Call to Arms

Curated by Claudia Shannon / Research Scientist / ishonest

Inside Canada’s impossibly high-stakes rush to lock down tens of millions of doses of the most sought-after product on Earth

When Agnes Mills was a young teenager, she battled tuberculosis for three years in a hospital in Aklavik, a remote hamlet nestled in the Mackenzie River delta north of the Arctic Circle. She contracted the disease when an epidemic hit the residential school where she lived. She led a solitary existence at the Anglican-run school known as All Saints, separated from her mother, who lived nearby. She was a long way from Old Crow, the tiny Vuntut Gwich’in community in Yukon where she grew up and her grandfather was chief.

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Mills, now nearly 85 years old, calmly explains those devastating formative years in Aklavik. She was sexually abused by older girls at the school. An extended hospital stay offered a break from All Saints, but Mills says she received little education.

Now she lives at Whistle Bend Continuing Care Facility in Whitehorse. Dementia is creeping into her life, and most of a year without seeing her grandchildren has been excruciating. “It’s a very lonely time. You’re all by yourself in this little room,” she says.

On Jan. 4, Yukon started immunizing high-risk residents with Moderna’s COVID-19 vaccine. Mills, a survivor of so much hardship, was at the front of the line.

Mills receiving her immunization (Courtesy of Mark Kelly Photography/Yukon Health and Social Services)

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Dozens of long-term care facilities across Canada haven’t been nearly as fortunate. Of the roughly 20,000 Canadians who succumbed to COVID-19 in the pandemic’s first 11 months, nearly 9,000 were residents of long-term care homes in Ontario and Quebec—a grim number that climbs daily.

Kevin Ackroyd delivers the vaccine shipment to Whitehorse. (Courtesy of FedEx)

As new, more easily transmissible variants of the disease threaten to spread quickly among vulnerable communities in Canada, the need for widespread vaccinations has never been more urgent.

Mills’ single inoculation was an early milestone in Canada’s desperate, stubborn quest for normalcy—a remarkable but still infinitesimally small step in a massive immunization campaign, the largest in Canadian history, meant to beat COVID-19.

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That campaign needs doses, and a federal bureaucracy upended by the pandemic has been duking it out with the richest countries in the world for what is now the hottest commodity on the planet. Without the ability to produce COVID-19 vaccines at home, Ottawa is bargaining with a powerful pharmaceutical industry that holds all of the cards. And the feds are racing against the clock. Every day without vaccines means more sickness, tragedy and preventable death.

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Bergstedt moved to Moderna after nearly 20 years at Merck (Photograph by Kayana Szymczak)

“I was commercial person number one,” he tells Maclean’s, describing the emerging biotech player as a “tiny little company that had never sold anything in its life.” He wasn’t exaggerating. Moderna was developing a wide variety of products, but had yet to make a sale.

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Bergstedt came from Merck, a pharmaceutical giant where he spent nearly 20 years and gained familiarity with Canada’s health system, which he viewed as “very progressive” on vaccinations. “You can have vaccines sitting in a warehouse, but it’s about vaccines in arms,” he says. “That’s what’s important.”

“There is a God,” thought Bergstedt.

In Ottawa, it was all hands on deck—even Global Affairs Canada had been pressed into duty to work contacts that might kick-start vaccine talks or dredge up some leads.

In these early conversations, Moderna’s vaccine was promising, but unproven. The company had created the vaccine in 42 days and dosed the first test subject three weeks later.

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“At that time, we had no clinical data,” says Bergstedt. “We had this early, experimental phase 1 data that says this vaccine produces an immune response. We had no data on efficacy or safety.”

Even to Bergstedt, the eager salesman, getting the vaccines into arms before the end of the year seemed an impossible task.

