"Unlike the US and Europe, Canada dragged its heels on pre-ordering vaccines"

Canada was one of the first countries to pre-order vaccines, signing massive agreements with just about every candidate maker. I'm aware of literally a single deal happening with another country prior to Canada's orders.

What thwarted Canada's efforts was that the US defacto nationalized the medical establishment in that country, while Canada had basically become beholden to larger centers courtesy of an over reliance on free trade. With the US production nationalized, Canada, and truly the rest of the world, had to rely upon manufacturing in Europe. The EU at times lurched towards protectionism but never did, and Canada is in its debt.

Though in the wake of it Canada has committed to no less than four vaccine manufacturing plants, including mRNA vaccines. Lesson learned.

`"Bold” strategy? Canada had no option if they wanted to vaccinate quickly.'

Yes, it was a strategy. The manufacturers were dictating a timeline for shots that would have meant that the number of people fully vaccinated would be quicker, but the number of people partly vaccinated would be much slower. People much smarter than you or I did an analysis and decided on another approach, including mixing shots. And yes, of course it was because of a supply constraint (for reasons mentioned elsewhere, but having positively nothing to do with Canada "dragging it's heels"), otherwise such approaches wouldn't be necessary, no?

Speaking of nationalising the medical industry:

Fun fact, Canada was the home of Connaught labs, a publicly owned laboratory which was the first lab to produce the Salk's Polio vaccine, and went on to produce the Smallpox vaccine.

In the 1970s, however, Canada went on a privatizing spree (incidentally, the same gov't that ratified NAFTA), and Connaught was privatised and sold many time since.

More info here https://www.thestar.com/opinion/contributors/2020/03/11/the-...

Canadian companies contributed significantly to developing these vaccines too.

Vancouver-based Acuitas Therapeutics developed the lipid nanoparticle delivery mechanism for the Pfizer vaccine, for example. There are others as well. This article lists three Vancouver companies:

https://blog.jonasneubert.com/2021/01/10/exploring-the-suppl...

And that's not even mentioning Vancouver biotech unicorn AbCellera, which has developed an antibody treatment.

Your dates are a little off. The 70s had little to do with it - Canada’s privatization spree under Mulroney lined up with Reagan and Thatcher. So Connaught Labs was destroyed in the 80s by the Mulroney Conservatives. And NAFTA was ratified in the 90s by the Chretian Liberals, although it was Mulroney’s baby.

Yup you're totally right. I got mixed up with Connaught's sale to the Canada Development Corporation in 1972, and again confusing NAFTA's ratification with Mulroney's gov't.

Canadian pharmaceutical R&D and manufacturing is almost entirely gone at this point.

A big part of that was little interest in supporting the industry from the government.

Apparently a vaccine manufacturer approached the government a while back and got a tepid response so decided to invest elsewhere.

That's definitely true, but I've some hope we'll be getting some back with the new gov't labs being built, and the AI hubs in Montreal and Toronto pushing the pharmacogenetics story.

Not to hijack this too much but the Australian vaccine rollout has been widely panned but much of the problems come down to a choice to rely on domestically manufactured AZ vaccines.

In a different timeline if the AZ vaccine hadn’t been associated with rare blood clotting, if Pfizer/Moderna hasn’t been able to scale manufacturing as well that strategy would be looking very good.

It’s interesting to think that Canada and other nations that instead depended on international supply chains ultimately did much better though.

The great hope of Australia's vaccine strategy was the University of Queensland's "Molecular Clamp". Unfortunately the clamp molecule, derived from part of the AIDS virus, triggered false positives in AIDS tests. They used that particular molecule as it was available and time scales were tight. A revised version is being developed with a new clamp molecule, but it won't be ready for the current round of vaccinations.

https://www.abc.net.au/news/health/2021-04-26/university-que...

Are false positive HIV tests really such a problem? I think most elderly patients wouldn't be concerned about that.

Where Australia really messed up was basically stopping use of AstraZeneca entirely (IIRC).

