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Old 01-22-2021, 12:18 PM   #701
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Production facilities do exist though (and more could have been built). The reason they're not being used is largely financial, not technical.

Sanofi is one of the leading vaccine producers in the world and has the facilities that they were going to use to produce billions of doses, but because their candidate failed in phase 1 trials they're not producing anything right now. There's more money in producing their own vaccine so they're going to keep working on that and most other companies don't want to license their vaccines because they'll make less money doing so. So the result is unused capacity.

Merck is another pharmaceutical giant that isn't producing anything even though they have the ability. They have just begun preliminary talks to use their facilities to accelerate production of the Johnson & Johnson vaccine, but it's going to take months to adjust the lines for that specific vaccine; those talks should have been happening months ago, but the companies likely didn't want to invest in production capacity until they had a better idea that the vaccine would actually work. Again, it was financials driving this.

And Moderna basically built their entire Swiss production lines from scratch in about 8 months. A facility in a small town in a country of 8.5M people is producing 250M doses a year; why couldn't that have been done many times over all over the world in places that have the skills for it? Again, the answer is largely money. It didn't make business sense to build more capacity than that, particularly when they were still unsure if their vaccine would even work. The same thing happened with Pfizer. BioNTech bought a facility in Germany in late 2020 and it'll already be producing doses by February. Why didn't that happen sooner and with more facilities? The answer is money. They waited until their phase 3 trials were nearing completion before spending the money on increasing production.

So I don't think it is the case that money is no object. Money is driving a lot of these things. Yes, there are extreme technical hurdles that can't be avoided and you can only speed up the process to a point. But other than money (and profits for pharmaceutical companies), there's no real reason that production lines couldn't have started to be built and/or modified starting last spring/summer when it became clear which candidates were mostly likely to succeed and be ready the fastest. But that was largely left to businesses to figure out, who naturally made decisions with their bottom line in mind.
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Old 01-22-2021, 02:27 PM   #702
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There was a federal government press conference about vaccines yesterday with a couple bits of new info:

-they're claiming up to 23M people (about 61% of the population and 75% of adults) could be vaccinated by the end of June if other vaccines get approved. They were asked several times to outline which vaccines they were referring to and the amounts, but they dodged that question about 5 times. I'm not even sure why they would release a number while refusing to answer questions about how they arrived at it, but that's been pretty typical for the federal government through this. Presumably (hopefully) those figures are based on reality (i.e. not including Sanofi and Medicago for Q2), so that might give a good idea of what J&J and AstraZeneca (and maybe Novavax?) could deliver in Q2.

-it looks like Canada is trying to avoid the mistake the EU made by officially approving each vial for 6 doses, which then led to Pfizer cutting the number of vials being delivered. It seems like they're trying to straddle the line between allowing the 6th dose where possible but keeping the official count at 5. They mentioned several times that the official monograph says 5 doses per vial and they expect shipments based on that figure.
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Old 01-22-2021, 06:04 PM   #703
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BC released their vaccination plan today, with fairly specific timelines for each age group. Note that these are based strictly on Pfizer and Moderna doses, so any AstraZeneca/J&J/Novavax doses would speed this up, potentially considerably.

But the basic idea is that by the end of March, all seniors aged 80+, all elderly in long term care, health care workers, some people in remote communities, etc. will all be done. After that it goes down in descending age groups with high risk younger people being moved up sooner (they didn't really saw how they'll determine/identify who fits that criteria). Here's a rough breakdown of the timeline and which age groups; all the dates are for the 1st doses:

April: 70-79 year olds
May: 65-69 year olds
June: 60-64 year olds (plus some 65-69 year olds)
July: 35-59 year olds
August: 25-34 year olds (plus some 35-39 year olds)
September: 18-24 year olds
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Old 01-22-2021, 06:50 PM   #704
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BC released their vaccination plan today, with fairly specific timelines for each age group. Note that these are based strictly on Pfizer and Moderna doses, so any AstraZeneca/J&J/Novavax doses would speed this up, potentially considerably.