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Within days of Moderna connecting with Ottawa, Mark Lievonen was sitting in his condo in Stouffville, Ont., when he pulled out his iPad and logged onto Zoom. For many years, Lievonen had been the president of the Canadian vaccine division of Sanofi, a pharmaceutical giant. Now he joined Joanne Langley, a Dalhousie University professor and head of infectious diseases at Halifax’s IWK Health Centre, as co-chair of the federal COVID-19 Vaccine Task Force (VTF).

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As the pandemic’s first wave was slowly subsiding in hard-hit Ontario and Quebec at the end of May, Lievonen and Langley were invited to head up the group. They were asked, says Langley, to serve their country. “When you get a letter like that, you just say yes.”

The federal government assembled an initial group of 12 core task force members, including epidemiologists, physicians, manufacturing specialists and industry insiders, with orders to recommend safe and effective vaccines the feds should buy in large quantities—a daunting assignment, since none of the leading candidates were anywhere near a sure thing. “As we were about to begin, I thought, this is a mind-boggling, important task,” says Lievonen. “What if we fail? That was in the back of my mind.”

A few weeks before the task force got to work, Lievonen had made a presentation —by Zoom, of course—to a public COVID-19 webinar at the University of Toronto’s Dalla Lana School of Public Health. He cautioned his audience that a novel coronavirus vaccine could take well over a decade to produce. Some observers had pegged 12 to 18 months as the fastest possible time frame, which Lievonen recalls was “still far beyond anything I would have thought at that point.”

While those experts toiled in obscurity, the government’s critics were already beginning to raise the alarm about a weak link in the federal procurement strategy. Other countries, like the U.K. and the U.S., had plans to manufacture vaccines by the millions on their own soil, but Canada did not; nor could it rely on American supply chains, which Washington had reserved for domestic supply.

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Canadians, it turned out, would be entirely at the mercy of European-made drugs.

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Prime Minister Justin Trudeau speaks with scientist Krishnaraj Tiwari, left, as Minister of Economic Development Melanie Joly, Minister of Science and Industry Navdeep Bains and NRC President Iain Stewart look on during a visit to the National Research Council of Canada's Royalmount Human Health Therapeutics Research Centre facility in Montreal on Aug. 31, 2020. (Graham Hughes/CP)

As Sorenson waited, his proposal started to look like a missed opportunity for a federal government desperate for domestic vaccine production.

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China’s CanSino was Canada’s big early bet on making a vaccine domestically. Attached to the plan was $44 million for upgrades to the NRC’s Human Health Therapeutics facility in Montreal. That plant was meant to eventually produce CanSino’s vaccine candidate, Ad5-nCoV.

But if not CanSino, could the NRC lab be used to produce another company’s more promising candidate? Other countries had plans to manufacture AstraZeneca’s vaccine on their own soil. Why, critics wondered, hadn’t Canada negotiated a similar licensing agreement?

The Liberals insisted that was impossible at the time. A spokesman for Public Services and Procurement Canada says when the feds were doing deals, the country “had no flexible large-scale bio-manufacturing capacity suitable for a COVID-19 vaccine.” Canada hasn’t had a publicly funded lab that mass-produces vaccines since the ’80s, and no big private labs have the technology in place to make mRNA vaccines. Both of the largest pharma facilities in Canada—GlaxoSmithKline’s plant in Quebec City and Sanofi’s operation in Toronto—would have had to build entirely new facilities in order to produce a vaccine like AstraZeneca’s, says Andrew Casey, the president of pharmaceutical lobby group BIOTECanada.

The feds could also have given Providence a shot. Sorenson laments what could have been with that $35-million injection last year. Providence, which is currently running phase 1 clinical trials, might have been much further down the line.

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CanSino, meanwhile, found a new locale to test its vaccine: Russia.

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Anand, Minister of Public Services and Procurement Canada, oversees the off loading of COVID-19 vaccines on Dec. 13, 2020 (Courtesy of Cpl Matthew Tower/ DND)

Canada’s hope for nailing down contracts for vaccines now rested with a tiny group of bureaucrats, just 10 to 20 people working from home in and around Ottawa—and Oakville, Ont., where Procurement Minister Anita Anand spent the summer.

