COVID-19 vaccination in Canada

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COVID-19 vaccination in Canada
Covid-19 Vaccination Map of Canada.png
COVID-19 Vaccination Map of Canada as of April 7, 2021
DateDecember 14, 2020 (2020-12-14)-present
LocationCanada
Also known asVaccins contre la COVID-19 (French)
CauseCOVID-19 pandemic in Canada
Organized byHealth Canada
Public Health Agency of Canada
Provincial and Territorial governments
Municipal government in Canada
Participants13,056,769 people with at least one dose administered of Pfizer-BioNTech, Moderna or AstraZeneca
1,152,995 Total vaccinated people
(to which the first and second dose of vaccine were administered)[1]
Outcome34.35% of the Canadian population has received at least one dose of a vaccine[1]
WebsiteGovernment of Canada
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The COVID-19 vaccination programme 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 approved COVID-19 vaccines during the COVID-19 pandemic in Canada. Some provinces have asked local Municipal governments, hospital systems, family doctors and independently owned pharmacies to aid in part, or in full with vaccination rollout.[2] The vaccination effort in full is the largest such immunization effort in the nation's history.[3] With Health Canada approving the Pfizer–BioNTech COVID-19 vaccine on December 9, 2020, mass vaccination efforts began across the country on December 14, 2020. The agency later approved the mRNA-1273 vaccine developed by Moderna on December 23, 2020.

In Canada, 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 approved 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 (NAIC) has also issued recommendations on how vaccines should be distributed.

From about mid-January until mid-February, both the Pfizer–BioNTech and Moderna did not ship the agreed upon quantities of secured vaccines to Canada and other countries, due to manufacturing challenges.[4] By February 18, Major General Dany Fortin, who leads vaccine logistics at the Public Health Agency of Canada (PHAC), announced that the vaccine delivery was back on track and that there will now be an "abundance of supplies" which will result in a "significant scaling-up of immunization plans in provinces."[5] 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 in March and April 2021.

On February 26, 2021 Health Canada approved the Oxford–AstraZeneca vaccine for use,[6] and its first shipments arrived in Canada on March 3, 2021.[7] The Johnson & Johnson vaccine was approved on March 5, 2021 to become the fourth vaccine to receive Health Canada approval,[8] however Canada did not receive a delivery of the vaccine until April 28, 2021.[9]

Background and timeline[edit]

Preparations[edit]

In anticipation of a COVID-19 vaccine, the Canadian government purchased more than 75 million hypodermic needles and syringes in summer 2020.[10] The government made deals with the leading research companies developing a vaccine.[11]

In September 2020, AstraZeneca agreed to provide 20 million doses of the Oxford–AstraZeneca COVID-19 vaccine to Canada.[11][12]

COVID-19 Vaccine Task Force (VTF)[edit]

In March 2020, the federal government announced a CA$275 million investment for "coronavirus research and medical countermeasures"[13] and on April 23, 2020 over CA$1 billion in additional financial support was announced. This funding for "national medical research strategy to fight COVID-19" included "vaccine development, the production of treatments, and tracking of the virus."[13]

There are two task forces in place to respond to COVID-19—the Therapeutics Task Force (TTF) and COVID-19 Vaccine Task Force (VTF).[14] Nancy Harrison and Cédric Bisson are co-chairs of the Therapeutics Task Force (TTF) tasked with prioritizing "financial support for promising COVID-19 treatment projects."[14] The secretariat of the Therapeutics Task Force is housed at the Department of Innovation, Science and Industry (ISED). Joanne Langley and J. Mark Lievonen are the co-chairs VTF advising the federal government on "vaccine development, related bio-manufacturing and international partnerships".[14] The secretariat of the Vaccine Task force is supported by the National Research Council of Canada.[14]

