How do you vaccinate an entire planet?

Jordan Heath-Rawlings: Someday, not too far in the future, hopefully we will get some good news. It will leak out slowly, but soon the whole world will know one or more of the vaccines and tests for COVID-19 will be declared viable, approved by the FDA and other health bodies. A vaccine will be ready ,finally, to help us really get back to normal. And we’ll celebrate, obviously the world will rejoice. The end of this pandemic will at long last be in sight. But what happens then? Who makes the vaccine and how fast can they do it? Who gets the first doses, who gets the second batch? Who makes sure that the vaccine doesn’t go to the rich and powerful first, rather than those at the most risk? How do we remove politics from a global health emergency? And even once we answer those questions, there are simple logistics. How quickly can you possibly vaccinate billions upon billions of people? How do you do it at scale and safely? Where do you do it? And what do you do if a significant percentage of people just don’t take it? So, yes, look when we get a vaccine celebrate, but just know that it’s not the end of the road as our guests today will tell us it’s more like an off ramp. I’m Jordan Heath-Rawlings. This is The Big Story. Danielle Groen is a journalist based in Toronto who investigated vaccinating a planet for The Walrus. Hey, Danielle.

Danielle Groen: Hello.

Jordan Heath-Rawlings: Danielle, maybe if you could start, just because I found it so fascinating, by telling us about some of the kind of primitive methods humans have used instead of vaccinations throughout our history.

Danielle Groen: Yeah. So we, I mean, humans have been trying to outsmart viruses for quite some time and, you know, in the 1600s in China, what they were doing is they would grind a smallpox scab into a powder, and then they would blow that powder up a healthy person’s nose, which if you were a boy, this was done in the left nostril. And if you were a girl, this was done in the right nostril.

Jordan Heath-Rawlings:  For scientific reasons.

Danielle Groen: Exactly. And so we moved, you know, from powders to pusses, those were quite popular for awhile. And, you know, in the 19th century in England, Edward Jenner would take fluid from a cow pox blister, which he got from of course a milkmaid and that he would scratch into the arm of a healthy patient.

Jordan Heath-Rawlings: And now, we have all the best science and medical technology at our disposal, and we’re trying to vaccinate an entire world. How monumental is that task?

Danielle Groen:  It’s monumental. I mean, we’ve just never done anything on this scale before. And so the time and the energy and especially the money that’s being thrown at this really reflects the scale of the challenge.

Jordan Heath-Rawlings: And describe for us, if you can, the Medicago facility in Quebec. What’s going on there? What do they do there?

Danielle Groen: Sure. So in Quebec, in their suburban facility, you walk in, it really resembles kind of a greenhouse or botanical garden. And what they’re doing is they’re growing thousands of plants there. The plants are kind of a cousin of tobacco and when the plants get old enough, maybe, six weeks old, they go on this journey. And so they’re kind of lined up onto, if you can imagine a flatbed. And then the flatbed is taken to a tank that’s filled with fluid and it’s inverted so that the leaves are upside down and the plants get dumped into this tank, the tank seals, and the roots are kind of trapped between the liquid in the tank and the lid. And what happens is that into that space, they slip a vacuum hose and it begins to suck. And so the plants pretty much act like sponges. When the pressure is applied to the roots, the leaves collapse, and then when the pressure is released, the leaves expand again they absorb all of this liquid into their leaves and into their cells. And what’s in this liquid is a bacteria that’s super good at infecting plants, but it’s been tweaked a little bit and it contains the spike protein from SARS-COVID2, which is the virus that causes COVID-19. And so then the plants are taken out. They go into an incubation chamber, you know, everything’s really, really controlled ,their temperature, light humidity. And over the next week, the bacteria is going to get into all of the cells of those infected leaves and reproduce those spike proteins, which ultimately are going to make up the base of the vaccine that Medicago is developing.

Jordan Heath-Rawlings: How far along are they with this vaccine, and how unique is this process?

Danielle Groen: This process is certainly something that Medicago has done for a while. They’ve been doing it to make a seasonal flu vaccine. They started the first of their human trials in the summer. So in order for a vaccine to be approved, it needs to go through a pretty rigorous system to prove that it’s safe and it’s effective. And you begin with your phase one clinical trial, which is maybe a couple dozen people. You move to a phase two. You’re looking to make sure that there aren’t any kind of untoward side effects that are happening and that you are seeing an effective response. And then you move to the large scale third trial, which is where some of the bigger vaccine companies like Moderna and Oxford Astra Zeneca are now. In terms of how unique it is, it’s not a common approach, but it’s not, it’s not something that hasn’t been done before. But you can make a vaccine in a whole bunch of different ways. You can do it in eggs. You can do it in human cells, in insect cells, in plant cells. We’ve developed a number of pretty ingenious ways to get this virus made.