But the basic idea is that by the end of March, all seniors aged 80+, all elderly in long term care, health care workers, some people in remote communities, etc. will all be done. After that it goes down in descending age groups with high risk younger people being moved up sooner (they didn't really saw how they'll determine/identify who fits that criteria). Here's a rough breakdown of the timeline and which age groups; all the dates are for the 1st doses:

April: 70-79 year olds
May: 65-69 year olds
June: 60-64 year olds (plus some 65-69 year olds)
July: 35-59 year olds
August: 25-34 year olds (plus some 35-39 year olds)
September: 18-24 year olds
re: the bolded- as you imply might be easier said than done to figure out and determine but am glad they are doing this. just one example I am familiar with- a 40 year old with Down syndrome has about the same risk as a 'typical' 80 year old, so I think any triaging has to take at least some comorbidities and diagnoses into account


any mention (beyond healthcare) of any professions/jobs being targeted (frontline grocery, transportation etc etc) or just an idea that the most bang for buck will just come from working through the decades?
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Old 01-22-2021, 06:51 PM   #705
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Haven't looked at the BC plan details, but from what I see they are not prioritizing essential workers?
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Old 01-22-2021, 07:09 PM   #706
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Haven't looked at the BC plan details, but from what I see they are not prioritizing essential workers?
That's correct. In the press conference they said that the risk of morbidity and mortality correlates so heavily with age that they felt that beyond health care workers, going strictly by age would have the greatest positive impact.

However, they did mention that if the other vaccines get approved, they might start prioritizing front line workers. Presumably with fridge stable vaccines, they could move towards more mobile clinics. So for instance if they're doing teachers, they could have a nurse go school to school or something like that. Or they could send a team to a meat packing plant to get everyone there. That's not really viable with the mRNA vaccines and their handling requirements.
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Old 01-22-2021, 07:25 PM   #707
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re: the bolded- as you imply might be easier said than done to figure out and determine but am glad they are doing this. just one example I am familiar with- a 40 year old with Down syndrome has about the same risk as a 'typical' 80 year old, so I think any triaging has to take at least some comorbidities and diagnoses into account
Yeah, upon reading a bit more it looks like they identified a bunch of groups who'd be moved into the Q2 immunizations regardless of age:

-people with most types of cancer
-people with severe respiratory conditions (asthma, cystic fibrosis, COPD)
-immunodeficient people or people on immunosuppresants
-adults with developmental disabilities
-adults on dialysis or who have chronic kidney disease
-people with significant neuromuscular conditions that require respiratory support

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any mention (beyond healthcare) of any professions/jobs being targeted (frontline grocery, transportation etc etc) or just an idea that the most bang for buck will just come from working through the decades?
As I mentioned above, they're not targeting any front line workers as of now. With the Pfizer/Moderna doses it looks like they're mostly going with large community-based vaccination clinics and as we've seen in the US, sometimes trying to target certain populations with those just slows everything down. I think the idea is to just open up registration to an age cohort, have a ton of people sign up, and then just run a few hundred thousand people through the clinics over a 2-3 week period and then move on to the next group. I think their philosophy is to just get as many shots into people as possible as fast as possible, and not let perfect be the enemy of the good.

And like I said, if vaccines with easier handling requirements get approved, it sounds like they'd then look at prioritizing front line workers with those.
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Old 01-22-2021, 09:40 PM   #708
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Although that plan would slide my place in line back 2-3 months, I have to say it makes good sense.
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Old 01-22-2021, 10:25 PM   #709
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Good article on the current landscape for Canadian vaccines:

https://www.theglobeandmail.com/cana...et-a-covid-19/

Based on the availability timelines in that article (Novavax right at the end of Q2, Medicago in Q3 in the best case scenario, and Sanofi not until 2022), I would assume that the Q2 numbers I mentioned above are based primarily on the Johnson & Johnson and AstraZeneca orders and their anticipated deliveries. Given the fairly good chance of both of those being approved, that might bode well for the timeline getting moved up.