From June through August 2020, initial proposals for domestic production and international acquisition of COVID-19 therapies and vaccines were evaluated—including proposals from pharmaceutical companies such as Laval, Quebec-based-Biodextris, Calgary, Alberta-based-Providence Therapeutics, Edmonton, Alberta-based-Entos Pharmaceuticals, Montréal-based Glycovax Pharma, Vancouver-based-Precision Nanosystems, Vancouver-based Symvivo Incorporated, Dartmouth, Nova Scotia-based Immunovaccine Technologies Inc., Quebec City-based Medicago Inc., Maryland-based Novavax whose vaccine will be produced at the Biologics Manufacturing Centre in Montreal,[15] AstraZeneca, Pfizer, Variation Biotechnologies (VBI), Moderna, Johnson & Johnson, Sanofi / GSK. The first announcements of approvals began on August 5 for Pfizer and Moderna and most of the approvals and related funding was announced in October 2020.[16] By February 2021, the NRC and the ISED support for Made-in-Canada vaccines and therapeutics for COVID-19, included $37 million in stage 1 funding for six vaccine candidates and seven therapeutics candidates for COVID-19.[15]

Although Canada did not have facilities capable of producing COVID-19 vaccines at the outbreak of the pandemic,[17][Notes 1][18][Notes 2][Notes 3][19] on August 31, 2020, Prime Minister Trudeau announced a federal investment of $126 million to "design, construct, commission and qualify a new biomanufacturing facility"—the Biologics Manufacturing Centre to be completed by the end of July 2021.[20] It will be built beside the National Research Council Canada's Royalmount site in Montréal and will have a "production capacity of approximately 4,000 litres per month, which translates to approximately 2 million doses of a vaccine per month".[20] The federal government will provide an annual operating costs fund of $20 million.

On February 2, 2021, Trudeau announced a deal with Novavax to produce COVID-19 vaccines at the Biologics Manufacturing Centre, making it the first to be produced domestically.[21] The Novavax COVID-19 vaccine is currently awaiting approval by Health Canada.[22] This is the first deal signed by Canada that allows a domestic manufacturing of a foreign vaccine. The contract with Novavax is for 52 million doses of the vaccine.[21] Following VTF and TTF recommendations, the federal government announced investment in two biomanufacturing companies—Vancouver-based Precision NanoSystems Incorporated (PNI) and Markham, Ontario-based Edesa Biotech Inc. (Edesa).[23] PNI, biotechnology company, will receive up to $25.1 million to build a "$50.2 million biomanufacturing centre to produce vaccines and therapeutics for the prevention and treatment of diseases such as infectious diseases, rare diseases, cancer and other areas of unmet need". Edesa will receive up to $14 million to Edesa Biotech to "advance work on a monoclonal antibody therapy for acute respiratory distress syndrome, which is the leading cause of COVID-19 deaths.[23]

Initial approvals and rollout[edit]

On December 9, 2020, Health Canada approved the Pfizer–BioNTech COVID-19 vaccine. The Public Health Agency of Canada supervises the rollout and administration of the vaccine.[24] By mid-December 2020, Pfizer had agreements to supply 20 million doses to Canada.[25] Healthcare institutions began administering the first 30,000 doses of the Pfizer–BioNTech COVID-19 vaccine in Canada on December 14. A total of 249,000 doses are expected to be delivered by the end of 2020.[26] Because of the cold storage logistics, the initial doses were delivered to 14 distribution sites in the provinces, with none being sent to the Canadian territories since they could not properly store the vaccine. The 14 original distribution sites are located in St. John's, Halifax, Charlottetown, Miramichi, Quebec City, Montreal, Ottawa, Toronto, Winnipeg, Regina, Edmonton, Calgary, and two in the Greater Vancouver area.[27] The Canadian government expects the vaccine to be administered to high-priority groups, designated by each province, until the end of March.[26] Most provinces are first prioritizing some subset of healthcare workers, except for Quebec, which is prioritizing residents of long-term care homes, as well as British Columbia, New Brunswick, and Prince Edward Island, which are prioritizing both. Most provinces also have plans to expand priority status to additional groups—such as the elderly, or adults in Indigenous communities—before expanding to the general public.[28]

In the same week as initial vaccinations for the Pfizer–BioNTech COVID-19 vaccine, Health Canada approved the Moderna COVID-19 vaccine, an mRNA-1273 vaccine on December 23, and it was announced that Canada would receive 168,000 doses of the Moderna vaccine before the end of 2020.[29][30] Unlike the Pfizer–BioNTech COVID-19 vaccine, the Moderna vaccine does not require extreme cold temperature storage[30] which meant that as of December 28, Northwest Territories and Yukon had received their first shipments of 7,200 each of the Moderna vaccine.[31] Vaccinations in each territory are not scheduled to occur until mid-January.[32]