Blood clot risk is much higher the younger you are[1]. It would have been far better to continue using AstraZeneca, but limit it to a certain age and older.

[1] For example, 1.1 of the specific clots per 100 000 vaccinations of people in their 20s, falling to 0.2 per 100 000 in their 60s. https://wintoncentre.maths.cam.ac.uk/news/communicating-pote...

That's exactly what Australia did, except all of the FUD led to older Australians choosing to forgo AZ due to the perceived risk.

Ah, didn't realise. Good they didn't ban it, but then that's still a clear failure of public health messaging. In exchange for falling behind on vaccination, Australia had some rather strict lockdowns (especially for the post-vaccine stage of the pandemic).

I’m in my 30s and had AZ. It certainly wasn’t banned.

Until recently it was the only vaccine available for over 60s even.

Also FWIW. The risk of blood clots seems to be significantly higher in women than men. I think they should have focused on giving AZ to men and Pfizer to younger women.

For a while though some states were giving Pfizer to men in their 40s and 50s working from home, while recommending young women go and get dosed with AZ.

Clots when young are much fun. Having a unknown clotting disorder really screwed me up

Yeah, sorry, doesn't sound like fun.

Canada signed the most deals but are you aware that Canada had delivery dates months scheduled for months later in the contracts which is why Canada had no recourse but to wait. Just to keep face 250k dose were flown in before the year but the contracts expected some delivery by March but most by summer.

And what is your point? The only countries that had a large amount of doses in the first few months of 2021 were the countries producing the vaccine. There was no way that the US would produce for export before vaccinating their own population.

Canada had no local production. There was literally nothing they could do but wait. Its of course a problem not to have local production. But it’s not a lack of orders that was the issue, everything was ordered early in 2020, there was just no doses available.

Israel beat the US in vaccination rate.

”Israel cast a wide net last year when trying to secure vaccine doses at the height of the pandemic and pre-ordered from a number of companies.”

By April of 2021 it was already giving excess doses away.

https://www.reuters.com/world/middle-east/with-enough-suppli...

Yes they acted faster with more political capital at stake AFAIK, in the end the important part is how free trade countries reacted to the pandemic. There is a lot to say about acting in a way that hinders pandemic compared to making nations feel safe.

Israel is a "free trade country".

If you were a rich nation, it was eminently possibly to get early delivery dates written into your contracts. Canada decided not to for some reason (cost?) and in actual fact deeply regretted it.

Source? Most reports indicate that Canada spent more per person than almost everywhere.

canada did, but their contracts assumed delivery from the us plants. when trump restricted export canada had to go back to pfizer and moderna and secure supply from the european plants

I'm not sure I buy this (about Canada).

Israel was one of the first to vaccinate most of their population - and they are a tiny country with no domestic manufacturing of the vaccines.

Although Israel quite openly stated they paid a premium to get early access to vaccines. So basically, it was simply a question of commercials, and ponying up the cahs.

Singapore did likewise - basically bought out every vaccine they could on the open market, and rushed to vaccinate their population.

I live in Australia, and it does appear our nation's leaders dragged their feet on the vaccine.

Our Prime Minister even publicly stated "It's not a race", regarding vaccinating the population.

A letter leaked recently, which showed Pfizer's managing director requesting an urgent meeting with our health minister, so we could get millions of doses. Pfizer was then told that the health minister wasn't available to talk with them, it got fobbed to some underlying in his department, then the deal got adragged out for six months after that - in the meantime, the UK and US signed up:

https://www.theguardian.com/australia-news/2021/sep/12/in-hi...

Israel is a small nation (1/4 the size of Canada, which itself is a small nation) which agreed to do data sharing with the vaccine makers [1]. It effectively became a testbed. 100% of Israel's Pfizer and Moderna vaccines came from Europe.

Israel was an extreme outlier. It is not a counterpoint whatsoever. Israel got priority first shipping before Canada, and even the European countries that hosted the factories.