The Novavax one is also interesting and is moving faster than I had thought. The US trial only opened a few weeks ago, so that's a long ways off. But the UK trial was actually fully enrolled by late November and given the very high infection rates there, might be able to report in the near future.
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Old 01-22-2021, 10:29 PM   #710
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Also, Pfizer successfully lobbied the FDA to change the labeling to 6 doses per vial rather than 5, reducing the number of vials the US will receive. Good for other countries as it opens up supply, but I have no idea why the US would agree to that.
Quote:
In December, pharmacists made the happy discovery that they could squeeze an extra vaccine dose out of Pfizer vials that were supposed to contain only five.

Now, it appears, the bill is due. Pfizer plans to count the surprise sixth dose toward its previous commitment of 200 million doses of Covid vaccine by the end of July and therefore will be providing fewer vials than once expected for the United States.

And yet, pharmacists at some vaccination sites say they are still struggling to reliably extract the extra doses, which require the use of a specialty syringe.

“Now there’s more pressure to make sure that you get that sixth dose out,” said Michael Ganio, the senior director for pharmacy practice and quality at the American Society of Health-System Pharmacists.

For weeks, Pfizer executives pushed officials at the Food and Drug Administration to change the wording of the vaccine’s so-called emergency use authorization so that it formally acknowledged that the vials contained six doses, not five.

The distinction was critical: Pfizer’s contract with the federal government requires that it be paid by the dose. And there were serious public health implications. If the label’s formal language told people administering the vaccine that the vial contained a sixth dose, that could accelerate the pace of vaccinations at a crucial time.

At one point, Pfizer executives lashed out at the top federal vaccine regulator over the government’s hesitation to approve the request, according to people familiar with the discussions who were not authorized to discuss them.
https://www.nytimes.com/2021/01/22/h...r-vaccine.html
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Old 01-23-2021, 02:23 AM   #711
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This came out on Friday and I think it's concerning for the supply for the EU and other's. AstraZeneca is looking at cutting deliveries to the EU by 60% and this is on top of the significant supply issues with Pfizer in their EU plant.

https://news.sky.com/story/covid-19-...ports-12195923

I will re-iterate my previous concerns and my post from earlier. I don't know if the health regulators and government's can better coordinate and better utilize available vaccine production facilities and associated suppliers. Let's try and untangle the bottlenecks and the capacity crunches in the system.

I almost refuse to believe that the G7 governments along with the WHO couldn't formulate an action plan to find efficiencies and reduce roadblocks for increasing production across the system. It just needs to be discussed, organized and supported across the board. Get the details sorted out on the financials and the legal paperwok. Industry is able to do this clearly as Pfizer has decided to re-tool their existing plant in the EU to increase production by 50% I believe.

Canada has vaccine production capability from my understanding, surely we can contribute SOMETHING to the fight. I refuse to believe that other G7 nations aren't able assist in other areas.

This is also more important with the daily changing news and evidence that the variants are more easily spread AND deadlier. How much risk can we absorb before we run out of luck and have a mutation that MAY not be protected by vaccine?


Hopefully smarter people than me can figure out how to squeeze some additional production out of the worlds vaccine factories .
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Old 01-23-2021, 09:54 AM   #712
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I know they done a lot of really hard things here, but production coordination is very hard thing. The smallest unexpected things can completely bottle neck your operations, and you never get lost capacity back. It's very frustrating, but I doubt it is something someone who is not intimately familiar with vaccine production could have helped to prevent, I just don't know how many of those people exist in the world?

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BC released their vaccination plan today, with fairly specific timelines for each age group. Note that these are based strictly on Pfizer and Moderna doses, so any AstraZeneca/J&J/Novavax doses would speed this up, potentially considerably.

But the basic idea is that by the end of March, all seniors aged 80+, all elderly in long term care, health care workers, some people in remote communities, etc. will all be done. After that it goes down in descending age groups with high risk younger people being moved up sooner (they didn't really saw how they'll determine/identify who fits that criteria). Here's a rough breakdown of the timeline and which age groups; all the dates are for the 1st doses:

April: 70-79 year olds
May: 65-69 year olds
June: 60-64 year olds (plus some 65-69 year olds)
July: 35-59 year olds
August: 25-34 year olds (plus some 35-39 year olds)

September: 18-24 year olds
Well my original expectation was September,
When they announced 20M extra Pfizer Q2 I got hopeful for June.
When Pfizer announced delays I pessimistically fell back to August/September in expectation.

