NEWS
11/13/2020 14:09 EST | Updated 11/17/2020 09:58 EST

What Must Happen Before Ontario Can Roll Out A COVID-19 Vaccine

The communities hit hardest by the pandemic need to be engaged in policymaking decisions around the vaccine, one expert said.

News of the Pfizer vaccine’s early success provided a glimmer of hope as Canada continues to grapple with COVID-19, but there are questions about how that vaccine — or another approved one — will be distributed when ready. 

Alison Thompson, an associate professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto, told HuffPost Canada it’s important for the government, public health units and physicians to engage with the communities that have been hardest hit by the pandemic to ensure they trust the vaccine will be safe. 

Data from Statistics Canada shows communities with the most visible minorities had the highest mortality rates during the first wave of COVID-19. 

Thompson said she’s concerned that the people who have been disproportionately affected by the pandemic — such as Black people, Indigenous people and people who live in low-income neighbourhoods — may not trust the vaccine if they’re among the first in line for it.

“We need to really be engaging with them in a conversation about how they feel about being prioritized, because we know from other outbreaks that when they are prioritized, they get the perception that they’re being used as guinea pigs,” she said. 

Xinhua News Agency via Getty Images
A security officer wearing a face mask and a face shield checks a person's appointment at a COVID-19 assessment centre in Toronto, Ont., on Nov. 12, 2020. 

She pointed to a past meningitis outbreak in a Maori community in New Zealand where an emergency vaccine was produced on a tight timeline. Although there were good ethical and epidemiological reasons to prioritize giving people in that community the vaccine, some felt they were being used as guinea pigs, Thompson said. 

“We’ve been a little late in the game in Ontario in terms of engaging with communities who are disproportionately affected and engaging them in the policymaking process and in making some of those decisions,” she said.

Vaccine distribution will be centralized 

The Pfizer vaccine needs to be stored at around -70 C to be stable and effective. The freezer can only be opened a few times a day for no longer than a minute, Thompson said, otherwise the vaccine will spoil.

That means it likely won’t be available at pharmacies or doctor’s offices — instead, experts expect there will be a centralized delivery. 

Health-care centres that have research facilities attached may have the kind of freezer that’s required, Thompson said. But she said the centralized delivery of the vaccine could mean rural and remote communities have a harder time accessing it.

Marko Geber via Getty Images
A young woman gets a vaccine. Experts say there will be logistical challenges with the rollout of the eventual COVID-19 vaccine. 

The centralized rollout could end up being a “silver lining” because it will make it easier to prioritize who needs to get the vaccine first, Dr. Barry Pakes, an assistant professor at the Dalla Lana School of Public Health at the University of Toronto, told HuffPost.

“It is a lot of extra work and a lot of extra costs, but one of the things we saw with the flu vaccine rollout just now is that if you have pharmacies and public health and family doctors and others giving out the vaccine, we’re not always able to adhere to the priority system that we’ve established,” he said.

Administering the vaccine in a centralized way will mean the people who get it first are those who are most vulnerable and the people who are essential to fighting the pandemic, he added.

There are still opportunities for Pfizer to tweak its vaccine to make it more heat stable, he said, but if it remains as is, it will be “logistically challenging” to store and transport it.

“But there are a lot of people at various levels who are working very hard on policies and procedures, as well as all the logistical pieces around storage and transportation and delivery right now,” Pakes said. “We’re still looking at at least a couple of months, in the best case scenario, and I think our plans will be ready by then.”

He also said if another vaccine proves effective and safe, it’s possible essential workers and other people could receive the Pfizer vaccine first and then the wider population could receive a different one that may come at a later time.

Ontario preparing to distribute vaccine ‘as quickly as possible’ 

Ontario Health Minister Christine Elliott told reporters Monday that there’s a group within the ministry who will have a plan ready for when the vaccine is available, including determining the first group of people who will receive the vaccine. 

“There’s a lot of work to be done around that, but it’s planning that needs to happen to make sure that we have a fair and equitable response for everyone,” she said.

Steve Russell via Getty Images
Ontario Minister of Health Christine Elliott at a COVID-19 press conference at Queen's Park in Toronto, Ont. on June 5, 2020. 

She said the decision around the first group to get the vaccine has not been finalized and acknowledged the challenges around needing to freeze the vaccine.

“That’s why we really need to have a very detailed plan for when we receive the doses of the vaccine, and as soon as we receive them, we need to be prepared to distribute them so that people can get the vaccines as quickly as possible.”

Another challenge in Ontario, Pakes said, is that the province doesn’t currently have a vaccine registry that includes people’s names and vaccination statuses. Pakes said it’s being worked on right now, but when the COVID-19 vaccine is available, it will be important to know who has the vaccine and who doesn’t, as well as the size of Ontario and Canada’s inventory.

“This is a very big project, and in order to have the data to keep that project moving and to be able to respond to changes and be flexible and make things better continuously, as we always like to do in public health, we need to have that data,” Pakes said.

A spokesperson for the Ontario Ministry of Health said the province’s COVID-19 immunization and vaccine management plan is flexible and will build on Ontario’s immunization repository, but did not answer HuffPost’s question about a provincial vaccine registry.

The Pfizer vaccine, along with some others, would require two doses per person at a set interval.

A vaccine registry would also help ensure people receive the second dose at the correct time and not too early, Pakes said. Over time, experts will be able to tell if one shot is sufficient for population immunity, he said.