Many of these comments are weird in that they seem to hold Canada's vaccination effort as some sort of failure. In reality it was one of the most rapid on the planet, dramatically faster than just about every other OECD country outside of the US (courtesy of nationalizing production) and the UK (courtesy of protectionism), and then testbed Israel.

I'm not sure what you don't buy -- the fact that Canada signed up early and for massive quantities is very well accepted fact. The reality that Pfizer and Moderna's European factories became massively oversubscribed (while US factories were basically off limits to everyone else) is also accepted fact.

[1] - Even if Canada was suitable as a testbed (e.g. it's too large and distributed), healthcare is run at the provincial level. There are 13 sovereign healthcare agencies, and this is constitutionally decreed, so it was unlikely to have been possible even if the country agreed to do it.

What part don't you buy?

https://www.bnnbloomberg.ca/canada-has-reserved-more-vaccine...

Out of the three vaccines in use in both Canada and Europe, it appears that Canada entered agreements as follows:

  Moderna: August 5th, 2020 [1]
  Pfizer: August 5th, 2020 [1]
  AstraZeneca: September 25th, 2020 [2]

Europe entered agreements as follows:

  Moderna: November 25th, 2020 [3]
  Pfizer: November 11th, 2020 [4]
  AstraZeneca: August 27th, 2020 [5]

I couldn't immediately find data on the quantities ordered, but this doesn't seem to support the claim that Canada was slow in placing orders?

[1] https://www.canada.ca/en/innovation-science-economic-develop...

[2] https://pm.gc.ca/en/news/news-releases/2020/09/25/new-agreem...

[3] https://ec.europa.eu/commission/presscorner/detail/en/ip_20_...

[4] https://ec.europa.eu/commission/presscorner/detail/en/ip_20_...

[5] https://ec.europa.eu/commission/presscorner/detail/en/ip_20_...

Yeah, what they did not expect is the US blocking all exports. All vaccines had to be flown in from Europe, even so the same vaccine was produced just a few miles across the border.

Yeah, not slow in placing orders; the problem was that they didn't prioritize guaranteed delivery dates in contracts like the EU and US and Israel

Evidently, Canada didn't prioritize Q1 delivery dates. From Our World in Data [1], Canada's total dose administration fell behind the EU during February/March 2021, as Pfizer's European production facility went offline for expansion/refurbishment. The dose-delaying recommendation discussed in this article became official in March, at the peak of the 'vaccine gap'.

However, the overall procurement strategy was a success even in comparison to the EU. Canada's total dose administration rate caught up with the EU's by April at 25 doses/100 people, and during the spring/summer when vaccines became available to the general public Canada had greater availability.

From contemporaneous reporting, it seemed that in summer 2020 Canada believed manufacturers' assertions that they'd have vaccine production ready by 2021Q2.

In general, Canada's vaccine procurement strategy was successful, and the 'gamble' on second-dose delays discussed in this article proved useful at expanding availability among the general population. Complaints otherwise tend to focus on the US comparator (neglecting its effectively nationalized industry) or come from partisan political attacks.

[1] -- https://ourworldindata.org/explorers/coronavirus-data-explor...

As far as I understand, the choice was an informed guess based on theoretical understanding of how vaccines work.

For most vaccines, the time between doses is measured in months, not weeks. Those vaccines were tested slowly over years, and the tests focused on finding the most effective timing between doses. Covid-19 vaccines were developed in a hurry, and the priority was getting them approved as quickly as reasonably possible. Testing therefore focused on the shortest time between doses that was expected to produce good enough results. Even if longer spacing was expected to be more effective, testing it would have delayed the approval by months.

Mixing vaccines also makes theoretical sense. Exposing the immune system to a more diverse range of threats may provide a more robust response when the virus mutates. Testing mixed vaccines is just more difficult in practice, because each company develops and tests its vaccines independently.

I got cross-vaccinated here in Germany due to being young and getting Astra Zenica as a first dosis. I still had the choice between a second dose of Biontech and AZ, so I read quite a bit about it at the time, and for example one of the leading Virologists in Germany basically said he wouldn't know why it shouldn't work. Basically, the data suggests that there isn't a suprising mechanism that does lead to less protection.

