Ontario pharmacies facing flu shot shortages
Lack of supply worries experts dreading possible ‘twindemic’ of influenza and COVID-19
With a major pharmacy chain suspending its Ontario flu shot program because of supply problems, experts warn that the province may be missing its chance o boost vaccine uptake in a critically important year and beyond. Rexall said appointments would be “temporarily ues that are paused currently due being to supply experienced is“s across the province,” noting that vaccine supply is determined by the Ministry of Health. Last week, an executive for McKesson Canada, the company that distributes flu shots to more than three-quarters of Ontario pharmacies and that owns Rexall, warned in a letter that its government-supplied inventory of flu shots would be depleted by Oct. 29. Vaccinations are still available at doctors’ offices and public health clinics, and most of these clinics don’t usually ramp up until November. Premier Doug Ford on Monday highlighted the successes of the province’s largest-ever flu shot program, noting the province would get one million more doses than last year. But with nearly 90 per cent of the province’s order of 5.4 million doses already distributed, and some primary care clinics reporting problems of their own obtaining enough doses or setting up vaccination clinics amid pandemic-related safety concerns, experts worried that Ontario would miss a rare opportunity. This is “the one year that (people) are finally willing to roll up their sleeves to get a vaccination,” noted Dr. Samir Sinha, director of geriatrics at Sinai Health System and University Health Network in Toronto.
The province-wide influenza vaccination rate has hovered somewhere between 30 per cent and 40 per cent in recent years, Sinha noted, despite the Public Health Agency of Canada recommending a target of 80 per cent coverage. Canada has worse flu vaccine coverage among seniors than other industrialized countries, including the U.S. and U.K.
This historic complacence is out of step with the harms of influenza, which exerts a massive strain on our health-care system. The flu causes an average of 12,200 hospitalizations and 3,500 deaths in Canada annually, with seniors and those with chronic health conditions especially at risk, according to a 2018 white paper.
Health experts have been dreading the “twindemic” of influenza and COVID-19, two infectious respiratory diseases slamming into the same vulnerable populations simultaneously, and threatening the same limited health-care resources. The one silver lining is that COVID-related restrictions may diminish flu too: Australia and other bellwether southern-hemisphere countries experienced historically low levels.
But frustrating people who are finally willing to line up for a flu shot could have long-term consequences outside of this critical season, Sinha said.
“We may have actually further eroded that very delicate level of public confidence that we need, that we can’t be complacent about … it’s going to make it harder to regain their confidence next year.”
In a 2018 research paper on influenza and Canada’s elderly, Sinha and other co-authors highlighted research showing that increasing flu availability in pharmacies raises vaccine coverage rates overall: Convenience is a key factor.
This year, Ontario originally ordered 5.1 million flu shot doses for its population of almost15 million. Another 300,000 doses were later added, according to the health ministry. The province has distributed nearly 4.7 million doses of that order as of Oct. 31, with about 30 per cent, or 1.4 million doses, going to third-party distributors for pharmacies.
McKesson is the largest of these distributors, supplying flu shots to about 80 per cent of participating pharmacies, according to the Ontario Pharmacists Association. A spokesperson for McKesson blamed the province for failing to meet “significant and early” demand.
“Unfortunately, the government’s allocation of flu vaccines to pharmacies is insufficient to service this increase in demand and pharmacies are having to turn away patients looking to be vaccinated due to limited vaccine supply,” Andrew Forgione said in a statement.
(Shoppers Drug Mart is in a similar position, said Justin Bates, chief executive officer of the Ontario Pharmacists Association.)
Ford hit back at a press conference on Monday, saying the company’s pharmacies had booked more flu shot appointments than the doses it knew it would receive.
“My friends at Rexall, you knew the allocations that you had, so don’t overbook people. It’s (as) simple as that,” Ford said. “If you have 100 flu shots, don’t book 200 people, you won’t have the problem.”
Approximately 3.3 million doses have also been distributed to public health units, the province says. Health units then distribute those to hospitals, long-term care homes, primary care clinics and their own flu shot programs. Toronto Public Health says it’s own flu shot clinics are running as planned.
Primary care clinics have reported mixed experiences, according to doctors in this sector. Some large, well-staffed family health teams are vaccinating as usual, while others have come up with creative solutions like drive-thru clinics or banding up with other health-care providers to find sufficient staff.
But other family doctors are reporting problems obtaining the doses they ordered, and even those that do get their full order are struggling to vaccinate at normal volumes.
“It’s not very transparent, how the flu shot distribution is done and who has responsibility for what,” said Dr. Tara Kiran, a family doctor at St. Michael’s Hospital and a professor in the Department of Family and Community Medicine at the University of Toronto.
“At any one time, you don’t know what you’re going to get next and when you’re going to get it,” making it difficult to plan clinics, Kiran said. “And then we’re also hearing from many family doctors offices where they didn’t get nearly enough flu shot relative to how much they know they’re going to need to give.”
Doctors are prioritizing kids under five who can’t be vaccinated at pharmacies, seniors and other high-risk groups, Kiran and others said — and many offices are telling patients to visit their local pharmacy.
A spokesperson said the health ministry is looking to reallocate existing inventory to areas where demand is high including in pharmacies, and is working closely with pharmacy and other providers on options for them to redistribute their current flu shot supply while maintaining vaccine safety, adding any future shipments would go to areas of greatest demand and providers focusing on high-priority populations.
Health Minister Christine Elliott said the province has reached out to the federal government and international suppliers for additional vaccine and that $28 million has been earmarked to purchase more.