Question Period Note: COVID-19 vaccine rollout and interchangeability

• What is the Government doing to ensure vaccine supply and to inoculate all Canadians?

Key Messages
• In partnership with provinces, territories, and Indigenous communities, the Government of Canada is continuing to successfully roll out Canada’s COVID-19 immunization campaign, the biggest in the country’s history.
• Health Canada has authorized four COVID-19 vaccines —Pfizer-BioNTech, Moderna, AstraZeneca, and Janssen. Another vaccine, Novavax, is currently undergoing Health Canada’s regulatory review.
• As of June 14th, we have distributed over 33 million vaccine doses across the country. By the end of September 2021, every person in Canada who wants to be vaccinated will have access to a vaccine.
• The Government of Canada will continue to ensure that Canadians have all relevant, accurate, and up-to-date information about the vaccines to increase vaccine confidence.
• We are working with the provinces and territories to track the number of vaccines administered and to identify and address any adverse events following immunization.

BACKGROUND
On December 8, 2020, Canada’s COVID-19 Immunization Plan was released. It is based on 6 core principles—Science-driven Decision-making; Transparency; Coherence and Adaptability; Fairness and Equity; Public Involvement; and Consistent Reporting.

Provincial and territorial governments are responsible for administering vaccination programs and determining public health requirements in their jurisdictions. The federal government is responsible for securing contracts with vaccine suppliers, conducting regulatory review and ensuring safety of vaccines, delivering vaccines and supplies to provinces and territories (PTs), liaising among different PTs and Indigenous leaders, and supporting the PTs with the administration of vaccines.

Federal, provincial, and territorial officials are continuing to meet frequently to refine plans for the distribution and administration of vaccines throughout Canada. Both levels of government are also sharing information with each other about vaccine coverage rates, vaccine safety, and inventory levels, so that any potential issues or shortcomings can be identified quickly and addressed. Adverse Effects Following Immunization (AEFI) are being tracked.

In order to address potential supply chain gaps and to have contingencies available, Canada has engaged the private sector to deliver a broad range of end-to-end logistics and support services. A contract has been awarded to a consortium for logistics services.

Priority populations
National Advisory Committee on Immunization (NACI) guidance outlined a targeted vaccination program to achieve public health goals as efficiently, effectively, and equitably as possible during this early period when vaccine supply is limited. NACI recommended the following key populations for early (‘stage 1’) vaccination:
• Seniors and workers in long-term care homes, assisted living senior facilities, retirement homes, and chronic care hospitals;
• Healthcare workers on the frontlines of patient care;
• Older adults, starting with those 80 years and above, and then moving in 5-year increments to reach those 70 years and older; and
• Remote or isolated Indigenous communities and the Territories.

On February 15, 2021, NACI released guidance on additional priority populations for vaccination, once initial populations have received a vaccine. Stage 2 populations include:
• Adults in or from Indigenous communities, including in urban settings;
• Residents and staff of all other congregate settings (e.g. migrant workers’ quarters, correctional facilities, homeless shelters);
• Adults 60-69 years of age, beginning with those 65 years of age or over;
• Adults in racialized/marginalized communities disproportionately affected by COVID-19;
• First responders (including police, firefighters, military, coast guard);
• Frontline essential workers who cannot work virtually and have direct close physical contact with the public;
• Essential primary caregivers for individuals who are at high risk of severe illness from COVID-19 due to advanced age (60 years of age or over).

NACI’s guidance for stage 3 priority populations includes:
• Individuals 16-59 years of age with an underlying medical condition at high risk of severe illness due to COVID-19 and their essential primary caregivers;
• All adults 50-59 years of age, beginning with adults 55 years of age or over;
• Non-frontline healthcare workers who are needed to maintain healthcare capacity;
• Non-frontline essential workers.

Vaccine interchangeability

NACI released its recommendations on the interchangeability of authorized COVID-19 vaccines on June 1, based on available evidence on interchangeability between mRNA and viral vector vaccines.

NACI recommends:
• Persons who received a first dose of the AstraZeneca/COVISHIELD vaccine may receive either AstraZeneca/COVISHIELD vaccine or an mRNA vaccine (Pfizer-BioNTech or Moderna) for their second dose, unless contraindicated.
• Persons who received a first dose of an mRNA vaccine (Pfizer-BioNTech or Moderna) should be offered the same mRNA vaccine for their second dose. If the same mRNA vaccine is not readily available or unknown, another mRNA vaccine can be considered interchangeable and should be offered to complete the vaccine series.

Adverse events following immunization (AEFI)
Canada has a well-established vaccine safety surveillance system that is a collaboration between provinces and territories, PHAC, Health Canada, and vaccine manufacturers. Manufacturers are required to report serious adverse events to Health Canada as the national regulatory authority, as well as submit regular summaries of global safety information. In addition, PHAC receives and reviews reports of adverse events following immunization from provinces and territories (PTs) through the Canadian Adverse Events Following Immunization Surveillance System. This system has been enhanced to support the rollout of COVID-19 vaccines, to expedite the timeliness and sharing of information with partners, and public reporting of adverse events.
Reporting on the use of interchangeability
Canada’s reporting structures for vaccine coverage and safety were not originally designed with interchangeability of vaccine types for 1st and 2nd doses in mind. Work is underway with PTs to revise reporting processes to better reflect the use of interchangeability of COVID-19 vaccines in Canada.

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