‘A senicide’: Strategic missteps, logistical hurdles plague Ontario’s early vaccine rollout

What caused the delays in reaching Ontario’s long-term care home residents with a COVID-19 vaccine?

Kristin Hunter wept when she heard the first doses of the Pfizer-BioNTech COVID-19 vaccine had arrived in Canada in mid-December.

“I was so excited that it was possible that the people that I loved, my dad in particular with his health issues, may make it through this pandemic,” said Hunter, whose 65-year-old father has dementia and lives in a retirement residence just outside of London, Ont.

Middlesex Terrace, a 105-bed facility, has seen 37 staff members and 25 residents become infected with COVID-19 amid an ongoing outbreak as of Jan. 22. Another 12 residents have died from the virus.

When Hunter learned that her father was diagnosed with COVID-19 on Jan. 8, 2021, tears of frustration filled her eyes again.

“These are people’s lives and they matter,” she said.

“My dad would probably say that ‘this isn’t right, that this is unfair. And this was preventable.’”

Just over a month into the country’s battle to vaccinate against the novel coronavirus, Canada has given first doses to 1.96 per cent of the population, as of Jan. 22. Canada lags behind Israel, the United Kingdom, Denmark and the United States among others in the race to get the first shots into arms, especially those in long-term care homes, which have accounted for the majority of the country’s nearly 19,000 deaths.

Of the 939,050 doses of the Pfizer-BioNTech and Moderna vaccines that Ottawa has delivered to the provinces, 81 per cent of doses have been administered as of Jan. 22, according to federal and provincial health data. Just under 20 per cent of the life-saving vaccines are still sitting in freezers waiting to be administered.

In Ontario, the early weeks of the province’s sluggish vaccination effort have been criticized by health-care experts, including front-line workers, as being marred by strategic missteps, a decision to prioritize hospitals over long-term care homes, and a rollout that allowed non-essential workers to get a first dose of the vaccine before some nurses and doctors.

For Dr. Samir Sinha, the director of geriatrics at Toronto’s Mount Sinai hospital and the University Health Network, the results have been catastrophic.

“This is what we’re calling a senicide,” Sinha told Global News. “Other countries have figured this out and realized that you probably should go and vaccinate the people with the highest risk of dying.”

Ontario begins the rollout

In November, prior to the arrival of the first vaccines, the National Advisory Committee on Immunization recommended the first stage of immunizations be given to residents and staff in seniors’ homes, adults over 70, health-care workers, and adults in Indigenous communities.

Yet in Ontario, long-term care residents took a back seat in the early days of the rollout on Dec. 14, when the first shipment of the Pfizer-BioNTech vaccine arrived.

As the vaccine needs to be stored at temperatures between –60 to –80 C, the province placed its vaccination hubs at 23 hospital sites across Ontario. The Pfizer vaccine has been estimated to be 52 per cent effective against Sars-CoV-2, 12 days after receiving the first dose. Its efficacy rises to 95 per cent one week after the second dose and Pfizer has stressed that both doses are required.

Doug Ford’s Progressive Conservative government said it would wait and deploy the Moderna vaccines, which is more easily transportable, to long-term care homes.

A pause in vaccinations around Christmas and Boxing Day led to further condemnation from experts who decried the lack of urgency by Doug Ford’s government as outbreaks continued to devastate long-term care facilities, including one Toronto home where at least 78 residents have now died amid a crushing second wave of the virus.

Ryan Imgrund, a biostatistician who advises Ontario public health units, said the province had months to plan for the logistics to distribute the Pfizer-BioNTech vaccine but was left flatfooted.

“We blamed a lot of it on the fact that there was a negative –70 C storage requirement for this vaccine, which was true. But we knew this vaccine was a front runner for about two or three months,” he said. “We should have planned for this well in advance.”

“It’s absolutely ridiculous it’s taking that long to give the first dose to all long-term care facility residents here in Ontario.”

But Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s vaccine task force, said there were “credible” concerns about moving the vaccine before Pfizer altered its transportation guidelines.

“At that point in time, there was some concern that if you move (the Pfizer vaccine) around and actually if you defrosted it and agitated and shook it up, it would denature it,” he said.

He said while there have been “clear hurdles and some missteps” getting vaccines into the most at-risk from the virus, there have also been improvements.

“It still can be improved, but it is much better than what we’ve seen in, for example, late December and the very early part of January,” Bogoch said.

By Jan. 5, fewer than 1,000 of the province’s 72,000 long-term care residents had received a dose of the Pfizer vaccine, and over 26,000 of the more than 100,000 staff had been given their first dose. Another 3,000 doses of the Moderna were administered by Jan. 3, but the province did not say whether it went to staff or residents.

British Columbia, by comparison, had by Jan. 4 given a first dose to over 4,700 long-term care residents — 20 per cent of all residents — and 11,600 workers — or nearly 50 per cent of all staff.

