3 ways Canada can take action as a global health leader on COVID-19 vaccines

This column is an opinionby Jason Nickerson, humanitarian affairs advisor for Doctors Without Borders/Mdecins Sans Frontires (MSF) in Ottawa, and a respiratory therapist with more than a decade of experience in clinical patient care and global public health response.For more information about CBC's Opinion section, please see theFAQ.

Vaccines are on their way for Canadians. Health Canada's authorization of the Pfizer/BioNTech mRNA vaccine on Dec. 9, following the announcement that Canada should expect to receive 249,000 doses by year's end, has sent positive signals that an end to the pandemic could soon be in sight for this country.

But not everyone can share in Canada's good news.

As COVID-19 vaccines start becoming available for use here and in a few other high-income countries, people living elsewhere will have to wait. From a global health perspective, that raises two major concerns and some hard questions for Canada.

The first concern is that it will be months, perhaps years, before we have the billions of doses needed to vaccinate everyone around the world. No single manufacturer today has the capacity to meet global demand, and although there is much to celebrate in the unprecedented and rapid development of these COVID-19 vaccines, their global roll-out appears poised to be inequitable and uneven.

The second concern is that this pandemic is having a disproportionate impact on people living in poverty in Canada, certainly, but also profoundly in countries affected by conflict and crisis. Ending this pandemic is a matter of global humanitarian urgency not just because of COVID-19 itself, but because of its knock-on effects.

Doctors Without Borders/Mdecins Sans Frontires (MSF)'s medical teams have seen a significant increase in emergency health needs, from malaria to sexual and reproductive health and beyond, with women and girls being disproportionately affected and facing greater dangers. These are the ripple effects of the pandemic, a result of imposed lockdowns and reductions of health services. Hard-won gains in reducing poverty and improving the health of billions are not only in jeopardy, they are actively being compromised.

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Which brings us to Canada's vaccination plan. The Canadian government has announced that it expects to receive at least 194 million doses of COVID-19 vaccines from different manufacturers, with options to purchase an additional 220 million. Given that most vaccines will require two doses, that's enough to vaccinate all 38 million Canadians plus an additional 169 million people.

That's a significant surplus, which has raised questions about whether Canada and other high-income countries are hoarding doses of a much-needed vaccine.

These disparities in access are meant to be addressed by COVAX, a global mechanism designed specifically for the purpose of developing COVID-19 vaccines, negotiating their purchase and distributing them equitably around the world. The Canadian government is one of the largest investors in COVAX, which is the right thing to do. But funding alone is not enough to solve this problem.

High demand and low supply mean that even if lower-income countries can count on money in the COVAX bank, there may simply not be enough vaccine doses available for them to purchase.

That could mean that high-risk people in low-income countries front-line health workers, people in vulnerable groups may not be vaccinated until low-risk people in high-income countries have received their doses first.

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How can Canada find the right balance between protecting its citizens at home while ensuring access to COVID-19 vaccines for people around the world who need them most? There are three things that can be done right now.

The first is to unambiguously commit to donating any surplus vaccines.

This is an obvious commitment to make, yet Canadian leaders have so far been evasive. Sources recently suggested that the government is moving towards such a plan; Canada should simply commit to it immediately and get working on the details.

Canada is not the only country that needs certainty in assessing when its doses will arrive in order to begin vaccinating high-risk populations, so we must also be clear about how many doses of which vaccines Canada intends to actually take possession of. We can then release the doses we don't intend to purchase back into the global supply, which will give the world a better overview of potential availability.

The second thing is to continue investing in COVAX as a donor with policy influence.

Committing to donate surplus vaccines is one thing, but what's really needed is not charity it's fundamental change to the way the global pharmaceutical industry operates. The inequities in the global supply of essential medicines are not new or unique to the COVID-19 pandemic; they are part of how the industry has operated for decades, for virtually all diseases.

COVAX can address some of the systemic problems in the way medicines are developed, such as by ensuring that vaccines with a more global yet less profitable profile still see the light of day. Both the Pfizer and Moderna vaccines have significant cold chain requirements that will make them challenging to use in resource-constrained environments, for example. It's essential that governments continue to push to ensure that other vaccines more suitable for global use continue to be developed.

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Thirdly, Canada now finds itself in a conversation about what biomanufacturing capacity we ought to have, following public revelations that we lack the ability to manufacture COVID-19 vaccines domestically.

Earlier in the pandemic, the federal government announced $126 million of funding to increase the capacity of the National Research Council of Canada's biomanufacturing facility in Montreal, ostensibly to produce vaccines. We should not squander this opportunity to invest in a pharmaceutical research and development ecosystem that can meet not only domestic needs, but global ones too.

Beyond COVID-19, this is about adopting a model of medical research, development and manufacturing that is guided by public health needs, and the principles of global, equitable and affordable access not just by market returns.

Canada has the talent and expertise to invest meaningfully in a needs-driven, open-science approach to drug development. In 2018, Parliament's Standing Committee on Health agreed that this is the path we should take for developing new medicines, and made recommendations on how to do this. Let's put that into action.

For months, Prime Minister Trudeau has committed publicly to ensuring "affordable and equitable access" to COVID-19 vaccines, at a time when other countries were looking mostly inward. We should celebrate this. But Canada's recent plans to potentially procure hundreds of millions of doses of high-demand, low-supply vaccines have raised eyebrows among global public health experts. There are legitimate concerns that if all of these options are exercised, Canada will have a surplus of vaccines, putting us out of sync with these global equitable access commitments.

Let's have some clarity on the federal government's intentions for these surplus doses and, if needed, a course correction to ensure Canada remains a champion of global health through both its words and its actions.

• This column is part of CBC's Opinion section. For more information about this section, please read ourFAQ.