After a slow start, Canada's vaccine rollout is now a race against time

Last week, before the crack of dawn, 466,800 doses of Moderna's COVID-19 vaccine landed at Toronto Pearson Airport in the belly of a FedEx plane after a journey of 8,500 kilometres,from Madrid via Paris and Indianapolis.

If cargo could fly first class, this cargo would qualify.

The vaccine doses, housed in metallic cargo containers, were unloaded before any of the other cargo.As they were carefully lowered off the hydraulic lift and onto a cargo trailer, temperature sensors showed the doseshadarrived at their ideal temperature of-20C. Ground staff whisked the pallets off the tarmac for customs inspectionso thatthey could be redistributed to the provinces and, eventually,injectedinto the arms of Canadians.

Minister for Public Services and ProcurementAnita Anandwas on the runwaythat morning to oversee the delivery the latest in a series of deliveries that have been growing in size and frequency in recent days.

"All day long, I'm spending my time trying to move doses from [the third quarter]or from the fall to the spring and working with suppliers to try to accelerate doses," saidAnand.

"But being here, and seeing the doses come off of the plane, means it is going to happen. Doses are going into arms in the very near term, and that is so meaningfuland so important for Canadians."

Under pressure

Canada's vaccine rollout got off to a sluggish start.As countries like Israel and the United Kingdom started mass campaigns early in 2021, Canada saw its per capita vaccination rates plunge in international rankings.

Critics at both the federal and provincial levelshave blamed the slow pace onOttawa's procurement process. Some have pointed to a lack of domestic vaccine manufacturing facilities, or the fact that provinces aren't able tosign their own contracts with vaccine producers.

Anandknows she's under enormous pressureto deliver.

"We did come through a rough period in February, and that's because global supply chains, as a general matter, are just ramping up," Anandsaid, referring to manufacturing delays at both Pfizer and Modernathatresulted in smaller-than-anticipated shipments to several countries, including Canada.

"This is the largest vaccination campaign in global history, as well as Canadian history. Having said that, we are ramping up."

Canada is expecting8 million doses of COVID-19 vaccines by the end of March. Deliveries are set to ramp up sharply after that, fuelled by weekly Pfizer deliveries of at least a million doses. More than 7million doses are expected to land inApril alone.

Anandsaid she expects 36.5 million doses by the end of June enough for every person in Canada to receive a single dose.

"The ramp-up is going to be very steep. But again, we've got to watch supply chains. This is very early days in this race of making sure that we have everyone inoculated," she said.

Prime Minister Justin Trudeau continues to stick to a September deadline for gettingevery eligible andwilling Canadian vaccinated. Because of the increasing supply andupdated guidelines that allow public health officials to waitup to four months before delivering asecond dose provinces are now looking to complete their first round of vaccinations before summer.

The 'big lift'

The appearance of morecontagiousCOVID-19 variants that might causemore severe illness hasput increased pressure on governments to vaccinate quickly.

"The provinces and territories are telling us that they are ready, they want more vaccine. And that's exactly what we as a federal government are aiming to do," Anand said.

Trudeau has called Canada's vaccine supply ramp-up "the big lift."The prime minister tolda virtual roundtable of health care workers in February that the country would be going from a trickle ofdeliveries in the early months of the yearto "receiving millions upon millions, even tens of millions of vaccines into the spring. And we're going to have to make sure we're getting them out to everyone."

The challenge is a daunting one. Taking into account the 8 million dosesdelivered to Canada before the end of March, about 23 million moreCanadians are eligible for vaccination this spring.

To deliver first doses tothat entire population between April 1 and July 1, health care workers will have to vaccinate an average of255,000 people per day, seven days a week.

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That's amessage the federal government is hearing a lot lately frommunicipalities. Anthony Di Monte, general manager of emergency operationsfor the City of Ottawa,said the cityhas seven clinic-based immunization sites including re-purposed hockey arenas and community centres plus two hospital sites and a mobile unitready to inoculate the city's population of one million.

He said that once he getsthe doses he needs, he'llbe ready tolaunch on72 hours'noticeOttawa's complete mass vaccination program whichis set to deliver, for a start,11,000 shots a daythrough all ten sites.

"Our objective for all seven of our(clinic-based)sites is to do in the neighbourhood of 1,200 to 1,400 vaccinations a day, per site," saidDi Monte.

"We've got some confidence that we could probably crank that up a little bit and get closer to the 2,000 mark per site once we get rolling and we have enough staff."

With enough doses and enough people,Di Monte said, Ottawa can keep itsclinics open around the clock. The cityhasplans for a drive-through vaccination site in the sprawling parking lot outside the Canadian Tire Centre,home of the Ottawa Senators; it's also looking atusing two convention centres.

'We ramp up and we never go back'

What Di Montefearsis a disruption insupply thatwould forcehim to close a vaccination site.

"You want the machine to start going and flowing and a regular flow," he said. "I would prefer to see that we ramp up and we never go back. We just keep going and I'll turn the switch up as much as we have capacity."

Anandsaid her department is keeping a close watch on those supply lines.

"We are seeing vaccine nationalism take hold in certain areas of the world, including in Europe and, to an extent, the United States," she said. "And we've got to make sure that Canada's supply chain is protected."

The cargoflight Anandmet at the airport last week crossed European and American borders, offeringaclear exampleof how"vaccine nationalism" countries limiting exports to concentrate on vaccinating their citizens first could tie Canada's supply lines in knots.

Anand saidCanada's diversevaccine portfolio four vaccines from five different suppliers serves asa hedge against that threat.

"We have to make sure that we're on top of this file and the delivery schedules," she said.

"I'm thinking of all the elderly people in Canada who need vaccine, want a vaccine, and Canadians at large.This is what makes this work so important, and this is why we have to see this right through to the end so every single Canadian will have access to a vaccine before the end of summer, if not before."

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