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What we know about Quebec's vaccine plans and what it means for 2021

A vaccine has arrived, but many questions remain about the enormous undertaking ahead, and how it could shape the year to come.

Key questions about how the province will distribute the vaccine and the challenges ahead

A health-care worker prepares a shot of the Pfizer-BioNTech COVID-19 vaccine in Northern Ireland. Quebec's vaccination campaign is underway now, too. (Liam McBurney/Pool via Associated Press)

A vaccine has arrived, signalling a welcome new chapter in the pandemic.

But many questions remain about the enormous undertaking ahead, and how it could shape the year to come.

Here's a look at what we know, and some of what we don't. This story will be updated as we learn more.

What vaccines are going to be used?

Canada has ordered vaccines from seven companies. The first two to deliver will be Pfizer-BioNTech and Moderna, both of which are headquartered in the U.S.

Pfizer-BioNTech's vaccine has been approved by Health Canada. It requires two doses and can be conserved for up to six months if it is kept at –80 C to –60 C. Once thawed for injection, it remains stable for five days if kept between 2 C and 8 C. The first doses are expected to arrive in Quebec next week.

Moderna's vaccine is also expected to win speedy approval. It too requires two doses and stringent freezing conditions, albeit marginally less so than Pfizer's (–20 C). It can be conserved in regular refrigerators for up to 30 days after it has been thawed.

The province expects the Moderna vaccine to be available in Canada at the beginning of next year.

Vaccines from Johnson & Johnson's pharmaceutical division, Janssen, as well as candidates from Novavax and AstraZenaca/Oxford University, each of which are in the final phase of human testing, could be available in the months to follow. There is also hope that Quebec-based Medicago, whose vaccine is in phase two trials, will also join the party in 2021.

Based on the quantities of vaccines ordered by the federal government, Quebec's pro-rated share amounts to 13.4 million doses of the Moderna vaccine and 4.8 million doses of Pfizer's over the next 12 to 18 months.

As far as keeping track of doses, which are administered roughly three weeks apart, Quebec already has a mandatory electronic registry for vaccinations, so knowing who got what, when shouldn't be a significant problem.

How safe is the vaccine?

Based on the evidence from tens of thousands of injections in clinical trials, the answer is: quite safe.

The Pfizer and Moderna vaccines both use a relatively new technology called "messenger RNA" or mRNA, which is basically a tiny molecule of genetic material, cased in a fatty nanoparticle, that teaches cells to recognize and fight the novel coronavirus's "spiked" protein before it can gain a footing. 

But while the formula is new, the mRNA approach isn't. In fact the science behind it dates back 40 years. It does involve RNA and it penetrates cells, but the molecule doesn't reach the nucleus and so, said Dr. Donald Vinh, an infectious diseases specialist at the McGill University Health Centre who is also a science advisor for the federal COVID-19 therapeutics task force, "it has no contact with our DNA."

And the effect is short-lived, a matter of minutes, he added.

Any vaccine that earns emergency-use authorization in Canada has undergone a lengthy and rigorous testing phase to assess its safety. The time frame for these vaccines may have been drastically shortened relative to past epidemics, but no corners have been cut.

Clinical trials have shown the side effects of the COVID-19 vaccines to mirror those of most other vaccines: pain at the injection site, occasional swelling, fatigue.

According to Dr. Gary Kobinger, the director of the Infectious Disease Research Centre at Université Laval, "nothing is 100 per cent ... what we do know is the results for the [test] population of 35,000 or 40,000 or 50,000, the results are very convincing in terms of safety and effectiveness."

Or as Vinh put it: "We don't anticipate the type of horrific side effects people might talk about on social media."

It's possible that a tiny number of people could experience more serious side-effects. Quebec has a no-fault compensation program for anyone who suffers from one of those adverse effects.

Who will get the vaccine first?

Patients in CHSLDs, which accounted for the vast majority of deaths related to COVID-19, will be the first to get the Pfizer vaccine in the province within days.

Inoculations will start at two long-term care homes grappling with outbreaks, the hard-hit Maimonides Geriatric Centre in Côte Saint-Luc and another in Quebec City, the CHSLD St-Antoine.

People living in private seniors' residences and those in isolated communities, including Indigenous communities and particularly those located in Nunavik and James Bay, will be next. 

Those four groups represent about 547,000 people living in Quebec. If all goes as planned, the vaccinations of those groups should be completed by the end of March.

The next groups of people to receive the vaccine will be organized by age group, starting with those 80 and up, then 70 to 79, and 60 to 69, followed by those who are 60 and under and have other risk factors.

For now, pregnant women and children are not part of the target groups because they were not included in the clinical trials. 

Patients at Maimonides Geriatric Centre will be among the first to be vaccinated in Quebec. (Graham Hughes/The Canadian Press)

Where will the vaccine be given?

Patients living in CHSLDs will receive the vaccination on site. For the general population, there will be 20 vaccination sites, developed in conjunction with Pfizer, across Quebec. 

Four will be in Montreal, two in the Montérégie region and one each in 14 other regions. Each site will be equipped with the cold storage needed to keep the Pfizer vaccine at the required  "super-frozen" temperature.

Each box from Pfizer contains 975 doses, and at the moment they can't be divided and sent to different places due to their storage requirements, said Dr. Richard Massé, a senior provincial public health adviser. 

The vaccine rollout for the H1N1 influenza pandemic hit similar roadblocks in 2009. Massé expects the province will receive permission from the company to divide the doses into smaller lots at some point, which will make it easier to reach smaller CHSLDs, or ones in remote places.