Read more:
Coronavirus vaccine rollout: How Canada compares with other countries

Ontario has given a first dose to all long-term care homes in hotspots around the Greater Toronto Area and in Windsor by Jan. 15 — nearly a week ahead of its target. Other provinces including Alberta and now PEI have vaccinated their publicly funded long-term care sectors, while Ontario has pledged to vaccinate all its nursing home staff and residents by Feb. 15.

Sinha said the Ford government set Ontario’s goals “exceptionally low.”

“That’s really disappointing because we’re managing to get to many other people who are at lower risk from dying, getting them the shots in the arms,” he said.

Sinha pointed to Quebec who made the crucial decision to place half of its vaccine distribution centres directly inside long-term care facilities, ensuring residents are inoculated more quickly.

British Columbia quickly adjusted course and moved the Pfizer-BioNTech vaccine directly into nursing homes on Dec. 23, after Pfizer broadened its transportation guidelines on Dec. 18, a directive the pharmaceutical giant said was sent to the Public Health Agency of Canada.

But Ontario’s Ministry of Health said it only began shipping the Pfizer-BioNTech vaccine into long-term care homes after a pilot project was completed in Ottawa around Jan. 5, nearly three weeks after the Pfizer update.

“We’re not putting the same urgency in getting to these people who are the most vulnerable,” Sinha said.

It wasn’t until after the first week of January that inoculation rates began to rise in Ontario’s most vulnerable, according to Bogoch.

“There’s been some meaningful and significant improvement. Quite frankly, the pace of vaccination in long term care has been swift since about Jan. 5,” he said.

“Things are really happening. Could they happen faster? Absolutely. But there is some significant progress. And that is going to save lives.”

By Jan. 20, Ontario had given first doses to more than 39,000 residents in long-term care homes — just over 50 per cent of all residents. Quebec had given over 34,000 doses to long-term care residents, around 87 per cent of all residents, by Jan. 19 despite receiving fewer doses overall.

Speed over perfection

University Health Network medical staff prepare to administer the Pfizer-BioNTech COVID-19 mRNA vaccine.

University Health Network medical staff prepare to administer the Pfizer-BioNTech COVID-19 mRNA vaccine.

Caryn Lieberman / File / Global News

Meanwhile, some front-line doctors and nurses across the province who interact daily with COVID-19 patients are furious that some, including researchers and public relations staff, were invited to get the shot ahead of them.

Dr. Alan Drummond, an emergency room physician in Perth, Ont., near Ottawa, said he and his colleagues who haven’t received the vaccine feel betrayed.

“We have been begging — literally on our hands and knees — begging for some degree of respect, not in priority access to the vaccination, but asking for some kind of timeline,” said Drummond, who interacts with COVID-19 positive patients.

“We need leadership in a time of a national crisis. I think communication and transparency would be a key feature of that leadership strategy, which has been sadly lacking,” he said.

“It’s been disheartening. It’s been demoralizing, and people feel quite betrayed lately.”

The Ontario government’s decision to pivot toward prioritizing “speed over perfection” came shortly after Christmas and was revealed in a video conference on Jan. 12 with Dr. Kevin Smith, president of the country’s largest research hospital, University Health Network.

Read more:
Vaccine confusion at Alberta senior care homes

The video revealed pushback from staff about who is being prioritized for the vaccine, including those who don’t interact with patients. An internal email from the William Osler health system, which serves Brampton and Etobicoke, invited any team member to get a vaccination, including “any back-office/administrative staff or volunteer,” sparking similar criticism about vaccine queue-jumping

In an interview, Smith said offering the doses to non-frontline staff was a “one-time event” and that “blame” right now is not helpful as hospitals are trying to do something that has never been done before in Canadian history.

“We are building the airplane as it’s in the air,” Smith said. “The vaccine rollout has had some ups and downs. Obviously, one of the downs was, the first few days of (receiving) the vaccine, there was more of it in freezers than we wanted to see, and very quickly after that we ramped up to warp speed.”

Smith said that following the outcry of vaccinations being halted for the holidays, there were “explicit” instructions from Premier Ford and retired general Rick Hillier to get vaccines in arms.

“At that point, we thought we had a very reliable supply chain, which we’ve discovered has been interrupted somewhat,” Smith said. “But we took orders and we moved rapidly to get those vaccines in (people’s) arms. For those people who received that, they were extremely grateful.”

Smith said the hospital network is now reserving some second doses of the COVID-19 vaccine after Ottawa announced last week there will be a “temporary” delay of the Pfizer vaccine shipments due to issues at its European manufacturing facility,

“It’s now a pretty complicated matching game of how much is coming in, how much goes out, and then how much will we need to ensure that the second dose can occur within that window that ensures that the vaccine is reliable, safe and effective,” Smith said.

A spokesperson for Osler health said its vaccine clinic has been in alignment with provincial guidelines.

