. That means Canada may not be first to crack the code, says Ian Culbert, executive director of the Canadian Public Health Association.
It’s not easy to gauge how quickly a vaccine developed elsewhere in the world would reach the territory, but Culbert says global exports “typically happen very quickly” so for-profit pharmaceutical companies can see returns on their investment.
Delli Pizzi said the speed with which the NWT’s residents get a vaccine, once one is created, “really depends on the type of vaccine being produced and how quickly the manufacturer can scale up.”
Once in the NWT, the territorial government will ship the vaccine to public health units and regional health authorities based on need and projected requirements.
However, that may pose another challenge. How will the territory decide who to inoculate first if, initially, there’s not enough for everyone?
In Culbert’s mind, it makes sense to prioritize elderly and immunocompromised populations because they have higher fatality rates, as well as front-line workers who have the most contact with the virus.
But geography is also a factor. Culbert argues the North’s remote communities should be a priority because of their reduced healthcare capacities.
“The case can be easily made that they need to get their fair and equitable share of the vaccine as it becomes available,” Culbert says.
Meanwhile, the territory’s residents are settling in for what looks set to be months, and may well be years, of existing alongside Covid-19 – and at least some public health restrictions – before a vaccine or treatment emerges.
“I think all the things we’re doing now, we’ll have to continue to do for a while,” says Cupples, “and just hope that either we get a vaccine or that we get good treatment for the illness.”