Explained: How Covid-19 vaccine development will compare in the UK, Canada and the US

From: New York Times |

Updated: December 15, 2020 3:15:13 PM

The United States has become the third most developed western country – after Britain and Canada – to approve such a shot and is expected to begin inoculating people in a few days. (The New York Times)

With the Food and Drug Administration’s authorization of a coronavirus vaccine on Friday, the United States has become the third highly developed western country – after Britain and Canada – to approve such a shot and is expected to begin inoculating people in a few days.

But the three countries have very different health systems. And they face different challenges in the race to get the vaccine to millions of people.

Here are some similarities and contrasts.

The same vaccine?

For now, yes.

The first vaccine authorized by U.S. regulators, and the first approved by their British and Canadian counterparts, is the one developed by pharmaceutical giant Pfizer and a small company, BioNTech. It could get European Union approval in weeks.

But several others remain nearby, most notably a vaccine developed by Modern and the National Institutes of Health, and another by AstraZeneca and the University of Oxford. It could be that half a dozen or more vaccines are approved in the coming months.

So as 2021 unfolds, which shots (most inoculations would require two injections, weeks apart) that someone receives could vary by country, depending on the speed of regulatory approvals, what agreements governments have made to buy supplies and how much the vaccines cost. Even within a country, there could be differences in how easily a particular vaccine is distributed and used.

The Pfizer-BioNTech and Modern-NIH vaccines are of a new type never before used; they require ultra-foreign storage and are more expensive than likely competitors. The Pfizer shot should be kept especially cold, at less than 94 degrees Fahrenheit, which most health facilities do not equip.

How centralized is the launch?

In Britain, a lot. In the United States no. In Canada, somewhere in between.

With a strong central government and a National Health Service covering all of its people, the UK, which began giving the vaccine last week, is leading the London process. The national government selected the 50 hospitals that will initially receive the vaccine, and made sure they are prepared; decided how much each would receive; and drafted the rules determining in what order people would be entitled to obtain it.

The Trump administration has delayed much of the decision-making to the states. The federal government will distribute the vaccine to each state according to population, not needed, but some states complain that they don’t know enough about the arrangements.

It will be up to the states to decide how to split the doses between hospitals, clinics and, ultimately, pharmacies and medical offices, but first at least the vaccine will go to hospitals with ultra-cold storage.

A committee advising the Centers for Disease Control and Prevention is developing a priority list, starting with medical workers. But that work is still underway, and the guidelines are not binding. States are expected to differ somewhat in their approach.

Like Britain, Canada has a universal health care system, but like the United States, it has a federal government. The Canadian health care system is decentralized, administered by the provinces and territories.

For vaccine distribution, the central government plans to work with those regional governments. Ottawa will play a major role in the direction of the process. 📣 Follow Explicit Explained in Telegram

How many people will get it first?

That remains a bit confusing.

Canada has ordered enough of the Pfizer-BioNTech vaccine for all its people, Britain enough for 30% and the United States enough for 15%.

But those numbers reflect deliveries that are expected to take months to complete, and Pfizer, like other companies, has managed to grow production. In addition, all three countries have also made previous purchases from other companies, so the speed of vaccine approval could significantly affect the speed of development.

That speed will also affect the need for vaccine sites to be equipped with the right freezers, the staff to prepare the shots, and enough syringes and protective tools.

The initial shipments are a small part of the pre-purchases – 800,000 doses to the UK and expected 249,000 this month to Canada.

U.S. officials said they hope to have 40 million doses of the vaccine by the end of the month, which may be optimistic. That would be enough to inoculate 20 million people.

Rural areas where hospitals are not equipped to keep the vaccines at the appropriate temperatures, or do not have the staff to prepare them for injection, will not receive Pfizer’s shots. This is more challenging in the United States and Canada, huge countries with vast, sparsely populated areas than in the UK, which is much more compact.

In Canada, where the military plays a central role in distributing vaccines, the government sends shipments to all 10 provinces. The three northern territories will have to wait.

In the United States, FedEx and UPS will ship vaccines from distribution centers to each region. But the holiday season is the busiest time of the year for delivery services that could slow things down.

How quickly will most people get vaccines?

That is even more obscure.

The UK, Canada, the US and the European Union have all followed similar strategies, pre-ordering a huge number of doses – more than enough to inoculate all – from many manufacturers, covering their bets if some vaccines are not approved or some manufacturers have production collapses.

In terms of their populations, the U.S. ordered far fewer doses than Canada or the UK, and last summer it skipped a bid to increase its previous order of Pfizer. Administrative officials say the numbers are misleading because the government has signed options to buy much more vaccine if it sees the need.

But despite intense global demand, it is not clear how quickly pharmaceutical companies will be able to fulfill the ordered orders, let alone any additional orders.

And again, the speed of development, approval and production will influence how quickly supplies reach people. A country that is more committed to one vaccine could be much better off than one that is more heavily dependent on another.

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