Doing the vaccine math

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This article was published 27/01/2021 (1430 days ago), so information in it may no longer be current.

OTTAWA — Manitoba will receive eight per cent fewer doses of the Pfizer COVID-19 vaccine by this spring than it had been promised.

The figure is contained in federal data that details how many trays of the vaccine will arrive before April 4. The data was shared with the provinces on Wednesday.

Internal records show Manitoba has been told to expect 138 trays of the Pfizer vaccine by that date, instead of the 149 trays promised.

By the province’s count, that means 6,435 fewer Manitobans will be immunized.

Here’s where the situation stood as of Thursday.

1) Why is the Pfizer-BioNTech vaccine delayed?

Pfizer makes most of its COVID-19 vaccines at a plant in Puurs, Belgium, which the company plans to upgrade so it can increase output.

Pfizer had insisted that countries would still get their full shipments in the first quarter, meaning all the doses scheduled to arrive by March 31, would be on time. It expected a decrease in January and February, followed by a surge in March, thanks to the larger output.

2) Will that still happen?

Canadian officials insist they will get their promised four-million doses from Pfizer by March 31, but information released by Ottawa to provinces Wednesday casts doubt on that plan, largely due to how doses are counted.

In the first weeks of vaccinations, nurses around the world realized they could often squeeze out six full doses from a vial meant to contain five.

Pfizer is now asking countries to count its doses that way, but Health Canada has not yet approved such a change, and not all syringes can actually suck up the sixth dose.

The internal document obtained by media suggested Canada would only receive 3.51 million Pfizer doses by March 31.

“The rub is (that) the numbers don’t add up to four million at this time,” Maj.-Gen. Dany Fortin, who is overseeing Canada’s rollout, told reporters Thursday.

Fortin claimed Pfizer would increase the doses if Canada can’t get all six from each vial it receives. “Pfizer is very much aware of that and will… scale up their (deliveries) if that is what is required,” he said.

3) When will everyone get vaccinated?

Ottawa insists that every Canadian adult who wants a vaccine will get at least their first dose by Sept. 30.

Manitoba says it can only guarantee 74 per cent of adults will get their two-dose vaccination by Dec. 31, and 53 per cent by the end of September.

Federal officials have given the provinces three scenarios for how many types of vaccines will be available.

Those internal projections suggest that only three-quarters of Manitoba adults will be vaccinated by the end of the year under current Moderna and Pfizer contracts.

That’s unless those contracts are renegotiated or more vaccines reach the market.

4) Why do Manitoba and Ottawa have different numbers?

Manitoba, which is already getting six doses from every Pfizer vial, counts the doses per tray differently than Ottawa.

For example, the projection Ottawa shared with provinces Wednesday, shows that Ottawa expects Manitoba would get enough trays of Pfizer vials to administer 134,550 doses, but Manitoba counts that as 161,460 shots.

The province is intentionally taking a cautious approach by publishing data based on the figures it receives from Ottawa.

For example, the province was given a single, overall number for the estimated number of doses Pfizer would send in the summer and fall.

On Dec. 10, Manitoba was told to expect 216,000 Pfizer doses from July to September, but still has no clue how many will arrive each month.

“We’re always, always looking for data. The biggest problem right now is nobody is telling us what’s happening,” a senior Manitoba official told the Free Press, on the condition of anonymity.

5) It’s about the number of doses per vial, right?

Yes. Manitoba has a supply of one-millilitre “low dead space” syringes that make it easier to get six doses from each vial.

However, these needles are in short supply in other parts of Canada, so the federal government has ordered millions of them.

These syringes help to avoid waste. Provincial officials say that 0.5 per cent of Pfizer doses have gone to waste so far; the company’s shipments create a buffer for five per cent wastage.

Each shot must come from the same vial because mixing leftover amounts from more than one vial increases the risk of infection and may result in an inconsistent immune response.

6) Is Manitoba slower than other provinces?

The province has decided to focus on giving each recipient both doses within the timelines recommended by Pfizer and Moderna.

It has rejected prolonging the period for a booster shot, unlike other provinces, and says the current supply-chain disruptions justify that approach.

That is why Manitoba ranks near the top when it comes to the number of people fully vaccinated. It is near the bottom for the proportion of shots given, because at least one-third is reserved for the second shot.

Like Britain, Quebec has opted to give all doses up front, wagering that more widespread, but partial immunity, is needed there because it has some of the worst COVID-19 spread in the developed world.

But Quebec’s plan to wait as long as 12 weeks for second shots runs the risk of coronavirus infections and even mutations. That’s why the World Health Organization suggests capping deferrals at six weeks.

Manitoba officials have patted themselves on the back for not having to cancel any vaccine appointments. Other provinces that held out for more shipments, must prioritize who can wait the longest for their booster shot.

Instead, Manitoba will send some doses it had allocated for first jabs to the Thompson vaccination site, to give other Manitobans their second dose on time.

7) What’s up with the European Union?

The EU was slow to sign deals with manufacturers despite having a larger role in the development and production of the vaccines being used today.

The European Commission has asked companies to report where they send doses. Some politicians have asked companies to halt exports, but it doesn’t appear this has happened yet.

The Prime Minister’s Office said European officials insisted Wednesday the existing plan “is not intended to disrupt exports of vaccines to Canada.”

Both the Pfizer and Moderna vaccines are made in the United States and in Europe. Canada’s Moderna shipments have so far not been delayed.

8) What else might cause vaccine delays for Canada?

Canada has bought more doses of approved and unapproved COVID-19 vaccines than any other country, but is a small player in terms of developing or funding these projects, and has limited manufacturing capability.

The federal Liberals have delayed an unrelated review of drug pricing meant to cut prescription costs. Some have speculated that this aims to appease Pfizer in vaccine negotiations, but both Ottawa and the company reject that idea.

The Liberals have hinted that the practice by some provinces to change second-dose timelines has made it trickier to negotiate with  manufacturers.

It remains unclear why Pfizer doses only arrive in Canada from Belgium and not its Michigan production plant.

The regulatory approval of another vaccine would likely ease Canada’s shortage, and some might even be able to be produced in Canadian factories.

—With files from Danielle Da Silva

dylan.robertson@freepress.mb.ca