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“You have to keep it small because we put our best negotiators on the table,” explains Arianne Reza, the associate deputy minister for procurement at Public Services and Procurement Canada.

They were a seasoned team already battle-tested by months of pandemic scrambling, says Reza. The department was just emerging from the springtime rush for personal protective equipment and testing supplies. They were buying billions of products seemingly on the fly. “You normally do business with pre- qualified, trusted suppliers. All of a sudden, we were in the thick of it, buying masks and gloves,” says Reza. “So much complexity. So much risk.”

At one point, when Reza turned to procuring all the supplies for immunization— syringes, vials, stoppers and swabs—she picked up the phone and called a vendor out of the blue. “That person was very suspicious of getting cold-called by the Government of Canada to offer them a contract,” she says. “I had to go through many layers, many verifications, to convince them I was the real deal.”

The feds bought up to two billion pieces of PPE, 40 million rapid tests, 145 million syringes and 126 cold and ultra-cold storage freezers. Even so, the negotiations for vaccines was a whole new game.

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Anand, a lawyer and professor who specialized in corporate governance before entering politics, explained the intricacies of vaccine deal-making. “It’s not simply a matter of distributing standard-form contracts and having vaccine suppliers agree to our preferred terms,” the procurement minister tells Maclean’s. “Each supplier has its own set of concerns. As a result, each agreement is bespoke and contains terms related to doses and price and manufacturing and finishing parameters of each vaccine.” The manufacturers, keen to see doses actually administered, were lured in part by Canada’s strong public health network and widespread embrace of vaccination.

Reza said Canada enjoyed certain advantages. “The reputation of having a first- rank regulator made it easy to attract them to the table,” she says. A senior government source familiar with vaccine procurement planning says Canada faced a “middle power issue”—wielding more influence than most countries, but offering smaller orders than the U.S. or European Union. Reza took the opposite view, arguing that Canada’s comparatively modest needs “wouldn’t add a huge burden” to manufacturers’ supply chains.

In the case of Moderna, Bergstedt says negotiations involved “tough conversations” that stretched late into the night and into weekends as the two sides haggled over the timing of supply and the volume of doses. The Canadians were “efficient,” he says; it had been more of a challenge to pin down negotiations with EU customers. Moderna knew the whole planet, including Canadians, were watching closely. “Building a relationship of transparency and trust is critical for us in a world in which people are very cynical about pharma in general,” says Bergstedt.

By early fall, Canada seemed to be sitting pretty, having secured up to 398 million potential vaccine doses between seven companies, the world’s most diverse portfolio and more doses per capita than any other nation on Earth.

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Some questioned Ottawa’s refusal to discuss the fine print of those deals—what was Canada paying and what did the contracts say about Canada’s place in the global pecking order? Canada was one of the first countries to lock down deals with Moderna and Pfizer, but was much later than some of its rivals to sign with other companies. Could that affect deliveries?

“Staking out the back of the queue means that we might beg for a little vaccine in a hurry for our health-care workers or most vulnerable,” Amir Attaran, a biomedical scientist and lawyer at the University of Ottawa, wrote in Maclean’s last summer. But ordinary Canadians should “expect to wait.”

Procurement Canada’s official line was the feds “cannot disclose details of specific agreements in order to protect Canada’s negotiating position and commercially sensitive pricing information, as well as to respect confidentiality clauses in the vaccine agreements made to date.”

Nevertheless, early doses would soon begin arriving, and months ahead of anyone’s wildest expectations.

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Arnold Roberts, 93, was the first Ottawa care-home resident to get vaccinated (Courtesy of Darren Brown/Ottawa Public Health)

Four days after Moderna’s vaccine was approved on Dec. 23, a FedEx delivery arrived in Whitehorse. Similar deliveries would happen over Christmas in all three territories.

