TORONTO — Health experts and seniors advocacy groups are urging provinces to speed up COVID-19 vaccinations as coronavirus infections surge following the holiday season.
Since the first vaccine was administered three weeks ago, on Dec. 14, slightly more than 121,000 people have received Pfizer or Moderna shots. That’s 0.319 per cent of the Canadian population. As of Monday afternoon, only Prince Edward Island had administered doses to more than 1 per cent of its population, according to the CTVNews.ca vaccine tracker. In Ontario, more than 110,000 doses — or more than 70 per cent of the province’s supply — sit in freezers, with approximately 42,000 administered in three weeks.
“Vaccine helps nobody if it’s in the closet,” Laura Tamblyn Watts, CEO of CanAge, a national seniors advocacy organization, told CTV News Channel on Monday.
“This needs to be a 24-7 initiative as we have seen in other countries. Vaccine spread is what we need to do. We need to make sure that it gets into the arms of people who need it because the virus does not stop for holidays.”
The calls for a speedier rollout come following weeks of an intensified second wave of COVID-19 infections around the country that has included new outbreaks in long-term care and retirement homes where much of Canada’s most vulnerable people live. Since mid-December, Canadian health officials have recorded more than 130,000 new infections. The majority of those infections have been in Ontario and Quebec, two provinces that have differing immunizations strategies. In Quebec, health officials have suggested they may forego second doses of Pfizer or Moderna vaccines in favour of immunizing more people with available shipments.
DOSING TWO-SHOT VACCINES
It’s a strategy that has faced a range of reactions from health experts, some of whom say the idea could help speed up immunity and others who say it’s too risky.
Quebec’s plan to speed up vaccination by delaying or even eliminating the second dose of the Pfizer or Moderna vaccines could backfire, said Dr. Colin Furness, an epidemiologist and assistant professor at the University of Toronto, who said that strategy uses people as “experimental subjects” without their consent.
“We also think that giving people partial immunity might actually provide an excellent opportunity for COVID-19 to mutate around the vaccine,” he told CTV News Channel on Monday. “I think that we need to proceed with what’s been proven.”
Other experts have said that using up all current shipments, rather than holding back some doses for later, is a more appropriate strategy. Infectious disease expert Dr. Sumon Chakrabarti said everyone should get both, but the one-dose strategy could work in the meantime to speed things up.
“Having many people that are partially protected, I think, is better on the whole than having a few people that are fully protected and still a lot of people who are vulnerable,” he told CTV News Channel.
MANAGING COLD LOGISTICS
One of the major slow-downs with the initial shipments of COVID-19 vaccines was the complicated storage requirements of the Pfizer-BioNTech product, which needs to be kept at temperatures between -60 C and -80 C until injection. Ontario has been particularly cautious with this guidance compared to Quebec, British Columbia and other jurisdictions around the world, said Dr. Samir Sinha, the Director of Geriatrics at Mount Sinai and the University Health Network in Toronto.
While much has been made about the difficulty of transporting the Pfizer vaccine, Dr. Sinha says that might not have been necessary.
“When you actually read the product monograph, you can actually transport these vaccines with dry ice and other things,” he said, adding that West Virginia vaccinated all 214 of its long-term care facilities by Dec. 30.
“If West Virginia can get it done, why can’t we get this done in Ontario?” he said on CTV News Channel on Monday.
“We’ve got health professionals who’ve been raising their hands saying ‘If it’s just a matter of you need more people, we’re willing to do this 24-7.’”
IMMUNIZING LONG-TERM CARE
Long-term care and retirement homes have facilitated mass immunizations before, as recently as last fall, noted Sinha. In October, there was concern that those facilities would bear the brunt of what some called a “twindemic” of influenza and COVID-19. Instead, provinces mobilized long-term care and retirement homes quickly.
“These homes, without a whimper, got all their residents and staff vaccinated within a week or two,” he said. “We have tens of thousands of dose[s] of just the Moderna vaccine that are still sitting in fridges and freezers that have been here long enough.”
Sinha’s is the same message that CanAge CEO Tamblyn Watts has for federal and provincial officials: use the systems that have long been in place.
“This is a vaccine problem, not really a logistics problems,” said Tamblyn Watts. “We have existing systems to put vaccine into people … Get public health involved, get doctors involved, get pharmacists involved. Don’t keep it so off to the side that people can’t get vaccinated.”
‘CUTTING DOWN BUREAUCRACY’
Though much red tape was cut to expedite the development of COVID-19 vaccines in 2020, the distribution of those vaccines in Canada may be facing official procedures contributing to the slow rollout. “There is something to be said about the bureaucracy of what’s been going on recently,” said Dr. Zain Chagla, an infectious disease specialist and associate professor at McMaster University in a phone interview with CTVNews.ca on Monday, noting public health protocols, the implementation of registration systems, and the development of teams to go into a variety of health facilities, to name a few procedures.
Compared to other countries, Canada has procured the most vaccine doses per citizen, but is falling behind in the rollout. Israel has vaccinated more than 14 per cent of its population, according to Our World in Data. The U.S. has vaccinated millions, or more than 1.2 per cent of its population. Health officials in Canada could consider looking at global models for the future rollout, particularly models that are “good enough” and not based on “perfection.”
“They don’t necessarily deal with models where there’s perfection around tracking, there’s perfection around registration and all that stuff,” he said. “It gives us a good scope to start looking at how [we can] minimize the bureaucracy in rollout.”
‘THE WAY FORWARD’
The irony of the vaccine rollout is that putting needles into arms is not difficult, added Chagla. While there are certainly human resource and training issues related to staffing and proper care at nursing homes and other facilities, injecting needles is not one of them.
“Most nursing students and medical students as well as other health professionals — it’s a core competency off the bat,” said Chagla.
Provinces will have to find a way to register individuals quickly and on a mass scale who can help with administering vaccines, but also other health professionals like pharmacy technicians to handle medications appropriately, non-clinical professionals to work through clerical procedures like registration and consent.
“Realistically, there’s a huge human resource potential to tap into to optimize all of that, such that every community has access to vaccine,” he said.
“Honestly, the way forward is not with hospitals,” he added, though the finicky Pfizer vaccine may be best for hospital use considering it must be stored at extreme cold temperatures. Instead, the rollout of more COVID-19 vaccines, first with Moderna, will depend on more than hospital systems but also public health and primary care, said Chagla.
“Realistically, that Moderna campaign really does need to be taken to communities and engaged at all levels,” he said.
“There is certainly a big lesson to be learned here in that, and a lesson to be learned in cutting down bureaucracy and how to recruit the community appropriately, because there are resources out there.”
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