Distribution needs a rethink, providers say
The group that represents pharmacists in Nova Scotia says the flu shot distribution system needs a revamp.
“Are there particular challenges to ensure a particular drug store has enough vaccine on hand? Of course there is, because we don’t control what public health distributes,” said Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia. “Unlike every other product we carry, this flu vaccine is distributed from the central provincial warehouse where they get it in from their supplier ... Then they move out to local public health offices across the province and then those local offices take orders from all providers, physicians, pharmacists.
“Based on those orders and what they have in stock at that particular moment, they distribute what they have out. So you can put an order in for 200 units and get an order ready for pickup that’s half that. You have no way to manage your inventory.”
Flu shot clinics were cancelled at Halifax drug stores last month and doctors offices reported being out of vaccine for as long as a week.
As of late October, the province had received about 88 per cent of the 461,000 doses it has ordered this year. The rest was expected to arrive by Friday, Nov. 1.
Bodnar said the distribution and supply system organized by public health, as opposed to the usual drug supply system that uses wholesalers, makes it difficult to keep a consistent vaccine supply.
“The issue is, it comes in in waves, it doesn’t all come at once. It comes over the first sort of four to six weeks of the season and maybe there’s an option for some a little bit later. We don’t know how much is coming so it’s really difficult to plan because you don’t know when or how much supply is coming, or how much of that will be allocated to you.”
Bodnar said a wholesale distribution system used in the first year of the free flu vaccine program worked well for pharmacists. But since wholesalers charge a fee per shipment, that system was more costly to the province and the distribution role was moved to public health.
Some provinces, including Prince Edward Island and most recently New Brunswick, have moved to a wholesale distribution system for pharmacies, she said.
“You just order with your regular drug order. That comes every day or every other day depending on your arrangement. And so you don’t have to order large quantities because you know you can just get it.”
Kevin Chapman, the financial director for Doctors Nova Scotia, acknowledged its members have expressed frustration over the years about inconsistent access to flu vaccine. His organization isn’t calling for a dramatic system overhaul but clearer communication between public health and shot providers on vaccine supply would help.
Given that only 36 per cent of Nova Scotians got their flu shot last year, Chapman said it’s clear we can do better.
“We have to figure out how do we ensure that there aren’t supply issues,” he said. “How do we ensure that the anti-vaxx movement isn’t taking more hold? How do we ensure we can educate the public about vaccination? And then, to your point, be able to supply the vaccine when the patient is there and needs it. That’s the bigger issue for us.”
A provincial Health Department spokeswoman said a change in the vaccine distribution system, for example back to wholesale distribution, would not increase supply.
“Like all provinces and territories, we receive our supply over a four-week period as it becomes available from the manufacturers,” said Heather Fairbairn in an email. “As in previous years, providers were advised to order an initial supply and re-order as needed.”
The flu shot program runs from October to December, Fairbairn said.
“There will be lots of vaccine and plenty of time for people to get immunized before flu season begins.”