A volunteer participates in Medicago’s Phase I clinical trial for its COVID-19 vaccine candidate in Quebec City.Handout
Bob Bell is an orthopedic surgeon, clinician-scientist, educator, and former president and CEO of the University Health Network who served as Ontario’s deputy minister of health from 2014 to 2018.
Almost a year into the COVID-19 pandemic, the consequences continue to be extremely high – for people, for health care systems and for the economy. Yet despite the extraordinary steps governments and individuals have taken to try to slow the spread of the virus, a second wave is upon us.
What has become abundantly clear is that, no matter what risk-mitigation measures are implemented, including strict lockdowns and mandatory quarantines, we will only be able to truly turn the corner on the pandemic when there is a safe and effective vaccine.
The recent announcement by Pfizer and BioNTech that their vaccine candidate has shown promising preliminary results in Phase 3 clinical trials is certainly welcome news. But finding a vaccine that works is just the beginning. It then has to be manufactured on a huge scale and transported around the world so it can be administered to as many as seven billion people.
Equally important, but often overlooked, is the need for federal and provincial public-health officials to establish a system that will allow people to reliably show they have received the vaccine so they can safely return to work and to school, so we can start reopening the economy and help businesses recover.
The time to set up that system isn’t when a vaccine has been approved for administration. It’s now, so it is in place as soon as a vaccine is available. Every day of delay would mean more infections, more deaths and more damage to our economy and to the lives of millions of Canadians.
Similar advance planning is already under way to decide who should be the first to be vaccinated. The work of groups such as Canada’s National Advisory Committee on Immunization is essential to ensure health authorities can get the vaccine to those most in need as quickly as possible. The same urgent effort is needed to implement a tracking system that goes beyond vaccine distribution to include documenting vaccination.
That system has to be unified, comprehensive and trustworthy, so it can track vaccines from manufacturers to health care providers to individuals. It must be able to record the administration of that vaccine to each patient in a secure way that provides proof of immunization while simultaneously protecting patient privacy. And it must provide a standardized credential that individuals control but is also portable and can be verified by anyone across Canada and beyond for international travel.
The current system of recording immunization is woefully inadequate for these purposes. Right now, individuals are responsible for maintaining their own immunization records, using a paper Proof of Vaccination Record (POVR) they take to a health care provider whenever they receive a new vaccination. If they lose their POVR, or if it is incomplete, there is no central, secure database to recreate it. Patients must contact whoever administered a vaccination to get a new POVR, and if they can’t find a record of their immunization, they may even need to be revaccinated.
Not only is this inefficient, time-consuming and costly, it’s risky when it comes to COVID-19. The person who lost their POVR may not be able to return safely to work or school until they have recreated the POVR or have been revaccinated. Meanwhile, they will be adding to the already heavy burden on health care providers by asking them to prepare a duplicate POVR or readminister a vaccine that is needed by someone else. This will interfere with the ability to get as many people immunized as quickly as possible.
Another important benefit of a standardized, secure digital health credential for COVID-19 immunization is that access control to protected sites (such as schools, seniors' homes, workplaces, public venues and transportation infrastructure) can be logged for contact-tracing purposes, all while preserving the privacy of the individual.
Canada must act now to have this system ready as soon as a vaccine becomes available. Fortunately, technologies already exist to create this system and make it portable and accessible to anyone (with or without an internet connection or a smartphone) in a way that promotes public health and protects personal privacy and patient data.
What is needed now is a national plan and federal leadership to co-ordinate and fund these efforts, similar to how the COVID Alert app was developed and rolled out across the country.
The price of not being ready is too great.
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