“At this time, in addition to patient-facing staff, vaccines are also being administered to hospital staff, physicians, and volunteers who spend time within our hospitals, when doses are available,” Donna Harris said in an email.

Read more:
Review underway at B.C. vaccine clinics over concerns of queue-jumping

But Dr. Diana Ahmed, a hospital physician at the Brantford General Hospital, said there has been an “inequity” in how the vaccines are being delivered.

“Speed over precision is not what we were hoping to see, and it’s certainly not fair,” she said, adding that many of her staff are still anxiously waiting to be vaccinated. She received her first dose earlier this week.

“I do feel betrayed, but I’m not quite sure who I‘ve been betrayed by.”

With Canada set to begin receiving nearly one million doses a week starting in April, Imgrund and other experts are concerned Ontario’s missteps through most of the first vaccination phase doesn’t paint an encouraging picture going forward.

“Phase one where you need to be vaccinating the most vulnerable people in Ontario — those that will succumb to COVID-19, those that will be hospitalized, those that will put a stress on our health care system,” he said.

“I have no faith that we’re going to be able to ramp up if we can’t start strong.”

Hillier, the head of Ontario’s vaccine task force, told Global News that long-term care residents are now the near-sole focus. The province has now doled out a first shot of vaccines to all long-term care homes in Toronto, Peel, York and Windsor-Essex, as well as Ottawa, Durham and Simcoe Muskoka.

“The only needles in the next four weeks, almost exclusively will go into the arms of those residents and essential caregivers and long-term care homes across Ontario.”

“That’s our priority for the next four weeks, because that’s all the vaccines we have,” he said.

Read more:
Canada will receive zero Pfizer vaccine deliveries during last week of January

Hillier also said the province is looking at creating “50 or 60” mass vaccination sites and the task force is actively speaking with pharmacies and general physicians about how they will be used in the next phase of the vaccine distribution.

In the U.S., some states like Connecticut and West Virginia have found success in vaccinating health workers and long-term care facilities through the use of pharmacies.

West Virginia, for example, used 250 pharmacies, many locally owned, to distribute COVID-19 vaccines. It has completed a first round of shots at all its long-term care facilities, and is now administering second doses while moving on to older populations.

Some of Ontario’s 4,600 pharmacies could be used as vaccination sites that could help deliver more than 750,000 shots a week or more, according to Hillier.

“We’re into planning and discussions with the pharmacies about how they’re going to be included in this and get them involved … so they’re ready to go as the bigger doses of vaccines arrive.”

Provinces vs. Ottawa

A war of words and finger pointing has now erupted between the provinces and the federal government as many premiers have criticized the speed of Ottawa’s vaccine delivery — something that could escalate amid global shortages of the life-saving vaccines.

“We are in desperate need of those vaccines from the federal government,” Doug Ford said Tuesday.

“The news from the feds that Canada won’t get any new Pfizer vaccines next week, and far fewer than expected in the coming weeks, is troubling. It’s a massive concern.”

Maj.-Gen. Dany Fortin, who is overseeing the logistics of Canada’s vaccine distribution efforts, told reporters this week that Canada is not getting any COVID-19 vaccine doses from Pfizer-BioNTech the week of Jan. 25 and Ottawa is unable to say exactly how many doses to expect over the next month.

“We are now seeing that our entire expected shipment is deferred for next week, and then the numbers start to pick back up in the first weeks of February,” Maj.-Gen. Fortin said on Tuesday.

The sudden shortage forced a pilot COVID-19 immunization site in Toronto, meant to be a “playbook for mass vaccination clinics,” to stop administering shots just days after opening.

The office of Intergovernmental Affairs Minister Dominic LeBlanc told Global News the federal government has been “transparent” with Canadians and the provinces on the number of vaccination doses they should expect.

“We’ve also been clear about the challenges surrounding global supply chains. Anticipating these challenges, we engaged in an aggressive procurement strategy, that saw Canada procure more doses per person than any other country,” spokesperson Corinne Havard said in a statement.

“We continue to push to ensure that vaccine deliveries across the country continue to ramp up.”

Hillier reaffirmed that everything is being done to get the vaccines into people’s arms.

“We would have loved to have had those vaccines going out for the long-term care earlier, faster, quicker. If we don’t have them, we can’t do that,” he said.

“We’re not wasting any of this time. We just don’t have the vaccines to get to it earlier.”

But for those who live in long-term care and their families, the wait for a chance to roll up their sleeves is agonizing.

Although Kristin Hunter’s father has not yet developed any severe symptoms, she remains anxious.

“Every time my phone rings, I think, ‘Oh, my goodness, his condition may have worsened,’” Hunter said.

“Can we please do better? I mean, we can’t go back in time with what’s happened. It’s rolled out as it has. … Let’s get it to those (most vulnerable) to prevent more death and more harm to families.”

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