The WHO doesn’t want the only Canadian-made vaccine. What does that mean for our 20 million twos?

The World Health Organization’s decision to pause the only Canadian-developed COVID vaccine’s application for emergency use around the world means the federal government may have a problem on its hands.

Or, more accurately, 20 million of them.

That’s how many doses of the plant-made shot known as Covifenz that are scheduled to be delivered to the federal government this year beginning as early as April, but with demand for vaccine here waning and WHO approval required for most donations internationally, many of them seem fated for freezers.

It’s a particularly jarring example as Canada continues to have regular access to vaccine deliveries — the product of seven different pre-purchase agreements, inked more than a year ago — while supplies remain scarce in some parts of the world.

The WHO’s issue with Medicago is not about safety or effectiveness. In trials, the dose was 71 per cent effective against infection by pre-Omicron variants, and 100 per cent effective at warding off serious illness.

But the Quebec-based company is partially owned by Philip Morris, the century-and-a-half-old tobacco giant that built a global fortune on, among other things, Marlboro cigarettes. (While Philip Morris owns 21 per cent of Medicago, a Japanese pharmaceutical company known as Mitsubishi Tanabe owns the lion’s share.)

This puts the company in violation of a long-standing World Health Organization policy against engaging with tobacco or weapons companies. This won’t affect the dose’s use here in Canada, though it’s not clear how many doses will be needed locally, when four out of five Canadians already have two shots.

Right now, Medicago is only authorized for adults, to be used in a regular two-dose regimen. It’s not recommended as a booster dose, for children or mixed with other vaccines.

Now the WHO’s decision will mean that the Medicago doses also can’t be given away through the international vaccine-sharing scheme COVAX, which depends on the WHO to vet all its vaccine candidates.

It’s a ruling that has divided even anti-tobacco activists and doctors over whether a total rejection of the tobacco industry is worth hampering a life-saving vaccine. (The shot itself is made from the leaves of a cousin of the tobacco plant, though officials are clear it’s not quite the same.)

“Your cynical side says, well, of course, (Philip Morris is getting into pharmaceuticals) because tobacco use is decreasing. But on the other hand, there’s a well-established agricultural approach to rapidly producing a lot of tobacco plants,” says Dr. Lynora Saxinger, an infectious disease expert based at the University of Alberta.

“My pragmatic side comes out a little bit ahead on this.”

In an email, a spokesperson for the WHO suggests the global body is itself mulling the issue over, and could decide to adjust its policies: “WHO is currently holding discussions on how to address a general trend of the tobacco industry investing in the health industry ,” the statement reads.

“We are exploring different policy options for potentially valid health products that are linked to the tobacco industry and will communicate as soon as a decision is made.”

The Medicago assessment is on hold until that happens. But the vaccine’s success is an especially pressing question for Canada, which sunk $173 million into the company’s new vaccine-manufacturing hub in Quebec City.

In an email, a company spokesperson said that while Canada is its only customer so far — having the only regulator to have authorized its use — “we are also in discussions with other potential customers worldwide pending approval.”

In the meantime, Canada could technically donate its doses bilaterally — meaning, directly to other countries, without going through COVAX. Doing so would require that country to have a regulator of its own to authorize the dose; not all low-income countries do. Furthermore, Canada’s bilateral donations so far have been in relatively small amounts.

The Medicago issue, however, is part of a larger issue, which is that Canada signed enough vaccine contracts for, if all of them were authorized, double-vaccinating the country’s population six times.

There was logic to this strategy, says Adam Houston, a PhD candidate at the University of Ottawa’s law faculty who works on public health and access to medicine. Back when these contracts were signed, no one knew which vaccines were going to work. But now, decisions will need to be made about what to do with the rest.

“This issue shouldn’t be allowed to overshadow Canada’s quite pathetic performance in terms of actually delivering on vaccines (to other countries),” he says, pointing out that Canada has other vaccines with WHO authorization that we could be sending.

“Nonetheless, we still have all of these vaccines.”