Manufacturing delays[edit]

Total number of people receiving vaccinations in Canada as of May 3, 2021[1]

  Unvaccinated population: ~25,134,125 people (66.06%)
  Population who has one dose of the vaccine: 11,777,736 people (30.95%)
  Population who has received two doses of the vaccine: 1,136,877 people (2.99%)

In mid to late January, details emerged about manufacturing delays by both approved vaccines made by Pfizer and Moderna affecting the country's vaccine rollout in late January through the month of February.[33][34] On February 3, the European Commission approved delivery of COVID-19 vaccine to Canada, in spite of production constraints in Europe. Canada was one of many countries that applied for delivery and does not have its own manufacturing capacity.[35] By February 4, Major General Fortin said while that Pfizer explained its dramatically lower vaccine shipments—with a decrease of 80% in all Pfizer shipments—as caused by "plant upgrades at a facility in Belgium", Moderna has offered no explanation for similar delays.[4] By early 2021, the speed of Canada's deployment of COVID-19 vaccines had become the topic of widespread public discussion, along with the related question of why the vaccines were not being produced in Canada.[36][37]

Fortin said that 180,000 Moderna doses had arrived in Canada on the morning of February 4 and Canada is "still expecting 2 million Moderna doses by the end of March.[4] On February 4, Fortin said that about 70,000 Pfizer-BioNTech doses will arrive in the next week.[38]

On February 3, COVAX published the country-by-country vaccine distribution forecast to COVAX participants—Canada will receive 1,903,200 doses of the Oxford–AstraZeneca vaccine by the end of the first half of 2021.[39][40]

On February 12, the minister of Public Services and Procurement Canada (PSPC) announced that Canada had "negotiated an accelerated delivery schedule for Pfizer-BioNTech’s COVID-19 vaccine."[41] By the end of September, Canada will receive the 40 million Pfizer-BioNTech doses.[41]

Return to regular shipments[edit]

Major General Fortin announced on February 18, that the period in which Canada experienced limited supplies, is now over and there will be an "abundance of supplies" in the spring and summer months. This will result in a "significant scaling-up of immunization plans in provinces."[5] Pfizer's new "locked in" delivery schedule includes 475,000 doses in February and 444,600 per week in March, according to the PHAC's vaccine distribution tracker.[42][5] A February 18, 2021 article in New York Times said that Canadians were concerned about the rollout of the vaccination program.[43] According to the same Times columnist, who had interviewed those involved in "vaccine development, epidemiology, infection control and medical supply chains", they all said it was not surprising that Canada's rollout was not happening as planned. While they could understand why Canadians were frustrated, they said, this is the "nature of new vaccines".[44]

Approval of Oxford-AstraZeneca and Johnson & Johnson[edit]

On February 26, Health Canada approved the Oxford–AstraZeneca COVID-19 vaccine for use.[6] The agency approved the use of two versions of the same vaccine, one to originate from the United States and the other produced in India by the Serum Institute of India.[6] The first shipment of 500,000 doses of Oxford-AstraZeneca arrived on March 3, 2021. The doses were marked with an April 2, 2021 expiry date, necessitating speedy administration.[45][46]

The Johnson & Johnson COVID-19 vaccine was approved on March 5, 2021 to become the fourth vaccine to receive Health Canada approval.[8] The vaccine is the first to be approved in Canada which only requires one shot to achieve efficacy.[47] Delivery times for the vaccine remain unknown.[48]

After an agreement was reached with Pfizer to move up some deliveries, it was projected a total of 8 million vaccine doses (from three suppliers) will be available in Canada by the end of March 2021.[49]

Minister Anand confirmed on March 26, 2021 that 1.5 million Oxford-AstraZeneca shots would arrive from the United States on March 30, 2021,[50] and that 10 million shots of the Johnson & Johnson vaccine would arrive between April and September 2021.[51]

Vaccination ramp-up and increase in deliveries[edit]