So I would say July/August sounds good to me, I would be right at the bottom of that July group. Hopefully Alberta is on the same pace.

One think I do wonder is my dad would be in the May group, and my mom would be in the June group, but I think they would generally see better uptake rates if they scheduled spouses together, there is a little bit of solidarity/peer pressure that goes into that. Not sure if that factors into the thinking at all.

Last edited by #-3; 01-23-2021 at 10:00 AM.
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Old 01-23-2021, 11:01 AM   #713
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I think part of the problem was it would have required picking winners. The reason we are in the position we are now is that 7 or 8 vaccines manufacturing lines were built based on phase 1 test results. Some of these didn’t work out. So if you wanted to increase capacity for today it would have been brand new construction of 8 factories to get 2 that work. The idea of drug companies licensing and modifying lines because their vaccine failed or is way behind is only possible starting now that we know who was successful.

It should be being done but to a significant degree what people are describing did occur to get us where we are. The second question is timing if it’s 8 months to expand production (based on Moderna) does it make sense to expand Pfizer / Moderna production which are difficult to distribute in non 1st world countries when the 1st world countries will be done by then?

Or do you wait until the next realease of Astrazenica data and J+J data and scale those up.

These companies will have landed on the moon in 18 months.
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Old 01-23-2021, 02:40 PM   #714
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B
July: 35-59 year olds
ok because this is still a Flames board, here's hoping for the same in AB- give Gio a little turboboost in the finals!
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Old 01-24-2021, 05:07 PM   #715
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How early is too early to get the second Moderna dose, does anyone know? I received the first one on January 12, but may be able to get the second one today, twelve days later. The official guide is to get it twenty-eight days later, but is there any harm in having it done earlier?
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Old 01-24-2021, 05:32 PM   #716
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I wouldn't stray too far from the minimum recommended interval (28 days for Moderna, though Health Canada has approved as short as 21 days). Receiving a booster too soon after the initial dose can reduce efficacy, potentially significantly. That may be less of an issue with mRNA vaccines than other forms, but it hasn't really been studied enough with these vaccines. The intervals were already a little on the short side in order to speed up the trials, so I wouldn't push that further.

I'm honestly surprised that they would even administer it with that short of an interval, as it directly contradicts the approved usage.
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Old 01-24-2021, 05:37 PM   #717
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I wouldn't stray too far from the minimum recommended interval (28 days for Moderna, though Health Canada has approved as short as 21 days). Receiving a booster too soon after the initial dose can reduce efficacy, potentially significantly. That may be less of an issue with mRNA vaccines than other forms, but it hasn't really been studied enough with these vaccines. The intervals were already a little on the short side in order to speed up the trials, so I wouldn't push that further.

I'm honestly surprised that they would even administer it with that short of an interval, as it directly contradicts the approved usage.
yeah, not sure what juriscdiction the poster lives in but seems like there must be someone else who could use the first (or properly timed )2nd dose rather than shortening- I realize this may just be a highly opportunistic one off situation
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Old 01-24-2021, 05:38 PM   #718
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so in the vaccine tracker Sask is now over 100% administered: delivered. I assume this is them working the 6 for 5 angle? or is it possible Sask didn't officially notify on their last shipment (ie denominator)
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Old 01-24-2021, 06:27 PM   #719
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so in the vaccine tracker Sask is now over 100% administered: delivered. I assume this is them working the 6 for 5 angle? or is it possible Sask didn't officially notify on their last shipment (ie denominator)

It's the first..."As of January 23, 101 per cent of the doses received have been administered. This overage is due to efficiencies in drawing extra doses from vials of vaccine received."


https://www.saskatchewan.ca/governme...zLwhoc6mDrCKhM
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Old 01-24-2021, 07:28 PM   #720
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yeah, not sure what juriscdiction the poster lives in but seems like there must be someone else who could use the first (or properly timed )2nd dose rather than shortening- I realize this may just be a highly opportunistic one off situation
Yeah, I'm in a job where sometimes we have leftover vaccines that would otherwise go unused, so definitely a one off type situation.
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