Trillium Health Partners vaccination clinic in Peel, University of Toronto Mississauga Campus. Image credit: Premier of Ontario Photography/Flickr

My American friends delight in repeating their favourite Canadian joke: “How do you get 50 angry Canadians to stand in a line?” Answer: “You ask them.”

An update would ask how you get 37 million Canadians to wait for vaccine shots against COVID-19. Except this time, the ask has not been that straightforward.

Yes, Operation Warp Speed in the U.S., as well as vaccination fast-tracks in other countries, accomplished things not previously done before. Pharmaceutical companies and university researchers created a new form of vaccine. Then they conducted trials in very short timeframes. And finally, national groups like the U.S. Food and Drug Administration and Health Canada reviewed and approved the drugs in record time.

At the same time, Canada shopped the world for vaccines even before they were approved. We signed deals for many millions more doses than there are Canadians. And Canada appointed former NATO commander Maj.-Gen. Dany Fortin to prepare a vaccine distribution plan. So far, so good. Canadians believed that the government was doing its best to deal with this aspect of the pandemic.

So what happened? Why are we still waiting for vaccines, when countries all over the world are far ahead of us in putting shots in arms? There are several reasons. The first is that Canada did not support the development of a made-in-Canada vaccine, despite requests from public and private laboratories and researchers. Compare this to England, with a population just under 60 million, where Oxford University and AstraZeneca collaborated to develop and manufacture a vaccine. At the end of February, some 20 million people had received at least one dose in England. In Canada, the number was under two million. Canada has the science and the knowledge to create a vaccine. We missed that boat.

The second reason relates to the first. Canada relies on facilities in other countries to produce vaccines. When Pfizer shut down its plant in Belgium to retool, supplies to Canada dried up. There is no guarantee that this won’t happen again.

The third reason is another part of the supply-and-demand puzzle. Each province prepares its own distribution plan. Fair enough, as each province has distinct demographics. But no province has yet devised a plan to deliver excess vaccines to people not on published criteria lists.

Think of this relative to airlines overbooking flights, way back when airlines were flying. There is rarely a 100 per cent uptake on shots; for one reason or another, there are no-shows even when appointments are booked. What happens to these doses at the end of the day? People not on the approved distribution list cannot receive the vaccine without blowback for jumping the queue. This means that doses are discarded.

And so, we don’t have the doses we need to vaccinate Canadians as soon as possible. And when the doses dribble in, we don’t have the full distribution plan nailed down. We may be able to deliver doses to individual provinces, but that is far from the individual arms of people who need vaccines.

Canada is trying to solve new problems with old thinking. The federal government is responsible for the purchase of vaccines. This is an interesting fact, given the years-long attempts to implement pharmacare. As with purchasing of drugs, buying vaccines in bulk provides negotiating advantages. But that doesn’t seem to sway the provincial ministries of health. Not all provinces are happy with being shut out of the purchasing decisions.

The provinces are responsible for getting the vaccines into arms. The suggestions from federal health authorities on vaccination strategies are just that — suggestions. Provinces are free to establish their own vaccine plans.

A recent example shows just how bizarre this situation is. At the very beginning of March, the chief medical officer of British Columbia announced that booster shots of the available vaccines would be postponed for up to several months in order to vaccinate more people with the initial doses available. The outrage was palpable: how could she do this? The next day, federal medical officials followed suit.

So where does this leave the angry Canadians still standing in line? Messaging is confusing. Be patient and be vigilant while you are waiting. And even when you are vaccinated, continue to be vigilant. Is this meant to make the unvaccinated feel better?

Media reports suggest that people have a huge sense of relief when they receive their shot. Yet vaccine hesitancy persists. And doses go unused at the end of the day.

This is true even in congregant care settings, where some staff (and a very few patients) refuse the doses offered. Yet when the media reports that excess shots were given to non-clinical staff and patients, for example to employees in housekeeping, public reaction is roused.

It seems to me that Canadians are expected to heed poet John Milton’s 16th-century advice: “They also serve who only stand and wait.” Maybe the joke really is on us.

Evelyn H. Lazare is a retired health-care planner, strategist and executive. She now devotes her writings to novels.

Image credit: Premier of Ontario Photography/Flickr

EHL rabble headshot BW

Evelyn Lazare

Evelyn H Lazare is a healthcare planner, strategist and executive. Lazare has led nation-wide healthcare organizations in Canada and has consulted to an array of healthcare and related clients in both...