(Region A – North America)
COVID-19 pandemic in Canada
The COVID-19 pandemic in Canada is part of the ongoing worldwide pandemic of coronavirus disease 2019 (COVID-19). It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most cases over the course of the pandemic have been in Ontario, Quebec, British Columbia and Alberta. Confirmed cases have been reported in all of Canada’s provinces and territories.
The virus was confirmed to have reached Canada on January 25, 2020, after an individual who had returned to Toronto from Wuhan, Hubei, China, tested positive. The first case of community transmission in Canada was confirmed in British Columbia on March 5. In March 2020, as cases of community transmission were confirmed, all of Canada’s provinces and territories declared states of emergency. Provinces and territories have, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. The federal Minister of Health invoked the Quarantine Act, introduced following the 2002–2004 SARS outbreak. For the first time in its legislative history, the act has been used, legally requiring all travellers (excluding essential workers) returning to the country to self-isolate for 14 days, until rules were changed to accommodate fully vaccinated travellers.
By mid to late summer of 2020, the country saw a steady decline in active cases until the beginning of late summer. Through autumn, the country saw a resurgence of cases in all provinces and territories. On September 23, 2020, Prime Minister Trudeau declared that Canada was experiencing a “second wave” of the virus. New restrictions from provincial governments were put in place once again as cases increased, including variations of regional lockdowns. In late November, there was the disbandment of the Atlantic Bubble, a travel-restricted area of the country (formed of the four Atlantic provinces: New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland and Labrador) which had been established in July 2020. The federal government passed legislation to approve further modified economic aid for businesses and individuals.
Nation-wide cases, hospitalizations and deaths spiked preceding and following the Christmas and holiday season in December 2020 and January 2021. Alarmed by hospital capacity issues, fatalities and new cases, heavy restrictions (such as lockdowns and curfews) were put in place in affected areas (primarily Ontario, Quebec, and Alberta) and across the country. These lockdowns resulted in active cases to steadily decline, reaching a plateau in active cases in mid-February 2021. During a third wave of the virus, cases began rising across most provinces west of Atlantic Canada in mid-March, prompting further lockdowns and restrictions in the most populous provinces like Ontario and Quebec. Due to a relatively low volume of cases in the Atlantic provinces, the travel-restricted Atlantic Bubble was planned to reopen; however, in late April, the third wave had spread to the Atlantic provinces. In response, Newfoundland and Labrador, Prince Edward Island, and Nova Scotia reinstated travel bans toward the rest of the country.
Following Health Canada’s approval of the Pfizer–BioNTech COVID-19 vaccine, and later the mRNA-1273 vaccine developed by Moderna, mass vaccinations began nationwide on December 14, 2020. On February 26, 2021, Health Canada approved the Oxford–AstraZeneca COVID-19 vaccine for use, and on March 5, 2021, they additionally approved the Janssen COVID-19 vaccine for a total of four approved vaccines in the nation. However, most provinces discontinued first doses of Oxford-AstraZeneca by May 12, 2021, while the administration of the Janssen vaccine was determined unnecessary. Canada became one of the most vaccinated countries in the world, with a continually high uptake of the vaccine. Despite high general uptake of the vaccine, cases began to surge particularly amongst the unvaccinated population in provinces like Alberta, which had removed nearly all pandemic restrictions.
Near the end of summer 2021, cases began to surge across Canada, notably in the provinces of British Columbia, Alberta, Quebec and Ontario, particularly amongst the unvaccinated population. During this fourth wave of the virus, return to pandemic restrictions such as mask mandates were reinstated in provinces like British Columbia and Alberta. The surge in cases was largely deemed to be a “pandemic of the unvaccinated” and resulted in the introduction of vaccine passports, for all provinces and two of the territories. Federally, Prime Minister Justin Trudeau instated requirements for vaccination in order to partake in air travel, as well as those who ride Via Rail and Rocky Mountaineer trains as of October 30, 2021. Additionally, the mandate included any federally regulated workers. In January 2022, all of Canada’s provinces and territories were experiencing record-level case numbers, primarily driven by the SARS-CoV-2 Omicron variant, which caused provincial and territorial governments to reintroduce restrictions surrounding travel and isolation. However, in mid-February active caseloads and hospitalizations began to decrease and towards the end of February 2022, almost all provinces and territories had announced plans to lift restrictions by early March or mid-March 2022, if epidemiology remained favorable.
