They’d been waiting for months.
In the heady early days of the COVID-19 vaccination campaign, the spotlight on vaccine makers birthed a new awareness of branding and vaccine technology. In a country that regularly authorizes almost a dozen different flu vaccines with little fuss — they’re all, collectively, known as “the” flu shot — suddenly people were keenly aware of which COVID vaccine they were getting.
The first two vaccines out of the gate in Canada — both powered by a new technology that used mRNA — took on a veneer of cool in many circles, with people online showing off their postvaccination Band-Aids and jokingly declaring themselves members of the #ModernaMafia or #PfizerGang. (An audio clip declaring that “only hot people get Pfizer” briefly took over TikTok.)
But through it all, another small — but vocal — group has been watching, and waiting, for one of the relative (non-mRNA) underdogs in the vaccine race.
The shot made by a small Maryland-based company is finally on Canadian soil, and in recent weeks roughly 75,000 shots have rolled out across the country. It’s not clear how many people were waiting, but what they lack in numbers they make up in passion.
They say the went without getting vaccinated for more than a year — not because they were against vaccines, but because they wanted only one.
While multiple people reached out to the Star about their plans to get Novavax, they were reluctant to be named because of fears they’d be targeted as anti-vaxxers online. But online message boards devoted to the vaccine are filled with people asking questions about where to get the shot and even claiming they’d travel to do so. (One person who reached out to the Star called to book an appointment the first morning doses became available in his region, but said there were no appointments available.)
It’s not a phenomenon unique to Canada — when Australia rolled out the shot in January, John Skerritt, head of the immunization regulator there, told reporters there that interest in the Novavax vaccine had been unusual.
“I have (received) several hundred emails from individuals and groups who have said for whatever reason we would like to have (this) particular vaccine … this just gives them further choice,” John Skerritt said.
The hope is that the vaccines will be an attractive option to people who trust this particular technology.
The fear, some experts say, is that anti-vaccine advocates will use them to undermine trust in existing shots.
By almost any metric, Novavax’s is a solid vaccine. It’s cheaper and easier to transport than the mRNA shots and was roughly as effective — around 90 per cent — in large-scale trials. Yet for many, the shot’s primary selling point is that it is made with protein, a familiar biological building block already used in vaccines for childhood illnesses such as flu or pertussis.
“People can understand that,” says Silvia Taylor, a senior vice-president for the biotech firm. “There are lots of pictures, you see the picture of the spike protein, and then you’re like, ‘Well, that’s what I’m giving you.’”
Taylor stresses that her company’s “tried and true” technology offers people a choice, which can be an empowering thing, even when there isn’t a global pandemic raging. Indeed, most of the provinces in which Novavax has now been distributed (it’s officially available in every province and territory except Nunavut) have a way for people to call and ask for this particular vaccine directly.
Politicians in Canada and in other countries are hoping that putting another item on the menu could push vaccination rates even higher.
“(Novavax) is a great alternative for those who don’t want an mRNA vaccine,” Ontario’s chief medical officer, Dr. Kieran Moore, told reporters in February. In Australia, health officials are hoping that rolling out the dose will boost vaccination rates by as much as a full percentage point.
Yet in some circles, the vaccine has been viewed in increasingly ominous contrast to the newer mRNA technology, which has become the target of misinformation campaigns online by people who said mRNA vaccines were dangerous, had been rushed too quickly, or even affected your DNA.
To be clear, hundreds of millions of shots have now been administered safely around the world, the mRNA vaccines were built on a decade of previous research and experts are clear it’s not possible for mRNA to change your DNA.
In the United States, Dr. Peter McCullough, a doctor who has made several false claims about the dangers of mRNA has pushed Novavax as an alternative. Online message boards devoted to the Novavax shot feature genuine questions from curious people, but also posts about the unproven dangers of mRNA.
As a result, some experts worry that the Novavax vaccine is being used as a Trojan horse for unscientific anti-vaccine views.
“For me, it highlights a very subtle thing, which is the power of doubt-mongering,” says Tim Caulfield, the Canada Research Chair in health law and policy, based at the University of Alberta, who specializes in misinformation.
“They’re not anti-vax, but they have heard just enough noise surrounding the mRNA vaccines that they have this doubt and are willing to wait for this new vaccine.”
Of course, some people on the Novavax bandwagon are there because they’ve read up on their options and just feel more comfortable with this one. In some ways, it’s a dialed-up version of last year’s #ModernaMafia or the #PfizerGang.
But the larger worry here, Caulfield says, is that the way we’re all talking about Novavax — emphasizing the traditional technology, and alternatives to mRNA — risks feeding into the very insidious anti-vaccine narrative that mRNA is dangerous.
“That’s my number one concern: that this entire conversation, how it’s portrayed in the media, and even how public health officials talk about it, is going to legitimize the concerns associated with the mRNA vaccines.”
As the world careens into the third year of a pandemic, the story of the vaccine race is still being written. Two years ago, no one was quite sure if we’d end up with even one working vaccine; now there are a handful to choose from.
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While Moderna and Pfizer dominated the early vaccine conversation, newcomers such as Novavax — and Canadian-made Medicago — are jumping in right in time for boosters, doses for children and shipments to other countries.
