Vaccine development is normally a long, drawn-out affair that stretches beyond a decade, but the COVID-19 pandemic has driven everyone with a stake in the process — including people who determine drug prices — to move faster than ever.
Once drugs are approved by Health Canada, they head to the Patented Medicine Prices Review Board, an independent federal agency that regulates drug prices.
Provinces, communicating on their own with manufacturers, or as a group through the pan-Canadian Pharmaceutical Alliance, then negotiate the prices they will pay to access the drugs.
This part of the process typically takes between six and eight months but it can last for two years.
"We cannot afford to wait," said Christopher McCabe, who is a health economist, professor in the University of Alberta's faculty of medicine, and the executive director and CEO of the non-profit Institute of Health Economics.
In a Wednesday interview with CBC Edmonton's Radio Active, McCabe explained why Canada's federal government, like many governments around the world, has rushed to make deals with drug companies before vaccines have been approved.
"We need to be set up to roll out the vaccine as close to the time it's approved as possible," he said.
McCabe compared the federal government's strategy to managing an investment portfolio.
Instead of investing in just one company, the government is backing a range of stocks in the hope that at least one will work.
"We have to get into agreements before we know the vaccines are entirely successful," said Dr. Lorne Tyrrell, a virologist who directs the Li Ka Shing Institute of Virology at the U of A.
Tyrrell was recently appointed to Canada's Covid-19 Task Force, a group of experts advising the federal government on COVID-19 vaccines.
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U.S. prices offer clues for Canadians
Experts are looking south of the border for hints as to what the medicine could cost for Canada.
In an interview with CBC's Edmonton AM last month, Tyrrell said prices for the pre-ordered vaccines are ranging from $20 to $60 per dose.
Some companies have made pledges to keep prices more affordable, he said.
By McCabe's estimate, it could cost more than $3 billion to immunize all Canadians, assuming everyone needs two doses of the vaccine.
Access and affordability are important from an ethics and public health perspective, considering the global spread of the virus.
"If our objective is to return to pre-COVID times in terms of freedom of movement around the world, then we need to be confident that people in low and middle-income countries are also getting covered," McCabe said.
Competition among companies could push prices down, should more than one vaccine work.
Canada has another tool available in the event a drug manufacturer refuses to agree to a "reasonable" price.
In March, Parliament made changes to the Patent Act, allowing for the use of a patented invention "to the extent necessary to respond to a public health emergency that is a matter of national concern."
This means the government could issue a compulsory licence to one drug company but have another manufacture the vaccine.
"There is protection against a company that tries to hold us ransom, requiring an unreasonable price," McCabe said, though the economist does not expect to see this happen.
Who will receive the first vaccines in Canada?
McCabe said the first batch of vaccines will go to high-risk and economically important parts of the Canadian population.
But determining who those people are is no easy task.
"That's a discussion that's going on now, I'm sure," he said.
"It's not a simple set of choices."
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