Jordan Heath-Rawlings: And that’s one of the reasons that we wanted to talk to you. Because we have covered,  the race for a vaccination on this program, but the way your piece pitched it is that, you know, even if one or more of these vaccination trials pan out, that’s kind of the beginning. Like how much work is left to do from that point?

Danielle Groen:  A lot, and I think that was something I didn’t understand very well. I mean, at the beginning of this pandemic, we heard a lot of experts and a lot of eqidemologists say, you know, it’s going to be 12 to 18 months before we have a vaccine ready. And you know, 12 to 18 months, like so much that’s going on right now would be unprecedented. And the fastest we’ve developed a new vaccine is four years. But even going through all these clinical trials and amassing all the data and saying, okay, this is an effective vaccine. That isn’t the end of the pandemic. It’s really kind of an off ramp for us. And there is a lot of scientific and logistical and ethical roads that still lie ahed as an example. I mean, we need to figure out how long and how well the vaccine’s production can last. We need to manufacture enough of it to jab into billions of arms, maybe twice, if we need a booster shot. We have to figure out how to distribute the vaccine to different countries, and then how to allocate it within different segments of their populations. And we need to persuade people who are skeptical about vaccines to still get the shot.

Jordan Heath-Rawlings: How much of that is being done globally right now versus each country scrambling to prepare what it can?

Danielle Groen:  A lot is happening within the companies that I think are increasingly becoming household names. So Moderna and Pfizer in the States, Oxford Astra Zeneca in England, Sanofi in France. You know, these are, there are more than 200 vaccine candidates that are currently being developed, but these companies are the ones that are really quite far ahead in terms of where they are. And accordingly, they’re the companies that a lot of countries around the world are racing to reserve the vaccine doses from. So just in Canada, we’ve made deals with six of those companies for their leading vaccine candidates. And we’re talking tens of millions of doses from Moderna, 20 million from Oxford, up to 72 million for Sanofi. In total, just in Canada, we’re pushing, you have 200 million doses reserved so far and committing more than $1 billion. Not all of those candidates  are going to work. A lot of them are not going to, but you know, there was a pretty alarming report that came out from Oxfam just a couple of days ago that estimated that rich countries like ours have already bought up half the promise doses of leading vaccine candidates, which means even if they all work, and again, that’s super unlikely, nearly two thirds of the world’s population won’t have access to a vaccine until at least 2022.

Jordan Heath-Rawlings: Is there any kind of global program looking at vaccinations or, are those countries kind of out of luck and at the mercy of whatever, United States, Canada, et cetera, decides to leave on the table or buy up for countries that don’t have it themselves?

Danielle Groen: No,  there are global initiatives. The major one is Kovacs, which,, is an initiative from the WHO and the Bill and Melinda Gates foundation. And they’re meant to level the playing field so high and middle income countries pool their money to buy and distribute vaccines around the world. And then the cost is fully covered for low income nations. Canada has committed $440 million to this initiative. China hasn’t and the U S hasn’t committed any money either.

Jordan Heath-Rawlings: When we talk about having a vaccine and it clearing trials and being available to people, you know, we’re talking about, as your piece pointed out and you just mentioned, you know, the first 10, 20 million doses. How much of us does that cover? I don’t just mean just as Canadians, but you know, I’m lucky enough not to be high risk. I’m assuming that I’m not getting a vaccine til months after it’s ready.