The Moderna vaccines will also help, he explained, because they don't have to be stored at such low temperatures. Once the Moderna vaccine is available, Massé said he expects the province will have a vaccine distribution network that will cover every CHSLD.

An ultra low-temperature freezer like the one pictured here could be used to store the Pfizer COVID-19 vaccine. (Communications Nova Scotia)

How quickly will things get back to normal?

That is difficult to say, but experts stress the effects of the vaccine on the transmission of the virus won't be visible overnight, or even in a matter of a few months.

David Levine, a former junior health minister who managed the vaccine rollout for the H1N1 flu pandemic, as head of Montreal's regional health authority, estimates it could take six months, or even a full year, to see the full impact, depending on how quickly it is distributed and how well it works.

"It's important that we don't get a false sense of security," he said.

In the meantime, he said, health guidelines will still need to be followed to limit the spread of the virus.

Dr. David Naylor, who serves as co-chair of national COVID-19 Immunity Task Force, also said maintaining vigilance is key.

He told CBC's Power and Politics this week that if the vaccines live up to the 90 per cent efficiency reported in the trial phase, and Canada succeeds in covering 60 per cent of the population by next summer "a lot of the current spread will be blunted dramatically."

"By the fall [of 2021] I think things will feel a lot better," he said. 

What is the goal of the vaccine? Herd immunity?

According to the Comité sur l'immunization du Québec (CIQ), the advisory body that set out the proposed prioritization guidelines, "the ultimate goal of a vaccination campaign on COVID-19 is to reduce the negative impact of the disease and of the virus's spread on the population to levels that will permit a return to normal or quasi-normal life, and that, in a lasting fashion."

The words "herd" and "immunity" do not appear in the guidelines. This vaccination campaign, which the CIQ said could involve "periodic re-vaccination," is primarily aimed at making sure Quebec's most vulnerable people don't get badly sick. 

As Dr. Caroline Quach-Thanh, an infectious disease specialist from the CHU-Sainte Justine and Université de Montréal who chairs the national advisory committee on immunizations, told CBC News recently: "To me, the overall goal of this vaccination program is not herd immunity, it's individual protection of those who are vulnerable and those who need to be protected."

Margaret Keenan, 90, is applauded by staff as she returns to her ward after becoming the first person in Britain to receive the Pfizer/BioNTech on Dec. 8. (Jacob King/Reuters)

Will the vaccine be mandatory?

No. Quebec health officials, as well as the premier, have maintained the vaccine won't be mandatory. Instead, the province plans to win over those reluctant to get a shot by persuading them that it's important, said Dr. Horacio Arruda, the province's director of public health.

A recent poll suggests a majority of people (64 per cent) would be willing to get vaccinated, while 16 per cent said they definitely would not. 

But it's possible Quebecers could eventually be required to produce proof of inoculation — a so-called vaccine passport. 

Christine Elliott, Ontario's health minister, floated that idea Tuesday, saying it would be "really important for people to have for travel purposes, perhaps for work purposes, for going to theatres or cinemas or any other places where people will be in closer physical contact when we get through the worst of the pandemic."

A nurse shows Roger Shaw, 87, his vaccination record card after he was vaccinated in London on the first day of the largest immunization program in the history of the United Kingdom. (Jack Hill/Pool via Associated Press)

If I have had COVID-19, will I still get a vaccine?

Probably, yes. About 145,000 Quebecers have contracted COVID-19, roughly 20 per cent of them health-care workers. Based on recent peer-reviewed studies, the vast majority of those who have recovered from the disease should be immune from re-infection for at least six to eight months. 

But those findings aren't categorical. 

Arruda has said that "in the context of the information we currently hold, and given we don't consider those people will have long-term immunity, vaccination will be recommended."

That's in line with the CIQ's recommendation: "For the moment, a vaccine should be indicated without regard for history of sickness or infection."

Will the vaccine prevent me from transmitting the virus to my loved ones?

It's not clear. While it's almost certain being vaccinated will prevent you from getting sick, there is no conclusive evidence to date proving it will prevent you from transmitting the virus to others.

"If I'm vaccinated, it might mean I'm protected against symptomatic disease and severe disease. It doesn't mean I'm necessarily protected against all types of infection, including asymptomatic infection for which I could have viral shedding," said Quach-Thanh.

Will I still have to wear a mask once I'm vaccinated?

The short answer is yes, at least for now, for the same reason as above: we don't know if the vaccine will prevent you from transmitting the virus to others.

"It will only be as effective as the number of people who take it," said Vinh.

Because COVID-19 can be spread by people who are asymptomatic or pre-symptomatic, personal protective equipment and other measures remain essential in a world where the vaccine may or may not prevent transmission.

What if I want to wait and see before taking a vaccine?

Vinh said those who are inclined to hold off until later are, wittingly or not, impeding the effort to stop the spread of the coronavirus.

As Quebec tries to get control of the pandemic, "vaccine-hesitant people are going to be the weak link," he said.

That's because time is of the essence and because of simple math: the more people protect themselves against getting sick, the slower the virus will spread.

"Complacency," Vinh said, "is our enemy." 

ABOUT THE AUTHOR

Sean Gordon

Journalist

Sean Gordon is a CBC reporter based in Quebec's Eastern Townships, and has previously covered the National Assembly, Parliament and the Montreal Canadiens. Follow him on Twitter: @MrSeanGordon

With files from Kamila Hinkson

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