COVID-19 Vaccine Rollout in Canada – Administration

The priority populations for COVID-19 vaccine administration in Canada include adults aged 70 and above, healthcare workers in direct contact with patients, and adults in Indigenous communities“. The COVID-19 vaccine roll out in Canada has been slow in comparison to other developed countries. Details on Canada’s approach to administration of the COVID-19 vaccines have been provided below.

ADMINISTRATION OF COVID-19 VACCINES IN CANADA

Priority Populations

• In Canada, the following are the priority populations for early COVID-19 vaccination:
  • Adults aged 70 and above, with priority given to those aged 80 and above.
  • Healthcare workers who stay in direct contact with patients, such as people who work in healthcare settings and personal support workers.
  • “Adults in Indigenous communities“.
• As more vaccines and supplies become available, the following populations will be considered next:
  • Healthcare workers who were not in the initial roll out. 
  • Staff and residents of shared living settings including correctional facilities, migrant worker housing and homeless shelters.
  • Essential workers who are at risk in order to “maintain services for the functioning of society.”

Locations

• Immunization clinics are not the only way in which vaccines are administered, but they are a way to “immunize large numbers of people over a short period”, and clinic sites include shopping centers, schools, colleges, universities, nursing stations, friendship centers, places of worship, arenas, legions, community centers, trade or convention centers, large empty stores and city halls.
• Other potential immunization clinic sites include outdoor areas such as parking lots and sports fields, with the appropriate equipment such as heaters and tents.
• Apart from immunization clinics, other delivery methods include:
  • “Community health care providers’ offices (physicians’, nurse practitioners’ or public health offices)”
  • “Pharmacies“
  • “Workplace clinics (including in health care settings)”
  • “Facility-based administration for institutional or congregate living settings (such as hospitals, long term care homes, retirement homes, shelters, group homes, correctional facilities)”
  • “Mobile vans“
  • “Home visits, including door-to-door clinics” 
  • “Walk-up, drive through or parking lot clinics”

Administering Staff

• Traditionally, vaccines are usually administered by nurses and doctors in primary care, or by public health nurses. Recently, however, this responsibility has been extended to pharmacists, and may also be extended to paramedics in order to provide surge capacity.
• At immunization clinics, additional staff will be necessary and this may be drawn from temporary-help and nursing agencies; nurses and physicians who work in the community, healthcare facilities, and healthcare institutions; nursing, pharmacy and medical students; and other providers such as pharmacists, dentists, midwives and paramedics.
• To fill the non-healthcare provider roles, volunteers, other allied health professionals and “non-health care provider public health unit staff” will be included, and their roles will be determined according to regulations and policies, as well as their experience and competence.

Booking

• In order to avoid crowds at the clinic and ensure physical distancing, the following strategies will be put in place:
  •  Registration and appointments online and by phone.
  •  Client invitation by school, postal code or alphabetically by name.
  • Assigning ticket numbers or wristbands after on-site registration.
  • Setting block appointments for groups. 

Product Quality Assurance

• Special attention will be given to handling and storage of vaccines because some are stored at ultra-low and freezer temperatures, while others can be stored in the normal 2 to 8 degrees Celsius. Those that require lower temperatures will need to be stored at 2 to 8 degrees before use. The date and time when vaccines are refrigerated and when they should be used will be specified. 
• Vaccines will be stored securely overnight in clinics that have the capacity and equipment; and for clinics that lack these, they will be transported to and from storage sites according to cold chain and transporting requirements. There will be protocols to monitor and record storage temperatures, especially if vaccines are stored in coolers or insulated bags rather than freezers and refrigerators.
•  Starting and ending time frames when vaccines can be kept at room temperature, used when pre-loaded into a syringe, used when mixed with other substances, or used when the vial is punctured will be noted down. Based on manufacturer recommendations, pre-loaded syringes and mixed vaccine vials that are not used immediately may be stored at room temperature, in coolers, or insulated bags.
• Vaccines will be thawed and maintained at 2 to 8 degrees Celsius, or brought to room temperature, according to manufacturer instructions, with time frames of thawing and usage clearly specified.

Administration of Vaccines to Vulnerable and Hard to Reach Populations

• Strategies to reach hard to reach and vulnerable populations include:
  •  home visits 
  • providing bus tickets or taxi chits, or organizing rides to clinics
  • holding immunization clinics at places where vulnerable persons gather such as shelters and food lines
  • using multilingual and younger family members to help in communication
  •  using translators at clinics
  •  translating immunization materials into different languages
  • working with mental health, social support case and outreach workers
• Indigenous Services Canada (ISC) is working regional provinces, offices and territories; PHAC and Indigenous partners to ensure that remote communities have access to the vaccine.