In mid-April 2021, the Government of Canada reached a deal with Pfizer to receive 8 million more vaccines on top of what was already ordered, with more than 2 million vaccines coming into the country per week beginning in the month of May.[52] Moderna however continued to delay deliveries and slashed an order for the end of April from 1.2 million vaccines to 650,000.[53]

Due to public frustration with variable vaccine booking systems across the country, a small volunteer group known as Vaccine Hunters Canada created a website, Twitter and Facebook page to help "eligible Canadians find vaccines." The group posts relevant information on appointments available, eligibility requirements and other tips to the public that might otherwise not be common knowledge. [54][55][56][57] On April 28, 2021 the City of Toronto officially partnered with the group to provide them end of day information in regards to vaccine availability and appointments that are currently unused, as well as information for pop-up vaccine clinics.[58][59][60]

The first shipment of the Johnson & Johnson vaccine arrived in Canada on April 28, 2021. The country received 304,800 doses of the single-shot vaccine in its first shipment.[61] However, Health Canada held the shipment for a safety review, citing production issues at the facilities of Emergent BioSolutions.[62][63]

In May 2021, NACI stated a recommendation that mRNA-based vaccines were preferred over viral vector vaccines such as the AstraZeneca and Johnson & Johnson vaccines due to the rare risk of post-vaccination embolic and thrombotic events, with vice-chairman Shelly Deeks stating that "individuals need to have an informed choice to be vaccinated with the first vaccine that’s available, or to wait for an mRNA vaccine." NACI received criticism for the recommendation, with critics arguing that it contradicted the view that patients should receive the first vaccine they are offered, and that the statement was mixed messaging over the safety of the vaccines that could lead to increased hesitancy.[64][65][66]

Vaccination rollout by province and territory[edit]

COVID-19 vaccinations in Canada by province and territory, May 4, 2021 (
)
Province Population Doses allocated to province[a] Doses administered[b] People fully vaccinated[c] Ref
British Columbia British Columbia 5,153,039 2,243,160 1,877,330 91,731 [69][70]
Alberta Alberta 4,436,258 1,774,065 1,640,303 301,398 [71][69][70]
Saskatchewan Saskatchewan 1,178,832 502,955 460,747 45,036 [72][69][70]
Manitoba Manitoba 1,380,935 575,990 495,482 73,445 [73][69][70]
Ontario Ontario 14,755,211 6,635,725 5,378,249 375,905 [74][69][70]
Quebec Quebec 8,575,944 3,850,087 3,256,401 109,135 [75][69][70]
New Brunswick New Brunswick 782,078 310,995 271,891 27,015 [76][69][70]
Prince Edward Island Prince Edward Island 159,819 64,335 53,202 10,585 [69][70]
Nova Scotia Nova Scotia 979,449 388,450 320,910 36,600 [69][70]
Newfoundland and Labrador Newfoundland and Labrador 520,438 209,050 181,653 9,676 [69][77][70]
Yukon Yukon 42,192 55,920 48,655 22,657 [69][78][70]
Northwest Territories Northwest Territories 45,136 58,800 48,007 21,674 [69][79][70]
Nunavut Nunavut 39,407 44,100 28,584 12,529 [69][80][70]
Canada Canada ~38,050,000 16,817,112 14,061,414 1,137,386
  1. ^ Each province is distributed an allocation of doses from the Federal government, to be administered by their own Provincial vaccination program.
  2. ^ Two doses are currently required for full vaccination the three approved vaccines in use.[67][68]
  3. ^ Full vaccination of the three approved vaccines in use currently require two doses.


Additionally, 67,900 Moderna vaccine doses have been kept for "Federal Application" for use with the Public Health Agency of Canada (PHAC), Canadian Armed Forces and the Correctional Service of Canada.[81]

Vaccines on order[edit]

Vaccines delivered per pharmaceutical company as of April 29, 2021[81]

  Pfizer-BioNTech (9,607,242) (61.06%)
  Moderna (3,506,580) (22.29%)
  Oxford-AstraZeneca (2,316,020) (14.72%)
  Johnson & Johnson (304,800) (1.94%)

