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Canada Countries around the world are scrambling to find a COVID-19 vaccine, but access remains uncertain

13:06  02 august  2020
13:06  02 august  2020 Source:   cbc.ca

Canada urged to avoid 'vaccine nationalism' in race for COVID-19 cure

  Canada urged to avoid 'vaccine nationalism' in race for COVID-19 cure OTTAWA — A top American health expert is praising Canada for not succumbing to "vaccine nationalism" because of its efforts to push for fair global distribution of a cure for the COVID-19 pandemic. Thomas Bollyky, director of the global health program at the Washington-based Council on Foreign Relations, says that sets Canada apart from the United States and European countries that are making moves to pre-buy massive amounts of potentiallyThomas Bollyky, director of the global health program at the Washington-based Council on Foreign Relations, says that sets Canada apart from the United States and European countries that are making moves to pre-buy massive amounts of potentially viable vaccines for their own popul

Researchers around the world are developing more than 165 vaccines against the coronavirus The first vaccine safety trials in humans started in March, but the road ahead remains uncertain . The company launched trials for a Covid - 19 vaccine in May, and the Coalition for Epidemic Preparedness

Governments around the world are adopting a variety of different measures to try to contain the spread of the novel coronavirus. Chat with us in Facebook Messenger. Find out what's happening in the world as it unfolds. Instead, the Covid - 19 crisis has spread abroad, with alarming new clusters

a close up of a person: A nurse holds a potential coronavirus vaccine produced by China's Sinovac Biotech before administering it to a volunteer during trials at Emilio Ribas Institute in Sao Paulo, Brazil, on July 30. When a vaccine becomes available, some countries may be able to get access quicker than others. © Amanda Perobelli/Reuters A nurse holds a potential coronavirus vaccine produced by China's Sinovac Biotech before administering it to a volunteer during trials at Emilio Ribas Institute in Sao Paulo, Brazil, on July 30. When a vaccine becomes available, some countries may be able to get access quicker than others.

The COVID-19 pandemic has hit the world hard, and countries around the globe are anxious to get their hands on a vaccine as soon as possible in the hopes that it will bring a return to normalcy

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The coronavirus COVID - 19 is affecting 213 countries and territories around the world and 2 international conveyances. The day is reset after midnight GMT+0. The list of countries and territories and their continental regional classification is based on the United Nations Geoscheme.

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Those vaccines are expected to be in short supply when they first hit the market, meaning not everyone will have access initially. Within countries, some groups will be prioritized for vaccination.

But what about globally? Which countries will get the vaccines first?

Many wealthier nations are already making bets on vaccines still in relatively early stages of development, with no guarantee that they will ever perform well enough to gain approval or protect their populations.

That has many concerned about "vaccine nationalism," where countries look out for their own interests at the expense of others.

Here's a closer look at what wealthier countries are doing to ensure supplies for their own citizens, how that might affect other countries, how Canada might fare and what efforts are being made to distribute a vaccine more fairly.

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COVID - 19 . Explore the latest strategic trends, research and analysis. This means having action plans, staff and budgets in place for rapid response. It also requires having access to laboratories to test for infectious disease and real-time monitoring and reporting of infectious clusters as they occur.

Some countries — notably Sweden, and briefly Britain — have experimented with limited lockdowns in an The herd immunity threshold for this new disease is still uncertain , but many Covid - 19 , unlike influenza, is a brand-new disease. Before this year, no one in the world had any immunity to it at all.

What can countries do to obtain a vaccine first?

There are a few different ways wealthier countries can try to ensure their own supplies:

  • Provide funding for the development and manufacture of their own candidates to help speed it up.
  • Manufacture a vaccine within their own country and prevent it from being exported.
  • Make deals to reserve or preorder large numbers of doses.

What impact does that have on other countries?

In previous pandemics, such as an H1N1 outbreak in 2009, wealthier nations were able to buy up the first batches, leaving no supply for lower-income countries.

And even some richer countries, including Canada, weren't always first in line if they didn't have their own manufacturing facilities. During the swine flu outbreak in 1976, for example, the U.S. decided to vaccinate its entire population before it would allow vaccine producers to export their products to Canada.

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What are countries doing to ensure their own supply?

The U.S. has a program called Operation Warp Speed, which aims to produce a vaccine faster than anyone else. President Donald Trump has said he hoped it would be available before the end of the year.

The program has already announced that it's providing more than $6 billion US to pay for development, manufacturing and preorders or reservations for hundreds of millions of doses of promising vaccine candidates from U.S.-based Johnson & Johnson, Moderna, Novavax, Pfizer and Merck, along with U.K.-based AstraZeneca.

