What the Dakotas can teach Canada

In mid-november, many Canadians were surprised to realize that, despite the depressing news about the beginnings of a second wave of COVID-19 in some of the larger provinces, the hot spot for coronavirus transmission was actually Manitoba. And it was not alone — at the time, neighbouring North Dakota had the highest per capita infection rate in the world, while South Dakota had one of the highest death rates. Since that time, the three jurisdictions have largely brought infections under control, but the Dakotas have emerged as North American leaders in the vaccination race, while Manitoba has been a noticeable laggard.

The keys to success for the dakotas appear to be a lot of pro-active planning, community engagement and co-ordination between the public and private sectors.

Here in Canada, delays in vaccine shipments have caused us to focus all our attention on the shortage of supplies recently. But we must not forget that there are two sides to the vaccination campaign: securing the doses, which is being handled by the federal government, and getting them into the arms of Canadians, which is a provincial responsibility. And before the provinces started running out of shots, it was clear that their plans left much to be desired.

There is certainly a case to be made that the federal government should have come up with a national vaccination program and bypassed the provinces entirely. But given the ineptitude of the federal Liberals on virtually every other aspect of the pandemic, it’s hard to imagine they would have done any better. And yet, the United States also has a federal system in which the states are responsible for their individual vaccination programs, which has left many wondering why they are doing so much better than we are.

One thing the u.s. government did was start planning early. The u.s. Centres for disease Control (CDC) publicly released its vaccine distribution plan early in the fall and actively worked with states to come up with their own. At that point, hardly anyone thought a vaccine would be approved as early as december. yet North dakota began work on its plan in August. In September, the state formed a committee made up of health officials, medical professionals, pharmacists, care home administrators and Native-american leaders that was tasked with coming up with ways to distribute a vaccine once it was available, with the goal of submitting a formal plan to the CDC by mid-october.

The group, which conducted much of its work through online public meetings, was able to forge alliances among stakeholders and come up with contingency plans for a variety of scenarios. It also devised a plan to create a centralized distribution centre, equipped with ultracold freezers and transport coolers, that is able to divide large shipments of vaccines for distribution to smaller centres — a key strategy in the largely rural state.

The planning process in Manitoba stands in stark contrast. If the federal government had been working on a national distribution plan, it didn’t release it to the public. By all appearances, the provinces were left to fend for themselves. The Manitoba government didn’t release details of its plans until Dec. 9, and although it said it had been working on them for “months,” it appears to have been done behind closed doors. The results speak for themselves.

The Government of Manitoba has struggled with the rollout of its vaccination program since it launched, and has been criticized for its poor planning. There have been problems with SMS alerts directing health-care workers to the wrong vaccination clinic. (At one point, the system sent 558 text messages telling people to go to Winnipeg instead of Brandon, which are 2½ hours apart.)

Numerous key jobs in the province’s vaccination program were not filled until after it got underway. The province still doesn’t have a good system for keeping track of who has been vaccinated and doesn’t issue cards informing people when they need to get a booster shot and which vaccine they got. There is no way to book appointments online. And dysfunction at the vaccination “supersites” — which have been set up in Winnipeg, Brandon and Thompson — have reportedly led to people standing in cramped conditions for upwards of two hours after their appointment times in order to get vaccinated.

In Manitoba, most of the vaccinations are taking place at the three super-sites, only one of which serves the vast northern part of the province, along with two “pop-up sites” that began operating in two smaller centres this week, and mobile teams that have been vaccinating people in long-term care homes. The limited number of sites have made it hard for those living in the north, which is currently a hot spot for infections, to access the vaccines.

Although the Dakotas don’t have to deal with a vast, inhospitable region like northern Manitoba, they set up a much more decentralized system that was specifically designed to reach rural and Native-American communities. Both states started co-ordinating with pharmacies early on. North Dakota now has around 400 vaccine providers, including private clinics and independent pharmacies in smaller communities, that are administering shots. Manitoba didn’t start accepting applications for medical clinics and pharmacies to give out vaccines until just this week.

THERE ARE TWO SIDES TO THE VACCINATION CAMPAIGN.

Likewise, Sanford Health — a large, centralized health network that operates in both states — had nine ultracold freezers for storing doses of the Pfizer shot before the vaccine rollout; Manitoba only managed to get one installed by early december. And instead of booking appointments over the phone and waiting in overcrowded vaccination supersites, many people in the dakotas have access to an online booking system and drive-thru vaccination sites.

Some have credited South Dakota’s success with the fact that much of its healthcare system is run by three centralized health networks that were given a lot of control over vaccine distribution, but if centralization was the only key to success, Canada’s public health-care system should have an advantage. What Canadian health care lacks is the foresight and planning that allowed the dakotas to hit the ground running once a vaccine was approved, along with the efficiencies of private health-care providers.

There’s no doubt that Canada has been plagued by supply problems recently. The Dakotas, which combined have around 300,000 more people than Manitoba, have received about 3.5 times the number of doses. And even that is not enough to keep up with demand. Yet Manitoba has only administered around 75 per cent of its supply, while North dakota manages to use all of its vaccine. Because the two Dakotas appear to have built a system that can do a much better job of scaling up when new doses become available, they have managed to fully vaccinate around five per cent of their populations. Manitoba has only reached a little over one per cent.

Yet Manitoba is not unique in Canada: in terms of the percentage of the population that has received at least one dose of vaccine, it is in the middle of the pack among the provinces. Unfortunately, throughout this pandemic, at both the federal and provincial levels, our governments have been far too reactionary, haphazardly dealing with changes on the ground as they emerge, instead of devising forward-looking systems and strategies to help us deal with the pandemic over the long-haul and adapt to changing conditions in real time. They have fallen into the uniquely Canadian trap of formulating policy under a veil of unnecessary secrecy and eschewing any private involvement in health care. Our lacklustre vaccination campaign is but the latest example.

While the federal Liberals have certainly made mistakes when it comes to ensuring Canada has an adequate vaccine supply, shortages at this stage in the game were always to be expected. At some point, we will start receiving larger shipments of vaccines. The big question is whether the provinces will be ready to effectively deliver them to the population. Judging by their past performance, Canadians should be prepared for more disappointment to come.