More data, detailed plan needed before COVID-19 vaccine distributed in Sask., experts say

There has been positive news about several potential COVID-19 vaccines over the last week, but Saskatchewan health experts say there is still little known about them and that a solid distribution plan still needs to be created.

Vaccines from Moderna, Pfizer/BioNTech and AstraZeneca/Oxford University appear to be front-runners to be the first on the market after posting positive clinical trial results recently. The Canadian government has inked deals with those companies and several others to secure between 20 million and 76 million doses.

But the data from clinical trials must be peer-reviewed before doses are handed out, several Saskatchewan health experts say.

"We still don't know a whole lot about the vaccine," said Nazeem Muhajarine, epidemiologist and professor at the University of Saskatchewan.

Dr. Cory Neudorf, public health physician and U of S professor, said federal regulators are reviewing the clinical trial data now to assess how safe and effective each vaccine is. Once those reviews are complete, that information will be forward to health-care providers who can inform the public about the drug.

"Part of what we're seeing with the initial vaccine hesitancy out there with people is that you don't have that information," Neudorf said. 

Some are also wondering if the vaccine is being put through the system too fast, making it unsafe, Neudorf said. He assures that is not the case.

"It's being developed with all the right steps," he said. "They are just speeding up those steps, not skipping steps."

Planning for distribution

Once vaccines are approved by Health Canada, federal and provincial governments have to figure out the logistics of rolling them out.

Saskatchewan has secured 180,000 doses of a vaccine that should be distributed within the first three months of 2021, with seniors and health-care workers likely to be the first to be vaccinated, Health Minister Paul Merriman said during a news conference last week.

Those are the only distribution details available so far.

"The Saskatchewan Ministry of Health is working with federal counterparts on priority groups for vaccination, however, it is too early to discuss preliminary plans for vaccine distribution beyond what [was] said in the news conference," a ministry spokesperson said via email Tuesday.

Considerations must include safety, efficiency, who needs each vaccine most and the logistics of distributing the doses, said Amy Zarzeczny, an associate professor at the University of Regina's Johnson Shoyama School of Public Policy.

"It seems unlikely that there will be enough vaccine for all interested individuals, at least at first instance," said Zarzeczny, who specializes in health law and health policy issues. "They will need a phased approach."

The National Advisory Committee on Immunization (NACI) has already detailed some preliminary guidelines for vaccine rollout, including who to target first.

Seniors and people living in care homes, immunocompromised people, and essential front-line workers — health-care workers, primarily — should be first in line, said health experts who spoke to CBC News for this piece.

First Nations and newcomers should be prioritized too, said Muhajarine, but the government will have to earn their trust by educating them about the vaccine and assuring them it's safe.

Neudorf added that prioritization of First Nations communities could be based on their COVID-19 situations whenever a vaccine is received. If there are high rates of transmission on reserves, then they would likely be prioritized higher, he said.

As of Tuesday, more than half of Saskatchewan's total COVID-19 cases have been younger than 40. Despite this, U of S pharmacy professor Ekaterina Dadachova said people in that demographic should not be prioritized, assuming they are otherwise healthy.

"If they test positive, that positivity very often is just that," said Dadachova, whose expertise is treating infectious diseases. "In those immunocompromised individuals, or elderly in care homes, there is no second chance for them. Positivity very often means death."

How to transport and store vaccines must also be considered. The Pfizer/BioNTech vaccine, for example, must be stored in -70 C. Health experts say this could be an issue outside urban centres and university labs. Several of the vaccines, including Pfizer/BioNTech, also require two doses to be taken a certain time apart.

"There has to be a very carefully drawn plan to get the vaccine to people not just in the cities," said Muhajarine.

"You need to have the transportation plan in place."

The province could look at promoting immunization, similar to flu shots or the H1N1 vaccine in 2009, and bringing the vaccine to places like personal care homes or areas with high rates of transmission, said Neudorf.

Once higher-risk populations are taken care of, then the general population should be able to book vaccinations, he said. Until then, the trick is to avoid "hundreds or thousands of people gathering and waiting in line to get a vaccine, acting as a superspreader event."

Zarzeczny said that the government may be receiving new evidence as a vaccine is being administered and that could impact further distribution.

Typically, for a vaccine to be effective and for herd immunity to develop, roughly 80 per cent of a population has to get the immunization, according to the health experts. But it's "highly unlikely" that the government will make getting the COVID-19 vaccine mandatory for residents, Zarzeczny said.

"There has been some public concern expressed about individuals who might refuse to be vaccinated," she said, noting that there is precedent for mandatory vaccination policies, for example in schools.

"Even these policies generally include exemption options. Sharing up-to-date, accurate information about the evidence regarding vaccine safety and effectiveness will likely be important in encouraging vaccine uptake."

There will likely be strong messaging urging people to get vaccinated, Neudorf said.

Muhajarine cited recent survey data that suggest the public may be slightly more willing now to get a vaccine, but Saskatchewan flu shot data may tell a different story.

A third of Saskatchewan's population got their flu shot in 2019, according to a Saskatchewan government spokesperson.

The province purchased more doses of the flu shot this year to try to avoid straining the health-care system with COVID-19 and the flu. But from Oct. 19 to Nov. 14, only about 23 per cent of Saskatchewan residents have gotten their flu shot, the province estimates.

A provincial spokesperson noted that the total number of people who have gotten the immunization may be underestimated due to a delay in data entry.