There are several COVID-19 vaccines at various stages of development around the world. As of 2 December 2020 the Canadian government had invested over $1 billion,[82] including pre-placed orders for seven different vaccines, four of which are now approved by Health Canada. These pre-orders total more than 400 million doses.[83][84][82][85] Six of the seven vaccines require two doses each to be effective, with the exception of the Janssen Pharmaceutica (Johnson & Johnson) vaccine which only requires one dose.[82]

COVID-19 vaccines on order in Canada (
)
Vaccine Progress Doses ordered Approval Deployment
Pfizer–BioNTech phase III clinical trials 48-76 million[86][87] Green check.svg 9 December 2020[88] Green check.svg 14 December 2020
Moderna phase III clinical trials 44 million[89] Green check.svg 23 December 2020[90] Green check.svg 31 December 2020
Oxford–AstraZeneca phase III clinical trials 23.9 million[6] Green check.svg 26 February 2021[91] Green check.svg 10 March 2021[92]
Janssen (Johnson & Johnson) phase III clinical trials 10-38 million Green check.svg 5 March 2021[93] Pending
Novavax phase III clinical trials up to 76 million Pending Pending
Medicago phase III clinical trials[94] up to 76 million Pending Pending
Sanofi–GSK phase III clinical trials up to 72 million Pending Pending


Pharmacological data and developments[edit]

As the COVID-19 vaccines are relatively new, certain aspects of delivery and pharmacological care of the products have changed rapidly over the course of the vaccination programme.

Second dose administration[edit]

Early in the vaccination effort, debate on when to administer the second dose of the approved vaccines appeared medically and politically.[95] Each manufacturer had recommended respectively 21 days apart for Pfizer-BioNTech;[96] 28 days apart for Moderna;[97] and 4–12 weeks apart for Oxford-AstraZeneca.[98] New data suggested the manufacturer's recommendation could be lengthened, in theory allowing for more people to be vaccinated as supply efforts ramped up. Stanley Plotkin and Neal Halsey wrote an article published by Oxford Clinical Infectious Diseases that urged single dose interim use in order to extend vaccination to as many people as possible until vaccine availability improved.[99] Several other articles and media provided evidence for delaying 2nd doses in the same line of reasoning.[100][101][102] The province of Quebec began to withhold second dose administration,[103][104] and eventually adopted a 90-day strategy.[105] The National Advisory Committee on Immunization (NACI) had initially only recommended a maximum of 42 days in between doses.[106] The province of British Columbia had also followed suit and began plans to extend second dose administration to a four month delay.[107]

On March 4, 2021, the National Advisory Committee on Immunization (NACI) recommended that a maximum of four months or 112 days could be achieved effectively between second doses.[93] Other provinces began to adjust their administration programme based on the federal-level recommendation.[107]

Quebec no longer recommends a second dose for those previously infected with COVID-19, as the immunity is considered strong enough.[108] People still wanting to receive a second dose will be allowed to get it.

Pfizer-BioNTech vial capacity[edit]

In January 2021, the province of Saskatchewan discovered it could draw extra doses of the Pfizer vaccine out of vials labelled as having 5 doses.[109]

As Pfizer prepared for industrial retooling to match international demands for its vaccine, causing a supply slowdown in Canada in January and February 2021, the company announced that their vials indeed contained 6 doses of vaccine, rather than 5.[110] Health Canada accepted the relabelling of the product, however the revelation required the acquisition of millions of low dead space syringes in order to extract the last dose from the vial.[111]

Pfizer-BioNTech storage requirements[edit]

Initially the Pfizer-BioNTech vaccine was required to be stored at ultra-cold temperatures (between -80 and -60 °C) in perpetuity, until application (in which time after dilution, the vaccine must be used within 6 hours).[112] On February 25, Health Canada recommended that the vaccine could be stored at regular freezer temperatures (between -25 and -15 °C) for up to two weeks.[113]

Oxford-AstraZeneca age range[edit]

On March 1, 2021, two days after the first delivery of the vaccine, the NACI announced that it would recommend that the Oxford-AstraZeneca vaccine not be given to patients older than 65 due to “the insufficiency of evidence of efficacy in this age group at this time.”[114] This recommendation was based on clinical trial data that only went as far as December 7, 2020.[115] Quebec did not follow this recommendation, but its own Immunization Committee recommended that the Pfizer and Moderna vaccines be given to higher-priority groups in the event of limited vaccine availability (with the AstraZeneca vaccine given to lower-priority groups).[116] On March 16, NACI revised its recommendations based on newly-obtained efficacy data from other countries.[115]