Avoiding Wastage

• Provinces and territories (PT) will direct local and regional departments on strategies or administering the vaccine, including minimizing wastage.  
• Plans will be made to ensure that any extra thawed vaccine is used either over the next few days at a clinic, or in a healthcare provider’s office or congregate living setting according to eligibility criteria and assuming appropriate transportation. If the thawed vaccine cannot be transported or is reaching maximum time at that particular temperature, a contingency plan can be used, such as a waiting list for eligible people who can be called for vaccination urgently. Moreover, vaccines can be administered in order of those currently eligible, those who will soon be eligible and others as appropriate.
• When doses are given to ineligible persons to avoid wastage, such cases will be documented.  

Data Collection

• Health Canada’s Canada Vigilance Program will collect and assess reports of suspected adverse reactions to the vaccine from manufacturers, patients and their families, and healthcare providers.
• Each province and territory (PT) has a system to track immunization data using paper-based systems, electronic databases or both. Key data elements will be determined such as age, risk groups and gender, and then information will be collected from vaccine recipients.
• Public health authorities will measure vaccine uptake as the vaccine is being administered, to check whether it is lower than expected or in line with expectations. If it is lower, there may be a need for promotional efforts or other strategies such as adjusting recommendations or vaccine allocations to different jurisdictions.
• The Canadian Immunization Registry and Coverage Network (CIRC) will develop data standards and facilitate collection and sharing of vaccine uptake reports from different jurisdictions. CIRC members will make weekly reports of vaccines administered in their respective jurisdictions, “broken down by recipients’ age and gender, as well as the number of doses administered to the populations targeted for early immunization.”
• There are plans for monthly national surveys via Statistics Canada to estimate the levels of vaccination coverage in provinces and territories. This survey, which will supplement data from PT registries, will provide information on attitudes, beliefs and knowledge of the vaccine among the immunized and non-immunized, reasons for immunization or lack thereof, and sociodemographic information.  

Performance Management

•  External networks will be engaged to monitor adverse events following COVID-19 immunization, and to carry out studies on the effectiveness and safety of the vaccine. An example is the Canadian Immunization Research Network (CIRN), a group of top institutions and researchers in Canada.
• “The Canadian Influenza Sentinel Practitioner Surveillance Network (SPSN) and the Serious Outcomes Surveillance (SOS) Network of CIRN” will provide information on the vaccine’s effectiveness. 

CANADA’S COVID-19 VACCINE APPROACH

Slow roll out

• The COVID-19 vaccine roll out in Canada has been slow in comparison to other developed countries which have shown good progress over a shorter amount of time. This is in spite of the fact that it was among the first countries to approve the vaccines and has secured the highest rate per capita of vaccine contracts.
• This slow roll out is attributed to logistical challenges that are brought about by Canada’s large geographical area. It is the second largest country in the world and has many remote, rural and underserviced areas, thus presenting cold-chain issues. It also has a “decentralized health system run by individual provinces and territories.”
• In addition, Pfizer recently announced a temporary reduction of deliveries to Canada and Europe as production capacity is upgraded. This will cause further delay in the roll out and could “affect the wait time between each shot of the two-dose regime.”

Pausing for the holidays

• Vaccinations were paused for two days during the holidays in Ontario, the most populous province in Canada. Due to staffing concerns, clinics had shortened hours on 24th December and were closed on the 25th and 26th.  
• This was not seen as a wise move, and the head of Ontario’s vaccine task force, retired General Rick Hillier, later acknowledged that it was a wrong decision. He promised that there would be no more days off. 

‘Me First’ Mentality

• Rather than working together, many countries have had a ‘me first’ attitude when it comes to obtaining the vaccine.

• Canada, among other rich countries, is said to have hoarded most of the available vaccines. All of Moderna’s vaccines and 96% of Pfizer’s vaccines have been secured by countries such as the UK, US and Canada. In fact, Canada has “ordered the most vaccines per person in the world”, and they would have enough to immunize their population five times over.
• This can create a global supply shortage and complicate international efforts that aim to promote equal distribution, especially because pharmaceutical companies can only produce vaccines in a finite capacity.