Vaccinating Canadians is a complicated process

With all due respect to the brilliant scientists who have developed effective vaccines against COVID-19, the most challenging part of the massive immunization program may well be the final step. Getting shots into the arms of those wanting to be vaccinated is a logistical nightmare.

At least 30 million people in Canada will be involved, spread out across the nation, from sea to sea to sea. Public Health authorities have to determine who gets the shots, in what order and at what locations, and most will require two doses. Then they have to make sure the right people show up in the right place at the right time in a frame of mind to be vaccinated – twice.

Designing this part of the program is complicated, especially since there are public safety concerns around all options. Right now, the Interior Health website simply says public health will arrange for priority groups to get the vaccine.

For people whose vulnerability to the virus is determined by their employment on the front lines (doctors, nurses, etc.), they can be reached at their workplaces where qualified practitioners who can administer the vaccinations can be assumed to work. Long-term care patients can be vaccinated at their residences to minimize risk. But what about the rest of us?

In British Columbia, every resident is supposed to have a health care number, and that number is keyed to information regarding age, gender and, if printed on a driver’s license, where the person is located. So presumably, targeting the age groups at high risk is fairly easy. For people without a driver’s license, it may be somewhat more complicated but still doable. You then mail or email or text instructions to each person.

The closest similar operations that I can think of are elections and the quinquennial census. For an election a government agency sends citizens a card that tells us where we can vote on what days and what identification is needed at the polls. For the census, households receive a form in the mail and there is individual follow-up capacity to try to maximize participation in the survey – ideally 90% or more of the public.

Perhaps the rollout of the immunization program will utilize the same methodologies to maximize the participation rate – which experts tell us needs to be at least 70% and possibly higher to ensure containment of the virus.

Now in any exercise of this degree of complexity where a high rate of success at completing immunizations is of prime importance, there are bound to be problems. Some may be unable to attend at a given time.

How do you provide choice of timing without clogging up the system? Some people will unavoidably miss their scheduled appointments. A natural disaster – a major snow storm or flood or a widespread power outage – can disrupt the schedule on a grand scale.

The critical factor will be the ability of the program to respond quickly and effectively to deal with and resolve problems. The whole process is, indeed, akin to waging war and victory is imperative. It will also, in all probability, be expensive.

Central to the success of this entire program is the need to instill confidence as to the safety of the vaccine and the accessibility of the immunization process. That means a transparent information program using lots of examples of different people testifying as to the ease of getting that shot in the arm.

A final complication is the matter of how long vaccination will be effective. Will it be for a lifetime or, as with the flu vaccine, at best for one year? The shorter the period the vaccine remains effective, the greater the risks of the virus again infecting significant numbers and again imposing costs in life and in economic well-being. In this case, dealing with the virus will be an ongoing problem that we will all need to help address.

The coronavirus has already had a tremendous impact upon the functioning of our society from work to recreation, from health care to individual behaviour. The longer-term question is: What permanent accommodations will we have to make to minimize its impact in future?

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