>> Canada dragged its heels on pre-ordering vaccines.

No. Canada made some bad bets on where they would be getting vaccine. Canada assumed that a particular person would still be in the white house and that early US vaccines would not be available for export. So Canada threw in largely with European suppliers. That gamble was wrong. The certain person lost and US vaccination rates were lower then expected. US vaccines were available for export earlier than predicted. Canada had not pre-ordered sufficient US vaccines. A mistake? Yes, but still a reasonable judgement call given the US political situation at the time.

The US was no more willing to export vaccines under Biden than Trump, the media were just less interested in criticising the new president. Same with border restrictions: Biden attacked Trump's as counterproductive in his campaign, then got into office and immediately insisted on reimposing them unchanged and keeping them way beyond the point they made any kind of sense, but the media lost interest in criticising those as well.

>> The US was no more willing to export vaccines under Biden than Trump

That may be true in hindsight, but at the time Canadian officials prediction that a second Trump term would be less friendly to vaccine exports. That wasn't an unreasonable estimation of the US political landscape at the time.

people like the softer version of the same thing, in all actuality more people have died when biden got into office, i am not talking about covid here, the air strikes on civilians, the pulling out of afghanistan only to re-enter through the back door is a new kind of okie doke, but hey at least the guy with the spray tan is gone.

Canada's two biggest suppliers by far have been Pfizer and Moderna. Canada doesn't dictate where they supply the product from.

The US nationalized production in that government decree made it illegal to ship to anyone else unless US contracts had been satisfied in full (NOTE: I am not judging this at all. The merits of it are arguable, but it does point out a weakness in a reliance on free trade). The change of government didn't change this an iota.

The defense production act dictated that 100% of production was for the US until the government said otherwise. Moderna and Pfizer were both forced to supply Canada from the European factories as a result, even long after US vaccine manufacturing far exceeded consumption.

How did Israel gets enough vaccine by April then? Canada had barely started receiving doses then?

I see an awful lot of whitewashing to cover mistakes going on.

Short story: they put in a higher bid and agreed to actively participate in studies, something that vaccine producers were looking for. But I would not discount the money aspect.

"The first question is how Israel was able to get that many vaccines when supply is short? It is not because—according to reports—Israel paid about $30 per dose, almost double what other nations did. [...] The answer: Israel is a great pilot country for the pharma companies—small and able to put together a massive vaccination program quickly and effectively." https://www.brookings.edu/blog/up-front/2021/01/05/the-secre...

Exactly. Israel was willing to play the game. Other countries like Canada decided to wait for more info. That proved to be a bad move.

And Canada isn’t the only one: Australia, New Zealand, Singapore. Vietnam really screwed itself over trying to get domestic production going (homegrown and in-licensed). Once Delta got hold they saw a 400x increases in cases. Once it dawned on them vaccines were the only out, then acquired whatever they could by begging and borrowing. Now they are looking at a loss of foreign investment and a possible recession.

>> And Canada isn’t the only one: [...] are looking at a loss of foreign investment and a possible recession.

Except that, now, Canada (78%) has a higher vaccination rate than most western nations, including the US (65%). And there is zero talk about loss of foreign investment.

a) Canada has 4x the population of Israel

b) Israel agreed to the extraordinary term of sharing their data with Pfizer, in exchange for getting doses early, something Canada almost surely won't be willing to do

c) The Israeli PM Netanyahu was facing significant electoral challenges and desperately needed a win, so there was a lot of political will

I wouldn't place too much weight on C. Even under the new Bennett-Lapid government, the country has been willing to go all out on booster shots.

There's just a lot of willingness to go for "good enough" solutions in emergency situations, and forget the rules for the duration.

Civil defense culture also helps, in that it's trained people to reason about countermeasures that are not 100% ("hermetic" in the local lingo) - you still get in the stairwell to protect from shrapnel, even if a direct hit will kill you anyway. People don't have the gut reaction of betrayal when a 90% countermeasure fails sometimes.