Francis Collins wearing glasses: Dr. Francis Collins, director of the National Institutes of Health, holds up a model of the coronavirus SARS-CoV-2 at a U.S. Senate subcommittee hearing on July 2 in Washington on the plan to research, manufacture and distribute a coronavirus vaccine, known as Operation Warp Speed. © Saul Loeb/Pool via The Associated Press Dr. Francis Collins, director of the National Institutes of Health, holds up a model of the coronavirus SARS-CoV-2 at a U.S. Senate subcommittee hearing on July 2 in Washington on the plan to research, manufacture and distribute a coronavirus vaccine, known as Operation Warp Speed.

Similarly, the European Commission has a plan to use an emergency fund worth €2.4 billion (almost $3.7 billion Cdn) to buy up to six vaccines in advance for 450 million people.

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COVID - 19 travel guidance. The Foreign & Commonwealth Office currently advises British nationals against all On 4 July our travel advice changed, with exemptions for travelling to certain countries and territories that Developments in the coronavirus pandemic remain uncertain around the world .

Germany, France, Italy and the Netherlands have also signed a deal with AstraZeneca for over 300 million doses of its vaccine, which they say all EU members can participate in.

Meanwhile, the United Kingdom has preordered nearly 200 million doses from AstraZeneca, BioNTech/Pfizer  and France-based Valneva.

There are concerns such preorders could reduce the initial availability of vaccines in the rest of the world, which has happened in previous pandemics

The European Commission has specifically said it will not buy vaccines produced exclusively in the U.S. over concerns that might delay supplies to Europe.

What is Canada doing to ensure its own supply?

The federal government has created a $600 million fund to support vaccine clinical trials and manufacturing in Canada.

It is also "closely monitoring vaccine development efforts — domestically and internationally — and will work quickly to negotiate advanced purchase agreements with vaccine manufacturer(s) to secure supply for all Canadians as soon as it is feasible," Geoffroy Legault-Thivierge, a spokesperson for the Public Health Agency of Canada, told CBC News in an email.

However, as of July 30, it hadn't yet announced any such agreements.

The government has also announced it is ordering enough equipment, such as syringes, alcohol swabs and bandages, to give at least two doses of a vaccine to every Canadian when one becomes available.

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Still, experts warn that Canada currently doesn't have much manufacturing capacity for vaccines, even those developed in this country — many of which would be manufactured elsewhere and some of which would likely be licensed to foreign companies for manufacturing.

a bottle of water: Vials used by pharmacists to prepare syringes are used on the first day of a first-stage safety study clinical trial of the potential vaccine for COVID-19 in March. © Ted S. Warren/The Associated Press Vials used by pharmacists to prepare syringes are used on the first day of a first-stage safety study clinical trial of the potential vaccine for COVID-19 in March.

Quebec City-based Medicago is the first Canadian vaccine candidate to begin clinical trials. But CEO Bruce Clark has said that his company's main manufacturing plant is in the U.S., meaning there's no guarantee that a supply would reach Canada in a timely manner.

"'Guarantee' is a strong word," Clark told The Canadian Press in July. "Strange things happen to borders in the context of a pandemic."

Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University and the IWK Health Centre in Halifax, said Canada is a very small market.

"And we will not have a vaccine if the manufacturer doesn't apply for approval," said MacDonald, who has done research on ethical issues surrounding vaccines.

In the past, some manufacturers have not prioritized Canada, she said. For example, the manufacturer of the chicken pox vaccine didn't apply for approval in Canada until it had already been available in the U.S. for five years.

Why should all countries have access to a vaccine?

Because it's a global pandemic and our world is interconnected, outbreaks in any country have the potential to travel to other countries and cause outbreaks there, MacDonald said. "For you to be safe ... your country needs to be safe and all other countries need to be safe."

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That's even the case if the entire population is vaccinated, she said, as a given vaccine usually doesn't work for everyone.

Due to manufacturing and distribution constraints, when a vaccine first becomes available, there isn't expected to be enough of it to vaccinate the entire populations of even countries wealthy and lucky enough to have preordered it. That means most of their populations could remain at risk for a long time if the pandemic isn't under control in other parts of the world.

Outbreaks also tend to be worse and harder to control in poorer countries, posing a higher risk to both their own populations and the world.

a person wearing a hat: A volunteer receives an injection of a COVID-19 test vaccine, developed at Oxford University in Britain, at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg, South Africa. © Siphiwe Sibeko/The Associated Press A volunteer receives an injection of a COVID-19 test vaccine, developed at Oxford University in Britain, at the Chris Hani Baragwanath Hospital in Soweto, Johannesburg, South Africa.

Dr. Joel Lexchin, a professor emeritus at York University in Toronto who has studied pharmaceutical policy, said many wealthier countries such as Canada are able to do a pretty good job of controlling the virus without a vaccine through such measures as physical distancing, frequent handwashing, mask wearing and temporarily shutting down certain businesses and services.