The vaccination race is a different game than it was a year and a half ago, however. People in countries such as Canada are no longer feeling the same urgency to get vaccinated, which means public health officials and vaccine makers are grappling with complacency.
“The thing that’s different about vaccines is that vaccines are given typically to people who are well — to prevent illness,” Taylor, the spokesperson for Novavax says. Speaking generally, it can be hard to convince an otherwise healthy person to take one — she points to influenza vaccination campaigns, which are in a perennial struggle to get people to show up.
Early on in the pandemic, fear of the virus drove many to vaccination sites, but now, both public health officials and vaccine makers are looking to pull on other levers.
That’s why the company is glad to see the passion from Novavax fans, and hopes this will translate into people getting vaccinated. Taylor stresses that the company has not tried to “find” them, but the fandom is something that has developed organically.
“You know, our vice-president in the U.S. (Kamala Harris) just tested positive for COVID,” she says. “I have colleagues who are just testing positive, I had it myself a few weeks ago. So there is a danger to people thinking this is over and not getting vaccinated.
“We’re excited to be able to meet the moment.”
When the pandemic began, Novavax had yet to get a vaccine to market. But like many biotech companies, when it became clear what was coming, they put their other projects on hold.
Most vaccines work by teaching your body to recognize — and then fight off — the coronavirus’ signature spike protein. But there are a handful of different platforms — vaccine-speak for technologies — that can be used. The mRNA shots pass instructions to your own cells so they make their own, while both the Johnson & Johnson and AstraZeneca shots are what’s known as a viral vector, when a different virus is used to sneak a bit of spike protein into your cells.
Novavax, meanwhile, simply injects you with a tiny spike protein, already made. Though viral-vector vaccines have been around for a few decades, by comparison, protein-based vaccines — with a technology commonly used for routine childhood shots — might be seen as easier to explain, and to trust. (Medicago, the Canadian-developed vaccine, is also protein-based, but isn’t yet available.)
There are some notable tweaks within the Novavax shot, however. Dr. Cora Constantinescu, a Calgary-based pediatric infectious disease expert who specializes in working with parents who are hesitant to vaccinate their kids, notes that the company has put their own spin on a protein vaccine by using moth cells to produce the bits of protein.
They’re also using an adjuvant — an ingredient which helps a vaccine prompt a bigger response, meaning you can use less of it — made from the soapbark tree, found in Chile.
“It’s the one type of vaccine that people are used to, but the actual technology and the way Novavax did it is still novel to the vaccine,” she says.
The vaccine’s Phase 3 trial (in which the shot is administered to thousands of people) showed strong efficacy and limited side effects, creating a buzz loud enough for a piece in the Atlantic to dub it “the best” COVID vaccine last summer.
But after a promising start, the vaccine quickly ran into issues, as Novavax raced to build a manufacturing network to rival much larger pharmaceutical companies. The company’s stock lost almost a quarter of its value in a day last fall after media reports that it was having manufacturing issues, and was struggling to meet American regulators’ purity standards, according to reporting by Politico.
In the annual filing with to the United States Securities and Exchange Commission from March, Novavax noted that this was its first attempt at a vaccine, and launching it during a global pandemic “creates additional challenges,” as the company needed to not only scale up quickly but establish supply chains around the world.
In short, it may not be able to do so as quickly as it had hoped, the filing noted. “Shortages of raw materials and supplies also negatively impact our manufacturing efforts,” it said.
In particular, the filing mentions the ingredient extracted from the Chilean soapbark, also known as Quillaja saponaria. “We need long term access to quillaja extract with a consistent and sufficiently high quality,” or the company may not meet its commitments, it notes.
As of February, the company had delivered just a fraction of the two billion doses it had planned to ship this year, and first-quarter shipments had been delayed in Europe.
But Taylor, the spokesperson for Novavax, said that while it’s clear about the challenges faced, it has resolved manufacturing issues, and the company is confident it will hit its two-billion goal.
Following a few months behind the vaccine front-runners has had some advantages, she said. The company did its large-scale testing months after Moderna and Pfizer, which means their dose was tested against some of the very first variants.
The next question, of course, will be whether the passion for Novavax will translate into real-world vaccination.
While Novavax has said that distribution in countries such as Indonesia is going well, health officials in the European Union have said uptake has been “underwhelming” so far.
Since mid-April, roughly 75,000 doses have been distributed in Canada, with the largest amounts, relative to population, going to Ontario, Alberta, British Columbia and Manitoba.
Both Alberta and Manitoba received about 10,000 doses each. Alberta has used about 420 and Manitoba has used 50 in vaccine clinics, though that doesn’t include any used by physicians. An Alberta spokesperson notes its system for Novavax is more challenging to navigate than for other doses — people must call to book appointments that are only available on certain days. (The Star has also reached out to Ontario and British Columbia.)
Experts are divided on whether all of this could spur an uptick in vaccination rates. But in the end, at least for now, most doctors are in agreement that the ends may justify the means.
“Whatever it takes for people to get vaccinated,” Constantinescu says. “If they’ve been waiting for Novavax, then come on out and take it.”
Alex Boyd is a Calgary-based reporter for the Star. Follow her on Twitter: @alex_n_boyd
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