Israel was paying something like $65/dose, which is way, way ahead of what other nations were going to pay.

Bibi's career at this point was up against a wall, and he was willing to do anything to 'be first'. Israel has a cagey foreign policy apparatus, I have no doubt they went 'all in' on this, calling in favours, applying pressure in addition to the regular negotiations.

In terms of B that’s called a “patient registry” which is quite common and done in Canada as well. It’s basically a clinical trial post-approval where you aim to capture every patient on the drug. I’d argue Canada’s lack of interest has more to do with capability and overall interest in early access.

A traditional vaccine candidate was happening between a tiny Canadian group and a Chinese group. It didn't pan out.

At the same time Canada had placed orders for literally hundreds of millions of vaccines from the major pharmas, doing so before almost anyone (your claim about shipment dates is just as factually deficient, as an aside).

Canada was ill prepared for a pandemic because it relied upon free trade and allowed for the hollowing out of medical manufacturing. Hopefully a lesson has been learned.

You are revisioning history. Contracts were with companies. Not governments. Canada didn’t order US vaccines. It ordered Pfizer, Moderna, Etc. They were free to ship from wherever they wanted as long as national governments allowed it. Yes once Biden authorized it it accelerated shipment. But there was no gamble, Canada never ordered from US government.

Yes, the US didn't ever have an explicit export ban. But the US government had passed the Defence Production Act, then went to the vaccine manufacturers and made priority contracts with them. What did you think would have happend if the vaccine manufacturers had say no, we'll supply the highest bidder from our US plants first?

The only other production locations were in Europe, so guess where the vaccine manufacturers thought Canada's doses would come from?

Please don't fall for the obvious obfuscation from the US government.

Canada's speed of vaccination (in terms of doses per capita) was in line with the EU, even though it was behind the US and the UK. Canada chose to delay second doses and mix and match, most EU countries chose to stick to the manufacturer recommendations. These results show that Canada's choice was a good one.

Delaying the second dose would have saved lives in other countries too. Many countries were in a desperate situation, including the US. People were dying everywhere.

But some countries were too inflexible to do the smart thing, so more people died.

People were dying in hospitals. Old people. Stop with the "durr, people are dying like flies" bs. Enough lives were ruined by that. The young will be paying for this crap for the foreseeable future.

By “everywhere” I meant “all over the world.” This was a worldwide pandemic.

Why is it luck? They all result in exposing the body to the exact same spike protein. We would have to be dangerously wrong about what the vaccines do for them to not work fine together.

It’s not the exact same spike protein.

The differences are stabilizers intended to prevent conversion of the labile form of the S protein. If the vaccines didn't work together then one or both of them wouldn't work at all.

Even better? Immune system learns of two (slightly) different ones, making immunity more robust.

That’s the logic, and the argument why actual infection with Covid produces an even better immune response than mixed vaccines.

But that’s by no means a guaranteed outcome. Mixed vaccines could have resulted in mediocre immune response to two different spike protein profiles.

>Unlike the US and Europe, Canada dragged its heels on pre-ordering vaccines.

The truth is the exact opposite. But don't let that get in the way of a good jab, eh?

Headline from Dec 7, 2020: "Canada has reserved more vaccine doses per person than anywhere". https://www.bnnbloomberg.ca/canada-has-reserved-more-vaccine...

Given what is generally known about vaccination, it was not bold. It was judicious.

However, given the hysteria of what passes for news outlets and social media, it was quite bold. People were convinced that the 2 week interval initially specified for Pfizer vax was bedrock truth. Any departing from that ONE TRUE WAY could only be bad. In such a political climate, actually following the known science was difficult.

Giving 1 shot to everyone and spreading out the shots to a more normal interval allowed a lot more people to get immunity. Gettin the 2nd shot at a longer interval allowed those people to get a better long term immunity.

Tbis is not an earth shaking discovery. If it worked differently than this, people would be asking why is this vax different?

In Germany I have a mixed vaccine. I think they found mixed vaccines were better at fighting delta.