On March 29, 2021, NACI recommended that the Oxford-AstraZeneca vaccine not be given to patients younger than 55, citing reports of a rare, increased risk of blood clots with low levels of blood platelets (post-vaccination embolic and thrombotic events). Most provinces adhered to this recommendation.[117][118][119] In April 2021, due to the third wave of infections, and increased hesitancy towards the vaccine due to these side effects, multiple provinces (including Alberta and Ontario) went against NACI guidance and began to distribute the vaccine to people as young as 40.[120][121][122] On April 23, NACI changed its guidance to recommend the vaccine be offered to patients as young as 30 years old if benefits outweigh the risks, and the patient "does not wish to wait for an mRNA vaccine".[123]

Rollout strategies[edit]

In December 2020, the NACI issued initial recommendations for a multi-stage rollout of vaccines that would prioritize specific populations in sequence, beginning with residents 70 and older, health care workers, and the employees and residents of long-term care facilities (due to the pandemic's disproportionate impact on them); and progressing towards wider age ranges, first responders, essential workers, and residents with comorbidities, before progressing towards the wider general public.[124][125]

Stage Recommended prioritization
1
  • Residents and staff of long-term care facilities.
  • Frontline health care and personal support workers who interact with patients.
  • Adults 70 and older, beginning with those who are 80 years and older, and decreasing in five-year increments as vaccine supply increases.
  • Adults who live in indigenous communities where they may be at a high risk of impact from COVID-19 due to
2
  • Essential primary caregivers of an advanced age.
  • Other adult residents of indigenous communities who did not receive vaccine during phase 1.
  • Adults 60–69, beginning with those who are 65 and older, and then decreasing.
  • Residents of "racialized and marginalized communities disproportionately affected by COVID-19".
  • Residents and staff of other communal living settings (i.e. group homes, homeless shelters, correctional facilities, etc.).
  • First responders
  • Frontline essential workers (direct close physical contact with the public)
3
  • Adults 16–59 with co-morbidities.
  • Adults 50–59 with no co-morbidities, beginning with those who are 55 and older, and then decreasing.
  • Non-frontline essential workers.
  • Non-frontline health care workers.
NACI recommendations for the prioritization of vaccine doses[125]

Key people[edit]

See also[edit]

Notes[edit]

  1. ^ In a January 14, 2021, Opinion piece in the Financial Post, responding to the delay in rolling out of Canada's vaccination program, GlaxoSmithKline Canada's Paul Lucas—who served as CEO from 1995 to 2012—said that, fifty years ago, during the Liberal premiership of Pierre Trudeau, there was little interest in chemical patents. Lucas said that this policy discouraged private investment in pharmaceutical innovations in Canada and caused the Canadian pharmaceutical industry to become focused on generic drugs.
  2. ^ Health policy professor emeritus Joel Lexchin said that the publicly-owned vaccine manufacturer Connaught Laboratories was privatized under the Conservative government of prime minister Brian Mulroney (1984-1993). Connaught was then part of Sanofi Pasteur. GSK acquired the Quebec-based vaccine manufacturer IAF BioChem. Sanofi and GSK—corporations outside Canada controlled decision-making about production. The three biggest vaccine makers—GlaxoSmithKline, Merck and Sanofi—lacked the new technologies essential for the production of newer forms of vaccine, that upstarts—such as Moderna and BioNTech—had mastered and by December it was evident that they were incapable of producing an effective COVID-19 vaccine.
  3. ^ According to Lexchin, newly-elected U.S. President Joe Biden reportedly continued the controversial America First policy of predecessor Donald Trump with respect to vaccine distribution. Canada was unable to obtain vaccine doses from the United States, even though the relevant American vaccine manufacturing facilities are relatively close to the Canada–United States border: Pfizer's facility in Kalamazoo, Michigan and Moderna's facility in Portsmouth, New Hampshire (actually a Lonza Group facility producing under contract).

References[edit]

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External links[edit]

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