10:23 GMT27 January 2021
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    US Health and Human Services Secretary (HHS) Alex Azar has said the Trump administration is confident that it has enough contracts with pharmaceutical companies to ensure there are sufficient doses to vaccinate all Americans despite media reports claiming otherwise.

    Reports suggesting that the United States might face a shortage of vaccines against the coronavirus, or that President Donald Trump's administration had turned down an offer to purchase more Pfizer/BioNTech vaccines have raised great concern among Americans.

    In light of these reports, the HHS assured the public that there will be sufficient doses to vaccinate everyone. Miles Fahlman, Associate Researcher, SPHERU USask College of Medicine, and epidemiologist who spent five years studying the first SARS virus for his master's thesis, has offered his views on the matter and revealed how Canada responded to the pandemic.

    Sputnik: According to a Washington Post report, despite the fact that the first batches of the COVID vaccine will be delivered by the end of the month, the number of vaccines has been slashed to about 10% of what had been promised. Manufacturing problems, logistics bottlenecks, and a lack of raw material supplies to laboratories are cited as one of the main reasons for a delay. What is in your opinion is the real reason for the lack of vaccine and such a delay at the height of the pandemic?

    Miles Fahlman: From my understanding, the populations to receive the Pfizer (and then likely the Moderna vaccine) have been segmented by internal vote (FDA-CDC and Health Canada) to the most vulnerable and aged >80, healthcare workers, the elderly >70-80 and then down to children and teachers in school and the rest of the population. Health Canada has yet to approve the Pfizer vaccine but will likely follow suit with the FDA (Thursday-Friday) or shortly after. These timelines and amounts of vaccinations available have been in the news for several news cycles, (weeks) so the 10% amount you reference both cannot be confirmed and has been expected due to the delays you describe.

    I am not aware of anything beyond that (being in touch with Canada’s top virologists and vaccinologists on a daily basis). These movements and amounts have been kept relatively free of the politicization that we have seen throughout the pandemic, both in Canada and the USA, I have read the documentation surrounding this, which was both developed by govt health agencies and in many cases, the stakeholders on these committees are people I know and interact with daily. Several statements have come out covering hundreds of thousands of doses for Canada in the near future and before December 31, and then in the millions for January 2021. It would be highly unusual (and frankly political suicide) for these announcements to be made without both contractual and factual evidence available to back them up. This timeline is widely circulated and is part of a messaging system that is inextricably tied to public healthcare in Canada (and answer to #3).

    Sputnik: The number of infected people in the US has only increased recently with an average of 200.000 new cases daily. How could a potential vaccine delay affect the current situation with the number of COVID cases in the US?

    Miles Fahlman: What we see here is mass inoculations following the segmentation described earlier in the USA from December 2020 to May 2021. In terms of disease transmission dynamics, politics and vaccination segmentation, there is the area of school aged children and educators that has been shifted lower. Due to spread in homes and the asymptomatic likelihood in children, this may be an area of concern.

    A passenger gets swabbed for COVID-19 at a testing site at the convention center in Providence, R.I, Tuesday, Dec. 1, 2020
    © AP Photo / David Goldman
    A passenger gets swabbed for COVID-19 at a testing site at the convention center in Providence, R.I, Tuesday, Dec. 1, 2020

    The concern is that the future of transmission dynamics is in the schools so this group should be further up the chain. That is a valid concern in my opinion, that much outweighs the vaccination delay as somehow premediated or corrupted. The economy wins, especially in the USA so you will see a huge push to get the vaccine out and into the population to combine with those infected toward dropping the transmission reproduction number to well below 1, that is a huge driver, rather than delay.

    Sputnik: Why is the incidence rate in neighboring Canada several times lower? How are their methods of dealing with the pandemic different from the US strategy?

    Miles Fahlman: Centralized healthcare, a distinct form of messaging driven by the provincial health authorities separate and announced each day (ad nauseum imo) by the health authorities and not the politically elected (in my case the SHA, who we report behavioral study results of the Social Contours Project on a monthly basis) which is delivered congruently with the Federal Health Authority.

    I have monitored this in Canada since the beginning, and it’s still going daily and I’ve cancelled a ski trip to neighboring Alberta who have announced a lockdown at 5 pm yesterday (by their public health authority, delivered by the elected premier who is accused of being late!) the PHA drove this decision, no question. Therein lies a key difference between the USA and Canada, science and the public health authority (credentialed and hired govt staff) dominating elected officials in an oil-rich province on full display for your 5 pm national news channel.

    Sputnik: What mistakes, in your opinion, were made in the fight against the pandemic?

    Miles Fahlman: As a Medical Anthropologist and a trained epidemiologist, the first mistake in both Canada and the USA was the late start and confusion on the information coming from China. I tracked the disease in December and heavily in Jan 2020, and read Dr. Bruce Alyward’s report Feb 14. Anyone who understood SARS1 knew SARS2 was coming by Feb 2020. At that time I was reporting it repeatedly to the PHAC on Twitter and remain to this day in touch with epidemiologists and virologists on that medium since Jan 2020. If you read that report and extrapolate, we had all the data we needed to manage our lockdown and contain.

    But the information overload and decentralized and private healthcare in the USA as well as messaging segmented the required central response and was devastating. If you track both centralized healthcare and centralized governments, you can see the correlation in epi data and results. After my thesis on central govt response in Vietnam after having gone through it with a colleague in Hanoi in 2003, on this I would not waiver. Where Canada has had some successes in central messaging by science and the PHAs, the fragmentation in messaging and execution in the USA is devastating, but likely in their view can be resolved with the vaccination rollout under a new administration. Canada's mistakes lie in opening the economy too soon, tracking and adjusting as data became available but to be honest it is mostly under control, and vigilance continues as we are already receiving messaging to stay aware even with vaccines coming.

    Sputnik: In your opinion, what strategy does the US need to combat the spread of the virus? Is the state-by-state approach rational or is it necessary to build out a national strategy? What are the merits and demerits of each of these approaches?

    Miles Fahlman: To date, there is no discernable strategy in the USA, as evidenced by the epi data. This may change under a new administration and an earnest approach to vaccination. Without a comprehensive national strategy and the social solidarity prevailing over individual rights and freedoms, you cannot combat pandemics. There is a decorated virologist from Columbia University and Georgetown USA who has just announced her move to her own lab at Vido Intervac here in my city of Saskatoon.

    That should suggest the fragmentation of response from a scientific perspective, and an in ability to utilize sound science in times of pandemic response. Someone who has dedicated their lives to one topic, has factual evidence and data to back it up, and cannot find traction in contemporary society due to politicization and conspiracy? There will be many lessons learned after this one both in Canada and USA. As I am writing this Health Canada just approved the Pfizer vaccine ahead of USA. Wonders will never cease my friends, but the USA should have completed the process already under the  “Warp Speed” initiative. Good luck. I have read some very good data on the Sputnik Vaccine in Russia, impressive and would like to hear of the vaccination roll out data there if at all possible.

    The views and opinions expressed in the article do not necessarily reflect those of Sputnik.

    Canada, Pfizer, Trump, US, Vaccine, COVID-19
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