5 million doses, 100 days: The hurdles facing Quebec on the road to June 24

Quebec Premier François Legault says every Quebecer who wants a COVID-19 vaccine will be able to get their first dose by June 24.

As far as deadlines go, this one — falling on St-Jean-Baptiste Day, officially known in Quebec as the Fête nationale — has some clear symbolism.

But there are potential milestones that could lead to restrictions being further relaxed well before that date. At the same time, there are some significant hurdles.

Here are some of the key challenges in the weeks ahead.

More than 5 million people still left

The Legault government is actually seeking to vaccinate three-quarters of the eligible population, which has been their objective with each age group already targeted. 

According to a document obtained by Radio-Canada, exactly 5,115,509 vaccines needed to be given to reach that goal by June 24 — 100 days from the goal's announcement on Tuesday. (Just over 800,000 people had been given a vaccine at that point.)

The Health Ministry says the objective has already been reached for the first four age groups. The majority of people aged 85 and over, 80-84, 75-79 and 70-74 years are already vaccinated.

Among 65-69-year-olds, to reach 75 per cent, 288,240 first doses remained to be given on March 17. Appointment slots for this age group opened in Montreal on Monday and have since been extended province-wide.

The government says vaccination adherence is high, despite current doubts about AstraZeneca-Oxford's product, and it expects that appointment slots will fill up quickly.

For adults 64 and under, Quebec will need 4,827,269 doses.

Quebec received a guarantee from Ottawa this week that the doses would be delivered in sufficient quantity by June 24.

Ramping up

To reach the June 24 target, a simple calculation shows daily doses will have to increase to at least 51,000 doses per day and 357,000 per week. On Thursday, a new record was reached, with 38,000 doses given.

In an interview with Radio-Canada, Dr. Richard Massé, the strategic medical advisor for Quebec Public Health, acknowledged that the target is a challenge. 

But he cited Quebec's yearly influenza vaccine campaign as evidence of pre-existing capabilities.

The province vaccinated up to 250,000 per week last fall for influenza, he said. 

"This challenge is a bit bigger, but we've increased the means to do it."

Quebec is turning to pharmacies (as it did with the flu shot) and big companies to assist with vaccinations.

More than 350 pharmacies in Montreal began taking appointments on Monday for vaccinations next week, with the eventual target of 140,000 vaccinations per week across the network. 

Major employers are expected to set up vaccination sites in the coming weeks.

Mid-April target for those over 65 

On Tuesday, Legault said the province expected to have vaccinated everyone over 65 by mid-April.

He has, in the past, spoken about how — once that age group has been given the vaccine — he plans to further loosen restrictions.

Massé said vaccinating those over 65 years old and people with chronic diseases and other conditions will mean fewer hospitalizations and deaths.

"Once we have a majority of this group vaccinated, this will let us have a bit more breathing room that everyone needs," he said. "It's clear, measures will be more relaxed."

Between now and April, what could go wrong?

The prospect of a third wave and more dangerous variants of COVID-19 looms over these vaccination targets. 

Quebec has so far avoided a surge in cases like the one underway in Ontario. 

But Legault said the province expects most COVID cases will be caused by variants by next month — and that a rise in cases more generally is also likely.

"We have to be prudent, but that's why we announced only a few new measures," he said Tuesday.

The challenge will be to fend off another spike in cases until more vulnerable populations get a vaccine, according to Dr. Horacio Arruda, the province's public health director. Otherwise, hospitals will quickly fill up again.

"The issue is to make sure that this happens later, when we're going to have more people vaccinated who will not need to go to hospital, for not going back to the movie, the bad movie we had this spring," he said. 

The biggest concern, Legault said, is that the later curfew will tempt people to visit each other in their homes.

"We must not do that," he said. "We have a few weeks left in front of us."

Another concern is that not enough people get vaccinated, and continue to spread it.

"It's a virus that will stay in society for the coming years," said Dr. Yves Bolduc, a former Quebec health minister under the Liberals.

Bolduc, who oversaw a vaccination campaign against the H1N1 virus, said the challenge in that instance was persuading people of the necessity of a vaccine. With COVID-19, he said, the population is largely on board. 

What about after St-Jean?

Life after June 24 won't mean we've entered a post-virus era. If Quebec reaches its goal, transmission will still continue because the vaccines cannot currently be given to those under 18, Massé said.

"While we don't have authorization to vaccinate the youngest, we'll have a situation where transmission will happen," he said. "There will be less impact, fewer hospitalizations, but there will still be transmission." 

Dr. Mylène Drouin, Montreal's public health director, said Wednesday she doesn't expect summer to be filled with the massive festivals of prior years. But she said smaller events are likely to be allowed.

There is also evidence that immunity is waning, "especially in the elderly, especially in the vulnerable population that have been vaccinated starting in December [and] January," said Jörg Fritz, an associate professor in McGill University's department of microbiology and immunology.

It means boosters will be needed, Fritz said, which in turn requires that the vaccination infrastructure be maintained.

"So all the logistics to keep up vaccination at a high speed needs to be built up for quite a while," he said. "This is not just a month or two. I would say we need to build that up so that it can last, and it's stable and effective, for about a year to come."

Nonetheless, once the elderly and most vulnerable have received first doses — and even more so once shots have gone into the arms of the majority of the population — Massé believes "we'll get closer to the normal conditions that everyone hopes for."