This is part of an ongoing series of stories — The Road to a Vaccine — that will look at Canada’s quest to secure a COVID-19 vaccine amid the global pandemic, as well as the hurdles and history it faces to do so. With the race on for a safe and effective COVID-19 vaccine, the fastest route to the return of some semblance of normalcy, Canadians have been primed to fixate on the country’s efforts to procure enough doses for its own citizens. But experts, including those on Canada’s vaccine task force, say it’s just as important to focus on what’s happening beyond our borders. A failure to achieve widespread immunity globally — whether due to inequitable access to vaccines in low-income countries, or pockets of vaccine refusers in developed ones — would hurt us, too. “The pandemic started with one person being infected in Wuhan. If we don’t stamp out the fire everywhere, it’ll just restart,” said Alan Bernstein, a member of Canada’s COVID-19 Vaccine Task Force and president of CIFAR. The task force’s mandate is explicitly Canada-centric: its 18 members were gathered to help the country acquire and produce promising COVID-19 vaccine candidates. But the group has nonetheless taken a broader international outlook and wants Canada to participate in efforts to distribute COVID-19 vaccines equitably around the world, members say. “The fact that this is an infectious disease means that it’s a global problem,” says Dr. Joanne Langley, co-chair of the task force and an infectious disease doctor at Dalhousie University’s Canadian Centre for Vaccinology. “Because everything is integrated, our well-being is (other countries’) well-being, and their well-being is our well-being.” The federal government has so far signed agreements with four companies that have COVID-19 vaccines in development. Together, those contracts would give Canada, a country of 38 million people, a minimum of 88 million and a maximum of 190 million doses. Individuals will probably need to receive more than one dose, and some or all of those vaccine candidates may end up failing in late-stage trials. Health experts have become increasingly vocal in urging Ottawa to ensure that low-income developing countries will receive the same access to vaccines as wealthy ones like Canada. On Friday, a coalition of more than 100 Canadian global health experts published a “call to action” that criticized the government for engaging in a “vaccine power play” and urged Canada to work in “global solidarity” with efforts for equitable worldwide distribution. The 118 signatories of Friday’s statement are urging Canada to participate in and increase funding for COVAX, an initiative that would supply successful COVID-19 vaccines to countries that can’t afford direct agreements like the four Canada has signed, and guarantee some domestic supply. “The success of this plan is now under threat due to the behavior of many wealthier nations, including Canada, who are currently maneuvering to secure vaccines for their own citizens — a phenomenon known as ‘vaccine nationalism,’ ” the statement reads. A spokesperson for the Public Health Agency of Canada said the government has already submitted a non-binding “confirmation of intent” letter to participate in COVAX, signalling the country’s intent to sign a binding commitment by Sept. 18. The government is “looking forward” to engagement with those involved in the collaboration, “with the aim of developing a mechanism that works for all countries and supports equitable global access to safe, effective and affordable COVID-19 vaccines, once developed,” said Geoffroy Legault-Thivierge. Langley, speaking for herself and not the task force, said a global collaboration would be more effective than individual nations working in their own interests. “We have a problem of perceived scarcity of vaccines, whereas in reality, I think we could provide vaccines for the world’s people if we looked at this as a global problem, and collaborated together. I think we’re moving towards that bit by bit. We’re not there yet.” While primarily a humanitarian concern — the pandemic has disproportionately affected marginalized communities within Canada, and vaccine hoarding could replicate that imbalance on a global scale — the persistence of COVID-19 in poor countries would also be an active threat to Canadians. “Viruses don’t respect borders,” says Dr. Jeff Kwong, interim director of the Centre for Vaccine Preventable Diseases at the University of Toronto’s Dalla Lana School of Public Health. Another threat to Canada from beyond its borders — and potentially within — is vaccine hesitancy, the reluctance or refusal to receive a vaccine when one is available. Surveys of Canadians have shown high levels of willingness to take a COVID-19 vaccine when one is available. A Statistics Canada online questionnaire found that roughly three-quarters of respondents were very or somewhat willing to get vaccinated. Polls in the U.S. have shown varying levels of willingness to take a vaccine, with some finding much lower support, and multiple surveys have found that large majorities of Americans believe the regulatory process for ensuring vaccine safety will be rushed or skewed for political reasons. Polls of COVID-19 vaccine hesitancy should be viewed with caution, says Heidi Larson, a professor of anthropology and director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. People may feel more willing to take a vaccine when one actually exists and has been properly vetted, especially as the human and economic toll of the pandemic balloons. Reporting of these polls also lump together those who have questions about the approval process — a reasonable position — with those who would outright refuse to be vaccinated and have made up their minds in advance, a much more immovable threat, Larson says. Larson, who will be presenting to Canada’s COVID-19 vaccine task force in the coming weeks, co-authored a study published in the Lancet this week that tracked vaccine confidence globally. In addition to the U.S., European countries including Poland and Ukraine may see pockets of refusal, too, Larson says. “I think it could happen in many countries,” Larson says. Public opinion is volatile, with confidence in vaccines generally waning and waxing in some countries and more stable in others. Kwong agrees that with enough vaccine refusers in the U.S., “absolutely there’s a risk” to Canada, pointing to a major measles outbreak that began at Disneyland and resulted in cases imported to Quebec. “We are a really interconnected world now, and it doesn’t take very long for viruses to travel around the planet. We can’t keep our borders closed forever.” Kate Allen is a Toronto-based reporter covering science and technology for the Star. Follow her on Twitter: @katecallen |