Danielle Groen: I think that’s exactly right. I mean, we are now quite well accustomed to thinking in waves and vaccines are gonna come in waves as well. And so, you’re right. We need to determine who gets the vaccine first. It’s probably not going to be you,  but you know, we do need to make sure decisions about who we do want to prioritize. And so, you know, what are your goals? I mean, if you want to vaccinate to prevent death, then you are going to want to vaccinate the highest risk group. That’s seniors, especially those in longterm care homes. If you want to prevent transmission and spread, then maybe you want to get the vaccine to people in their twenties. We usually prioritize frontline workers because they are at greater risk of infection based on the work they do. But I think we also all have a much clearer sense now of how many different sorts of essential workers we have. Not just, you know, healthcare workers, but public transit drivers and grocery clerks. So do they go first? And then the last thing is that here we absolutely know that racialized and low income people are infected at rates that are hugely disproportionate to their populations. Not because of any epidemiological reason, but because of historic and systemic disadvantages. So we could perhaps prioritize the vaccine based on structural social causes. Instead, those are all things that you know, we do need to be looking at. There is in Canada, a national body that looks at prioritization, the national advisory committee on immunization. They make recommendations on who should roll up their sleeves first. But because healthcare is a provincial responsibility, it is up to the provinces and the territories to actually implement those recommendations.

Jordan Heath-Rawlings: Assuming we can prioritize and that the provinces and territories can come to an agreement on what that looks like, do we have the infrastructure to do that, to like, get everybody vaccinated in a short span of time?

Danielle Groen: We do. I mean, we have flu clinics and those are things that we put on every year. And I think we will take our cues from what that looks like, but some of that is going to have to be determined by just how much we can get, how many doses we need, and what supply we have access to at what time. So if we are really lucky and a bunch of different vaccine candidates prove successful and are manufactured and, you know, procured by Canada at one time, I think we can expect to see a lot of different vaccinators in a lot of different places. So we might be doing vaccinations in pharmacies, in local libraries, in, at family doctors and at local clinics. If we have a tighter supply, what I’m hearing is that a lot of that will be done by local health clinics. And you know, I think that you can expect to see a longer hours, appointments, possibly even some at-home vaccinations because you’re not going to want to be putting a whole bunch of people into a waiting room for a considerable amount of time.

Jordan Heath-Rawlings: One of the last things I wanted to ask you about, and you touched on it early, is getting people to take it. On the one hand, for sure there’s the anti-vax movement, which is a challenge, but I’m also wondering just about, you know, in the early days of a vaccine, are people going to want to go first?

Danielle Groen: That’s certainly a concern. And you know, if we think back to the fact that given the disproportionate rates of infection being experienced right now by racialized and low income people, that might be a cohort that should be prioritized. But again, there is a long history of medical racism, which means that black and indigenous and racialized people might not want to be among the first to be vaccinated. They might not want to feel as though they’re being used as guinea pigs. I think that there needs to be a huge public education campaign. Someone described it to me as people need to see what’s in the needle in order to understand how exactly we were able to produce a vaccine at such a rapid club . There is going to be a lot of data that is available. I think it will be, you know, reviewed by a lot of people. I think there will be an enormous public education campaign to try to reassure people. But it’s, you know, it is certainly a concern that we could move heaven and earth to get a vaccine or even a number of vaccines available at an unprecedented speed. You know, we need to reassure people that they’re not jeopardizing their own safety by then getting it.

Jordan Heath-Rawlings: What about the people who aren’t aren’t skeptical and worried, but who are just, you know, ideologically, for whatever reason, against this stuff. What does it come to for them? Do we end up making it mandatory? Can we even do that?

Danielle Groen: I don’t think so. I’ve not heard that that’s a possibility. I think it’s really tempting to see a vaccine as kind of our silver bullet. And I think that it’s tempting to want to vilify people who might not be comfortable or inclined to get this vaccine. I do think that not everyone is going to be able to get the vaccine at the same time. Not everyone is going to be protected by the vaccine in the same way. And there are people who are just not going to get it at all. And so I don’t think that we’re going to be able to dispense anytime soon with some of the other measures that are keeping us safe. I don’t think that physical distancing or mask wearing, or really good and constant hygiene practices are going to go away anytime soon. So I think we’re also all going to be holding onto her hand sanitizer for a little while longer.

Jordan Heath-Rawlings: Well, that’s a fittingly depressing way to end it, but thank you for giving us a glimpse of what happens after a vaccine is ready Danielle.

Danielle Groen: Thanks so much, Jordan,

Jordan Heath-Rawlings: Danielle Groen, who looked at this for The Walrus. That was The Big Story. If you want more of thebigstorypodcast.ca is your destination every day for 4am new podcast. You can also find us on Twitter at @thebig storyFPN. You can also find us in your podcast player, whichever your favourite one happens to be. You can listen to us there. You can subscribe for free everywhere. You can rate us in some of them, you can review us in some of them. And you can tell your friends in real life and on social media. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.

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