The rollout required a big country like Canada, with so many rural and remote communities, to reckon with monumental logistical questions. Former military leaders, known for their mastery of rules and promptness, emerged as obvious choices to lead the effort. The feds enlisted Maj.-Gen. Dany Fortin to coordinate federal-provincial co-operation. Ontario turned to Rick Hillier, Canada’s chief of the defence staff during the height of the war in Afghanistan. UPS and FedEx unveiled advanced tracking technology that monitored every shipment from Europe.

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A vaccination kit at a Montreal clinic (Paul Chiasson/CP)

But a less hopeful Christmas story was unfolding in Ontario, where the real challenge with the vaccine rollout was proving to have little to do with logistics.

On Boxing Day, health-care workers in Ontario took to social media in protest after the province stopped vaccinations for a short period over the holidays. Observers also noted a significant drop in injections on weekends. At a time when more than 100 people in Ontario were dying every day in an out-of-control second wave, a pause in vaccinations looked as absurd as firefighters leaving a five-alarm blaze for a lunch break.

A source close to Ontario’s rollout team stood by the province’s strategy, arguing that health-care workers desperately needed a holiday break, and the province was ratcheting down weekend appointments largely to prevent no-shows that would result in thawed doses going to waste.

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The truth was that the numbers were now out of the government’s control.

Israeli Prime Minister Benjamin Netanyahu, whose country emerged as a global vaccination leader, boasted of a dozen phone calls with Pfizer CEO Albert Bourla. Suddenly, everybody was calling Pfizer Canada’s president, Cole Pinnow. Doug Ford called him up. Erin O’Toole picked up the phone and then demanded Trudeau call Bourla—which he did.

Anand maintains “very close contact” with Pinnow. “I text with him regularly,” she says, adding that she spoke to him every day the week Pfizer announced reductions. Moderna gets the same treatment. Patricia Gauthier, the company’s country manager for Canada, says phone calls certainly don’t hurt. “Everybody’s looking at how can we accelerate? What can we do? I understand people are anxious.”

On Jan. 29, Moderna also announced a temporary reduction in shipments to Canada.

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Amid the uncertainty, NDP MP Don Davies, the party’s health critic, joined the Tories in pressuring the Liberals to release at least some of the terms and conditions of their contracts, as the U.S. had already done. “I’m very suspicious of a government that’s gone through such Herculean efforts to resist that. What are they hiding?” he asks. “Deliveries are probably contingent on a lot of factors that are out of the government’s control.”

Moderna’s Bergstedt offers that the company will face penalties if it misses its first-quarter obligations. “The government has held the industry responsible for keeping its commitments,” he said. “We’ve not been given a blank cheque.”

The limited supply of approved vaccines meant that one country’s gain was necessarily another’s loss. That contagious vaccine nationalism threatened to launch a supply chain cold war.

At the end of the month, Canada’s sputtering vaccine effort ranked 20th in the world, behind countries like Spain, Hungary and Estonia.

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Paramedics prepare COVID-19 vaccines at the Extendicare West End Villa in Ottawa (Courtesy of City of Ottawa)

Health-care workers at a Toronto vaccine clinic (Nathan Denette/CP)

But Canadians will surely be looking enviously at countries that will ramp up much sooner. Australia will be pumping out AstraZeneca doses by the millions domestically as soon as that shot is approved. Japan plans to manufacture up to 90 million doses of the same vaccine.

Israel bet on closer ties with Pfizer, agreeing to hand over anonymized biometric data in exchange for early doses—a deal that raises serious privacy concerns but has also seen five million shots administered in a month. It’s already seeing sickness declining among those over 60.

But there’s no real winning in this race. Canada has lost 20,000 souls and counting. There isn’t a vaccine on the planet that can fix that.

Read more on: vaccines, vaisey


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