`WELL-OILED MACHINE'
Vaccine help ready for next phase
At British Columbia’s medical association, Dr. Matthew Chow’s phone has been ringing off the hook lately with unusual offers. Not only practising physicians but retired ones are offering to administer the COVID-19 vaccine once the province has enough doses for population-wide immunization.
“We’ve been overwhelmed by the number of people who have volunteered,” says Chow, president of Doctors of B.C. “It makes one almost emotional to know that so many (retired) people — even though they may be at higher risk because they’re older — would selflessly put themselves out there.”
Faltering deliveries of the two coronavirus vaccines authorized in Canada have created an unwanted lull in immunizing action. That may not end until next month.
But across the country, health professionals and public health officials are girding for more robust supplies to come, and a vaccination campaign likely to be unprecedented in scale.
Delayed rollout of the one million doses Canada has received so far is raising a crucial question: Will provinces be ready to efficiently administer millions more doses when they finally arrive?
Officials insist they will be, with plans for mass vaccination clinics, using pharmacies as well as medical offices as de-facto immunization centres, and in some cases training health-care workers who have never done injections before.
“The fact we have this kind of interim period where the vaccine came and then stopped coming, it’s really unfortunate,” said Kelly Grindrod, a pharmacy professor at the University of Waterloo. “But it’s also bought a window for all these programs to catch their breath ... (and) replan for the next round.”
Chow says he’s feeling optimistic about those preparations, suggesting that kinks are being worked out now and the system should be a “well-oiled machine” by the time large quantities of vaccine show up.
Doris Grinspun, CEO of the Registered Nurses Association of Ontario, is not as sure, saying various missteps during the pandemic have taught her to keep expectations low.
“I’m not jaded, I’m just disillusioned that things did not go as they should have gone,” she said. “I’m not willing to think of hopefulness anymore, quite frankly ... All I can do is to push in the direction we think it should go, so the public gets shots in the arm.”
What's clear is that when the vaccine starts being delivered in greater bulk, the task will be unlike anything before it. While flu shots are given en mass every year, uptake is only about 40 per cent, much less than what is expected for the COVID-19 shots. And there will be urgency, as virus mutations that are more transmissible, and possibly more resistant to vaccines, continue to spread.
“The task at hand is huge,” said Joelle Walker, a vice-president of the Canadian Pharmacists Association. “We've never done it before on this scale.”
While the federal government procures the vaccine, the provinces are responsible for actually using it on people.
As of Thursday afternoon, Canada had received about 1.1 million doses of the PfizerBioNTech and Moderna shots, and administered about one million of them, according to the covid19tracker.ca website. Those have mostly gone to frontline health-care workers and nursing home residents.
But various issues, including manufacturing glitches, competition from other countries, and lack of any manufacturing capacity in Canada, have brought the supply almost to a standstill.
Procurement Minister Anita Anand has said Canada should directly receive another six million doses by the end of March, and as many as a million more in that period through the international COVAX vaccine-sharing initiative.
So what will regional authorities do with the shots once they arrive?
Two of the four biggest provinces asked by the National Post for their mass-vaccination plans responded by deadline Thursday.
Ontario is looking primarily to use as many as 75 mass vaccination centres — like one already set up in the Metro Toronto Convention Centre — which should provide “immense capacity,” retired general Rick Hillier, who's marshalling the effort, told reporters this week.
The province will also look to use physicians' offices, some of the almost 5,000 pharmacies, and mobile clinics, he said.
The province has authorized a wide range of health practitioners to give shots, including interns, pharmacy students and pharmacy technicians, said a ministry spokeswoman.
In Alberta, the province is looking to mirror to a certain extent its recent flu vaccine campaign, where 1.3 million shots were injected in six weeks, largely through pharmacies, said Steve Buick, press secretary to health minister Tyler Shandro.
“Provinces are ready to get vaccines into arms,” insisted Buick. “But we can't vaccinate people when Ottawa has failed to secure the necessary supplies.”
Alberta's heavy reliance on pharmacists to deliver the flu vaccine makes sense, and should be a model for other provinces with COVID-19 shots, argued Walker of the pharmacists association. Canadians are increasingly attracted to getting vaccinated at drug stores, which tend to be close at hand and open long hours, she said.
A 2017 study, when pharmacists were just beginning to play a role with flu shots, suggested that uptake actually increased when druggists got involved.
Dr. Ann Collins, president of the Canadian Medical Association, said she's heard from “countless” physicians willing to help out with large-scale vaccination.
“The boots are on the ground, ready to do this,” she said. “(But) co-ordination is critical.”
All agreed that pharmacists should play a key role, but Grinspun said a central focus for delivering vaccine ought to be primary care — doctors offices, community health clinics and family health teams. She said that was the strategy used by Israel, which has led the world in getting its citizens vaccinated.
Thousands of doctors and nurses work for such clinics in Ontario, for instance, and are largely under-employed because of the lack of in-person patient visits, said Grinspun.
Chow said the initial rollout in B.C. has had to target some of the most difficult-to-reach people, including residents of homeless encampments.
But when the population-wide phases begin, no one should expect perfection, said the B.C. medical leader. “This is a monumental task,” he said. “Any time you go to scale on something this big, you're going to have hiccups”