COVID-19 vaccination in Canada
COVID-19 vaccination in Canada is an ongoing, intergovernmental effort coordinated between the bodies responsible in the Government of Canada to acquire and distribute vaccines to individual provincial and territorial governments who in turn administer authorized COVID-19 vaccines during the COVID-19 pandemic in Canada. Provinces have worked with local municipal governments, hospital systems, family doctors and independently owned pharmacies to aid in part, or in full with vaccination rollout. The vaccination effort in full is the largest such immunization effort in the nation’s history. The vaccination effort began December 14, 2020, and is currently ongoing.
Health Canada is responsible for approval and regulation of vaccines (and other pharmaceuticals), while the Public Health Agency of Canada (PHAC) is responsible for public health, emergency preparedness and response, and infectious and chronic disease control and prevention. Vaccines are authorized by Health Canada, purchased by the Government of Canada and distributed by PHAC to individual provinces and territories in tranches based on various factors such as population size and prioritized peoples. The National Advisory Committee on Immunization (NACI) has also issued recommendations on how vaccines should be distributed, in what intervals and to which populations. NACI has also been involved in recommendations on the use or disuse of vaccines to certain ages or populations.
The National Research Council Canada (NRC) has made investments in the domestic development of vaccine candidates, including candidates by the University of Saskatchewan and Variation Biotechnologies. In May 2020, the NRC announced a planned agreement to conduct clinical trials of a vaccine candidate by Chinese company CanSino Biologics, and plans to manufacture it at its facilities in Montreal once authorized. However, the deal collapsed due to strained Canada–China relations, and the federal government later announced commitments to purchase vaccines being produced by AstraZeneca, Moderna, Pfizer and Janssen.
In early 2021, both Pfizer–BioNTech and Moderna did not ship the agreed upon quantities of secured vaccines to Canada and other countries, due to manufacturing challenges. This caused a vaccine shortage and significant slowdown in vaccine rollout. By mid-February 2021, significant increases in manufacturing and delivery of vaccines in conjunction with a recommendation by NACI to extend second dose administration to a maximum of 16 weeks resulted in a larger ramp-up in vaccine delivery across the nation and by July 2021, Canada’s vaccine supply had grown to allow a return to shortened dose intervals.
Following Health Canada’s emergency authorization of the Pfizer–BioNTech vaccine on December 9, 2020, mass vaccination efforts began across the country on December 14, 2020. The agency later authorized the Moderna vaccine on December 23, 2020. On February 26, 2021, Health Canada authorized the Oxford–AstraZeneca vaccine for use. Following concerns of blood clotting events the Oxford-AstraZeneca vaccine was largely discontinued for use, and those who had already received a first dose were encouraged to receive an mRNA vaccine as their second dose. The Janssen vaccine was authorized on March 5, 2021; however, Canada did not receive a delivery of the Janssen vaccine until April 28, 2021; which was then destroyed due to contamination issues at its factory of origin. Use of Janssen was put on hold until November 2021, when the government acquired doses for use with vaccine-hesitant populations.
Canada became the first country to authorize a COVID-19 vaccine for people younger than 16 after approving Pfizer’s vaccine for children aged 12 to 15 on May 5, 2021. In August 2021, the Moderna vaccine was authorized for use in children aged 12 and up. On September 16, 2021, Health Canada granted full approval to the Moderna and Pfizer vaccines and in November 2021, Health Canada approved the Pfizer-BioNTech and Moderna vaccines for use as booster (or third doses). On November 19, 2021, Health Canada approved the Pfizer-BioNTech vaccine (with a lower dosage) for children aged five to eleven. On February 17, 2022, Health Canada approved the Novavax vaccine, which is the first approved COVID-19 protein subunit vaccine.