Meanwhile, lower-income countries where many people live in crowded conditions — some of them with limited access to things like clean water and soap — are struggling with both controlling the epidemic and treating those who have fallen ill.

"I think you need to look at where the outbreak is still the greatest threat to public health and also where the medical care resources are the lowest," Lexchin said.

"You can make the case that however much we need a vaccine in Canada, there they need it much more than we do."

What about global efforts to ensure a fair distribution?

There are some, but perhaps the biggest is the COVAX Facility, an initiative of the World Health Organization; Gavi, the Vaccine Alliance, which is a public-private partnership founded by the Bill & Melinda Gates Foundation that vaccinates children against deadly diseases; and the Coalition for Epidemic Preparedness Innovations, which aims to develop vaccines to stop future epidemics.

The risk of Covid three and a half times higher among caregivers

 The risk of Covid three and a half times higher among caregivers © kali9 / IStock.com Carers were, in April, almost 3.5 times more likely to catch Covid-19 than the rest of the population according to a study published on Saturday Carers were, in April, almost 3.5 times more likely to catch Covid-19 than the rest of the population according to a study published on Saturday, which notes an even higher risk for ethnic minorities.

COVAX is pooling money from dozens of countries to invest in vaccine candidates around the world, with a goal of delivering two billion vaccine doses globally by 2021.

The program is designed to connect developing and developed nations, with all partners getting enough doses of a successful vaccine for 20 per cent of their populations, initially prioritizing health-care workers. So far, it's signed on 75 higher-income countries — including Canada but not the U.S. — to partner with 90 lower-income countries that together represent more than 60 per cent of the world's population. It's also joining forces with vaccine manufacturers.

a person standing in front of a building: Health workers screen residents for COVID-19 symptoms at the Deonar slum in Mumbai, India, on July 11. In just three weeks, India went from being the world’s sixth worst-affected country to the third, according to a tally of coronavirus cases by Johns Hopkins University. © Rajanish Kakade/The Associated Press Health workers screen residents for COVID-19 symptoms at the Deonar slum in Mumbai, India, on July 11. In just three weeks, India went from being the world’s sixth worst-affected country to the third, according to a tally of coronavirus cases by Johns Hopkins University.

The program includes investment in production facilities and incentives to scale up through preorders.

Because most vaccine candidates are not expected to succeed and make it to market, COVAX is designed to get higher-income countries to participate by improving the chance that they'll invest in a successful vaccine.

"This is an initial opportunity for a wealthy country to kind of hedge their bets and protect their own interests and also contribute to a global effort to secure vaccine for people living in countries where the resources are not there to do it on their own," said Prof. Ruth Faden, founder of the Johns Hopkins Berman Institute of Bioethics in Baltimore.

"It's very smart."

Prime Minister Justin Trudeau has spoken in favour of and co-authored an op-ed article with leaders of other countries calling for equitable access to a COVID-19 vaccine when it's ready. Canada has already pledged $850 million to Global Coronavirus Response and $120 million toward the broader initiative that COVAX is part of, called the Access to COVID-19 Tools Accelerator.

Gavi, the Vaccine Alliance, says it has raised $600 million US from higher-income countries and the private sector to provide an incentive for manufacturers to make enough vaccine to ensure access for developing countries.

Will efforts for a fair distribution of vaccines work?

York University's Lexchin said it's not clear if vaccines will be fairly distributed. He noted in an article in The Conversation that even for COVAX, rich countries will get the vaccine before poorer countries. And all countries will only be able to vaccinate their highest-priority groups, including health-care workers — just 20 per cent of the population through the program, limiting its influence.

At least one humanitarian group has expressed concern that the program doesn't stop rich countries from buying up all the supply in advance, limiting what can be distributed to the rest of the world.

Lexchin said in an interview that middle-income countries such as Brazil and Mexico sometimes fall through the cracks, as they're not poor enough to take advantage of lower prices offered by manufacturers, who set the prices.

He said he thinks leaders, including Canada's, need to step up as well, by requiring that vaccines and treatments be made available at affordable prices to low- and middle-income countries if government funding was received for their development.

Still, MacDonald of Dalhousie University is cautiously optimistic.

"We're in better shape to be more equitable about a COVID-19 vaccine globally than we were for the influenza pandemic," she said.

"Do I think we're going to get it right? ... I hope we'll get it more right."

The risk of Covid three and a half times higher among caregivers .
© kali9 / IStock.com Carers were, in April, almost 3.5 times more likely to catch Covid-19 than the rest of the population according to a study published on Saturday Carers were, in April, almost 3.5 times more likely to catch Covid-19 than the rest of the population according to a study published on Saturday, which notes an even higher risk for ethnic minorities.

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