In an ideal world, a world without financial, logistical, and political constraints, your imagination is free to roam the galaxy. Universal free dental care? Guaranteed minimum income? Free post-secondary tuition? Sure. Why not?
Since, sadly, we don’t live in such a world, we’re forced to carefully weigh the potential benefits of proposed government programs against their costs.
Are there real-world constraints out there that could have helped us better focus our vaccination programme? Let’s first learn a bit more about the programme itself.
Statistics Canada reports that nearly $2.7 billion of “vaccines for human medicine” were imported to Canada between January and August, 2021. Of course, that figure covers all vaccines and not just those intended for COVID. And some might have been imported by private organizations or other levels of government. So we’ll need to compare 2021 with previous years to get a sense of how much of that 2021 number was spent for COVID.
Statistics Canada also tells us that the average total value of annual human vaccine imports between 2018 and 2020 was $663 million. We can therefore imagine that, without COVID, that’s more or less what we would have needed in 2021, too. Since, however, our 2021 figure only covers the first eight months of the year, we’ll assume that we’d normally have spent only around $437 million by this point in the year. Subtracting that amount from the actual total of $2.7 billion tells us that we actually spent around $2.26 billion on COVID vaccines.
But just paying for the vaccines themselves is only one part of the picture. Distributing and injecting all of those doses is the responsibility of the provinces. Ontario, for example, committed around $1.135 billion for vaccine administration between its 2020 and 2021 budgets. This, presumably, included practical infrastructure costs like reimbursing pharmacies “$13.00 for the costs associated with administering an injectable publicly funded COVID-19 vaccine” and staffing for public health facilities, along with maintenance for associated websites and mobile apps.
Extrapolating Ontario’s budgeted amount to the rest of the country by population (Ontario has 35% of the total population) would suggest that Canada’s provinces spent $3.3 billion administering COVID vaccines. Added to the federal vaccine purchases, it seems reasonable to estimate Canada’s total vaccine-related expenses up until August, 2021 at around $5.5 billion.
What did all that cash buy us? As of mid-October, 2021, an impressive 57 million doses found their way into Canadian arms. That translates to around $96.50 for each dose. By all measures that’s a lot of money. Nevertheless, most of us would agree the goal was worthy.
But could the program have been both more effective and a great deal cheaper? Or, in other words, did the vaccination campaign need to indiscriminately target the entire population, or could our primary goals have been largely met through vaccinating just a subset of the population?
We certainly started out thinking along those lines. After all, early vaccine doses were restricted to the oldest and most vulnerable Canadians. Back then, of course, it was about availability rather than cost. But government decisions should always account for strategic considerations just as much as tactical. And squeezing the greatest possible impact out of every public dollar should be a core strategic goal.
To illustrate, how important was it to insist on - and mandate - universal vaccination when that would include a large cohort of previously infected individuals? The global healthcare knowledge provider BMJ recently summarized the current state of the research:
“Several studies (in Qatar, England, Israel, and the US) have found infection rates at equally low levels among people who are fully vaccinated and those who have previously had covid-19. Cleveland Clinic surveyed its more than 50 000 employees to compare four groups based on history of SARS-CoV-2 infection and vaccination status. Not one of over 1300 unvaccinated employees who had been previously infected tested positive during the five months of the study. Researchers concluded that that cohort ‘are unlikely to benefit from covid-19 vaccination.’ In Israel, researchers accessed a database of the entire population to compare the efficacy of vaccination with previous infection and found nearly identical numbers. ‘Our results question the need to vaccinate previously infected individuals,’ they concluded.”
It’s certainly true that the Israeli study, for instance, noted the potential value in administering single shots even for infected individuals. But should that incremental “potential value” be a primary goal - even if it would mean starving other government programmes?
Just how much extra the universal vaccination program cost us will depend on how many Canadians have been infected. Unfortunately, that’s a number we can’t know with any precision. We do know that, as of mid October, 2021, there were 1.67 million confirmed COVID cases in Canada. And there’s strong evidence from multiple sources (including here, here, and here) that somewhere around 40 to 45% of all COVID cases are asymptomatic.
Since the large majority of people with asymptomatic cases would never have been tested and since, for various reasons, some symptomatic cases would also have gone unreported, it’s probably safe to assume that pegging total infections at a conservative three million cases is not unreasonable.
If, then, we had discouraged those three million people with natural immunity from getting vaccinated, how much would we have saved? Given that they represent around 8% of the total population, their share of the existing $5.5 billion budget would come to $440 million. Or, to put it in context, around six months worth of universal free dental care.