Where will you get your shot? Strategies vary across Ontario
We asked all 34 public health units how they were rolling out plan
Star reporters Olivia Bowden, Maria Sarrouh and May Warren contacted all 34 public health units to get their vaccination plans,
In York Region, Canada’s Wonderland will be transformed into a mass vaccination site.
At Huron Perth Public Health, home to many rural communities, officials are thinking about how to get shots to Mennonites who travel by horse and buggy.
And in Peel, the vaccine rollout is being tailored for the large South Asian community.
How ordinary Ontarians get their coveted COVID vaccines will depend on where they live. To better understand what the rollout will look like, from downtown Toronto to remote northern Ontario, the Star contacted all 34 public health units to get the vaccine plans they are responsible for developing, based on provincial guidance.
Twenty-one provided them; the Star found another eight on their websites. There were five that were either explicitly not ready or the Star could not find.
They ranged from 100-page documents to a couple of slides, and in Toronto’s case a press release, revealing a wide variation in the level of detail, and some differences in the pace of vaccination.
The province sets the priority groups, based on advice from a federal expert committee. Now that long-term-care residents and health-care workers are mostly covered, the vaccines will slowly be opened up to more of the general population, starting with those 80 and up, and all Indigenous adults. A provincial web portal and call centre for booking vaccine appointments will go live March 15, for those eligible under the first phase of the rollout.
But a handful of health units are racing ahead.
“Public health units are already out there now, vaccinating people over the age of 80,” said Dr. Gerald Evans, chair of the division of infectious diseases and a professor of medicine at Queen’s University. “They aren’t waiting.”
Reductions in vaccine shipments provided a chance for the health units, and the province, to complete further planning, added Evans, who is also a member of Ontario’s COVID-19 Science Advisory Table. But that hasn’t happened everywhere.
“Some health units did do something,” he said, “and they are the ones that probably have a more elaborate, well laid-out plan that is specific to their unit. But many of them were just waiting for something to happen.” Evans added that shipment delays are not an excuse to hold off on planning.
Some health units have identified the location of mass immunization sites, from hockey arenas to convention centres, while others don’t yet have these logistics pinned down.
Southwestern Public Health Unit told the Star its plan will be released this coming week. Porcupine Health Unit, in northeastern Ontario, is making changes to the plan, a spokesperson confirmed.
Toronto’s immunization task force announced last week that nine clinics will open to the public on or before April 1. But a detailed plan is not yet publicly available for the largest city in Canada, while other units like Sudbury and Districts released a 90-page plan last month.
Meanwhile, a short drive away, Guelph is already offering shots to adults over 80 in the community through its own registration web portal, with a target to vaccinate at least 75 per cent of the population above 16 by early August. Windsor and York will start Monday
Simcoe Muskoka District Health Unit is also booking vaccine appointments on its website for adults 85 and up, Indigenous adults 55 and up, and adults who get chronic home care. Waterloo is pre-registering eligible people for appointments. Hamilton is also beginning to vaccinate seniors 85 and older ahead of the province’s schedule.
Ottawa has started clinics for Indigenous seniors and has adapted its flu vaccine booking system to start arranging appointments for seniors 80 and up and adults who get home care, with jabs to start March 5. They’ve identified areas with high rates of COVID to start with, based on their supply, according to the chief medical officer of health, Dr. Vera Etches.
It makes sense that public health units have been charged with where people get vaccines as they know their communities, said Dr. Zain Chagla, an infectious disease specialist at St. Joseph’s Healthcare Hamilton.
The rollout is “not one size fits all,” and they have “a good road map” of how to reach the people most at risk in their regions.
But, given that a new brief by Ontario’s COVID-19 Science Advisory Table has found that postal code, and not just age, plays a role in COVID risk, it makes sense for health units to target neighbourhoods with more cases now if they can, Chagla said.
“I would be really making sure the high-risk postal codes have all the resources to get going right now, rather than waiting for the provincial rollout plan.”
Each health unit will determine the number and type of immunization sites, such as mobile vans, community clinics, hospitals and other healthcare centres, said Dr. Isaac Bogoch, a member of the Ministry of Health’s COVID-19 Vaccine Distribution Task Force.
“Public health leads have a much better understanding of how to roll out the program locally than anyone who’s sitting 1,000 kilometres away from them would,” he said.
Ministry of Health spokesperson Lindsay Davidson said in an email all 34 public health units submitted their plans for review at the end of January. They were asked to, so the province can “understand the regional approach and identify where provincial support or resources may be required or helpful.”
The plans are meant to be “evergreen” and evolve with changes such as Health Canada’s possible approval of more vaccines, he added.
Health units can tailor their plans based on their population’s needs, he said. For example, in Kenora, Indigenous health will be a big factor in the type of vaccine sites available. While Northwestern Health Unit did not respond to the Star’s inquiry about the region’s detailed plan, the unit’s website states the vaccine is not currently available to the general public and wait lists are not being developed at present.
Vaccinations have begun in the northern region of the unit’s service area, with Moderna administered in Sioux Lookout and remote First Nations communities.
“Some Indigenous Ontarians won’t feel comfortable going to a mass vaccine site, because of mistrust in the health-care system, or the government,” Bogoch added, explaining that Indigenous community centres may be used instead.
Of the plans Bogoch has looked at, Peel’s “stood out to be fantastic,” he said. Based on data from Feb. 8, Peel’s plan states the unit will have the capacity to deliver around 23,400 doses a day or 702,000 doses a month at community clinics. Community centres focusing on outreach to South Asian communities and mass vaccine sites in heavily impacted neighbourhoods will be necessary.
“They have a very mobile and active South Asian Task Force that’s been really helpful … when they have access to vaccines, they’ll really be able to care for the community,” Bogoch said.
While he “didn’t see any issues” with the plans he looked at, he said health units will need to scale them up through March and April.
But Jillian Kohler, a professor at the Leslie Dan Faculty of Pharmacy and Dalla Lana School of Public Health at the University of Toronto, said she worries the rollout could become inequitable, with some people getting shots sooner, just because they live in a better organized health unit.
“We’re dealing with a pandemic where people are literally dying because they’re not getting access to a vaccine,” she said, adding the approach seems like “passing the buck to the local level.”
While several public health units failing to present detailed plans could be concerning, they haven’t had much time to put them together, said Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto.
“Right now, the focus is on getting vaccines to health-care workers and those who are aged 80 plus,” she said. “The logistics are going to be different than when we start talking about having mass vaccination clinics.”
There’s still time to figure out a larger plan, said Tuite.
The province could help with communication among public health units, as some may be further along than others and can give advice, she said.