The purpose of this paper is to report on the emerging findings of case study research on the impact of COVID-19 and the capacity of the health system to respond to this pandemic in the seven Canadian provinces.

What is centrally important for all the countries is prioritizing vaccination scalability as a strategy to overcome the devastation of this pandemic – 'vaccines do not save lives, vaccinations save lives' (Orenstein 2019). The much more challenging phase is scaling vaccination capacity quickly enough to vaccinate an entire population. However, the procurement of vaccines and the logistics of distribution during a pandemic are only the first steps in achieving a scalable vaccination strategy. Early efforts have focused on the procurement of vaccines in anticipation of vaccine approval by each country. However, despite the promise of these rapidly emerging vaccines, almost every country is facing challenges in mobilizing the capacity needed for rapid implementation of vaccination at the population level. Given the lack of effective antiviral medications to treat COVID-19, vaccination is widely viewed as the most effective strategy to control the COVID-19 pandemic (ECDC 2020). COVID-19 cases continue to surge well beyond the rates evident in the first wave of the pandemic. Global health systems are struggling to meet the demands of the second wave of the COVID-19 pandemic while attempting to implement a mass vaccination strategy rapidly enough to slow the spread of infection across populations.

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