As two promising Covid-19 vaccine candidates emerge, there are more questions than answers about how doses could reach Northwest Territories residents.
Moderna and Pfizer say late-stage trials show their vaccines are around 95-percent effective in preventing Covid-19 infections. Both companies expect to soon seek regulatory approval.
If the vaccines are approved, they’ll still need to reach the Northwest Territories before northerners will feel any impact.
Neither the territorial nor federal governments appear to know for sure how many doses the NWT will initially receive, when those doses might arrive, how they will be transported and stored, and who will get priority.
“This is a national effort and there are still a lot of variables as to how this rolls out,” Mike Westwick, communications manager of the NWT’s Covid-19 Secretariat, told Cabin Radio by email.
Health Canada declined to provide details about vaccine transportation, distribution, or prioritization in the North.
The federal department instead issued a brief statement saying it was “working with provincial and territorial partners on potential gaps in the supply chain” and capacity issues that could affect a Canadian mass immunization campaign.
“We want to ensure we are as ready as possible to get the vaccine to Canadians as quickly as possible,” the statement read.
Who will get priority access?
The territorial government did not provide an interview with health officials or respond to questions about the rollout of a vaccine in the NWT. A spokesperson referred Cabin Radio to preliminary guidance from a federal national advisory committee on immunization.
That document states a Covid-19 vaccine should be prioritized in people for whom clinical evidence shows the vaccine is safe and effective.
A phased rollout can’t happen, the advisory committee says, until vaccine characteristics, the results of clinical trials, and the number of available doses are known.
When that information is available, the federal committee expects the elderly, people with high-risk illnesses, healthcare workers, essential workers, and “household contacts of those at high-risk of severe illness and death from Covid-19” to be prioritized.
NWT health officials on Thursday told the CBC any vaccine will first go to the elderly, essential healthcare workers, and residents in communities with less access to healthcare services.
Chief Public Health Officer Dr Kami Kandola told the CBC she expects a Covid-19 vaccine to be rolled out to the general population by the end of 2021.
Uncertainty across Canada
Kerry Bowman, a clinical ethicist for Toronto’s Mount Sinai Hospital and assistant professor at the University of Toronto’s faculty of medicine, described wide-ranging uncertainty at how a Covid-19 vaccine will be distributed across Canada.
“Everything’s different with Covid-19 because there’s an urgency to it and we’ve never done this before on such a huge scale,” Bowman said.
“Many of the details of this are absolutely not known at this point. We really don’t know.”
Bowman said the first priority for the vaccine in Canada will likely be front-line healthcare workers, followed by those people considered most at risk. After that, he said, it “gets a little more murky.”
“Who goes first will be easiest. Who goes second, third, fourth, fifth, sixth, that type of thing, is going to get much more complicated,” he said.
Bowman said there is a strong argument for Indigenous communities to have earlier access to a vaccine as they are disproportionately affected by Covid-19.
He noted, however, that detailed information about the vaccines is not yet publicly available. Some vaccines work better for different populations than others, he said – like certain age groups or ethnicities – which could affect where doses are targeted.
Another question, Bowman said, is how many people across Canada will be willing to get vaccinated.
“The amount of fake news, conspiracy theories, anti-vaccination movements – it’s considerable,” he said. “People may say, ‘This is a money-making scheme and I don’t trust it.’”
If less than 60 percent of Canada’s population is vaccinated, Bowman says that won’t be enough to ensure herd immunity.
More broadly, if the vaccine doesn’t eventually reach most or all countries, the virus could mutate elsewhere and keep coming back to Canada and the NWT in new forms.
‘We have access’
The good news is that Canada will have access to the Pfizer and Moderna vaccines.
“It is better to have challenges with distribution than challenges with access,” Bowman said. “We have access. Now we have to figure out distribution. Lots of countries in the world won’t have access.”
The Canadian government has signed deals to receive a minimum of 20 million doses of the Pfizer vaccine and 56 million doses of the Moderna vaccine.
While several provinces have estimated the proportion of those doses they expect to receive in early 2021, NWT health officials say they don’t have that information yet.
Alberta health minister Tyler Shandro said the province will receive around 686,000 doses of Covid-19 vaccines in early 2021. Ontario health minister Christine Elliott said her province expects to receive 2.4 million doses of vaccines during the first three months of 2021.
‘Astronomical’ logistical challenges
There are additional logistical challenges to transporting the Pfizer vaccine, which must be stored at -70C temperatures achievable only in ultra-cold freezers.
Many medical centres – particularly those in rural areas – don’t currently have those freezers, which can cost around $15,000 to buy and are expensive to run because of their high energy use.
Both the Pfizer and Moderna vaccines also require two doses, taken several weeks apart.
“The logistics of this are going to be astronomical,” Bowman said.
He noted, however, that several other vaccines are in the works. According to a Covid-19 vaccine tracker from McGill University, 57 vaccines are being developed in 37 countries.
“Maybe pipe dreaming a little bit here but we could end up with, let’s imagine, five or six – all of which work well. That would change a lot,” Bowman said.
Pfizer Canada told Cabin Radio it’s working with the federal, territorial, and provincial governments to determine logistics of the vaccine’s distribution. In Canada, the company plans to ship from its manufacturing sites directly to the point of use.
“We have developed detailed logistical plans and tools to support effective vaccine transport, storage and continuous temperature monitoring,” an email from the company states. “Our distribution is built on a flexible just-in-time system which will ship the frozen vials to the designated locations.”
Pfizer has developed shipping containers with dry ice that can maintain the super-cold conditions needed to transport the vaccine for up to 10 days. Each container has a GPS thermal sensor that will track temperature changes.
Once vaccines arrive at their intended destination, the company said there are three options for storage.
Doses can be kept for up to six months in an ultra-cold freezer, the shipping containers can be refilled with dry ice to store the vaccine for up to 15 days, or the vaccine can be stored for up to five days in refrigeration units commonly available at hospitals.