COVID-19 vaccination lessons from Canada's largest-ever mass immunization effort

TORONTO -- In the fall of 2009, Canada launched its largest-ever vaccination campaign to protect against an outbreak of influenza A, or H1N1, with varying degrees of success. There were delays in production, supply shortages, and difficulties administering the new vaccine.

According to Statistics Canada, by April 2010, the majority of Canadians (59 per cent or 16.5 million people) had not been vaccinated against the H1N1 virus, which was also known as the “swine flu.”

The government agency said that a total of 428 Canadians died from H1N1 and thousands more were infected. Worldwide, there were more than 18,000 deaths from the virus. 

There were a number of reasons why there were delays in the rollout of the vaccine in Canada – timing being a key one – as the H1N1 virus spread in the spring of 2009 and the vaccine wasn’t ready until months later, in the fall, when health-care providers were trying to administer seasonal flu shots.

Earl Brown, a virologist and a former member of Canada’s H1N1 Pandemic Vaccine Task Group, added that manufacturers were also preoccupied with creating a vaccine for avian influenza H5N1, or the “bird flu,” when they were forced to suddenly turn their attention to the new swine flu outbreak.

“It was a real rush because they wanted the vaccine for the winter, which they got, so that the pandemic started in the spring and then they had the vaccine for the fall,” he told CTVNews.ca during a telephone interview from Ottawa on Thursday.

While Canada’s ambitious vaccination program for H1N1 may have had some hiccups along the way, the experience may provide some valuable lessons for the administration of future vaccines, such as those already in the works to combat against COVID-19.

MANUFACTURING

During the H1N1 pandemic, the federal government was criticized for relying on only one domestic vaccine supplier, GlaxoSmithKline (GSK), to manufacture the vaccine.

Brown said countries often prefer to produce their own vaccines domestically, in case there are border closures or what he called “vaccine nationalism.” However, the dependence on only one supplier comes with its own risks because any disruptions or interruptions in the production line can cripple the whole’s country’s supply.

In the case of GSK, Brown said there were difficulties bottling the vaccine at their Quebec plant, which caused delays.

An internal review of the Public Health Agency of Canada and Health Canada’s response to the H1N1 pandemic addressed the government’s use of a sole vaccine supplier. The review stated that, at the time, there was only one manufacturer “interested in establishing sufficient domestic capacity to manufacture enough vaccine to inoculate the entire population in the event of an influenza pandemic.”

 Brown said that Canada’s manufacturing capacity for vaccines is actually quite limited.

“We really don't have the vaccine companies to do the work here in Canada, we could do some of it, but then you're restricting yourself too on that,” he said. “We require somewhat international companies.”

During the COVID-19 pandemic, Brown said the Canadian government has taken a proactive approach and has already secured contracts with at least four vaccine makers in the U.S. to distribute their product once it’s developed and approved by Health Canada.

“The resources being what they are, you really don’t want to restrict yourself just to the one Canadian resource, you have to reach out more, it’s just the facts of the matter,” he said.

DISTRIBUTION

The rollout of the H1N1 vaccine in the fall of 2009 was not without problems as some provinces and territories experienced long waits to receive the vaccine or were not able to inoculate people due to a lack of manpower in the health-care sector.

In the internal review of the government’s response, they noted there were delays in the beginning of the vaccine campaign due to several factors. 

They included Canada’s limited vaccine manufacturing capacity, which meant the seasonal flu vaccine had to be completed first, before work could begin on one for H1N1. The review also said production was briefly interrupted when GSK had to develop a separate vaccine for pregnant women in accordance with World Health Organization (WHO) guidance.

Due to the production delays, provinces and territories faced some initial shortages and were asked to prioritize the administration of the vaccine to segments of the population most at risk, such as health-care workers, seniors, pregnant women, children, and those vulnerable to complications. That resulted in some confusion, according to the review.

In preparation for a vaccine for the coronavirus, Brown said the Canadian government has already been pre-ordering supplies, such as vials and syringes, and working on logistics to store and transport the vaccine once it is ready.

“You have to be ready to get, store, distribute that vaccine and so that is something the public health addresses and they will have to be ready to achieve that,” he said.

Brown said it’s a considerable undertaking with respect to Canada’s population of more than 35 million people.

“Not everyone will want a vaccine, not everyone will get it, but in broad numbers, 35 million vaccines would be needed or 20 million, and then if you need two doses, that’s double that,” he said.