Helen Branswell, Medical Reporter, THE CANADIAN PRESS

Stumble Upon

del.icio.us

Digg

Facebook

Print

Email

Speak Up

TORONTO - The slowdown in the H1N1 vaccine rollout may frustrate Canadians looking for a flu shot, but provincial and local health authorities see an opportunity in the problem.

Having less vaccine to administer gives places that didn't have a seamless vaccine rollout last week a chance to hit the reset button, several key public health officials admit.

And not a moment too soon, says Rick Krehbiel, a land use consultant and part-time professor from Prince George, B.C., who has been watching the H1N1 vaccination program's early stages with dismay.

"If we'd invaded Normandy in this kind of an atmosphere, we wouldn't have made it," says Krehbiel, 59, who thinks he'll likely get a shot when his turn rolls around, because the teens and young adults he teaches are at high risk of catching this flu.

Krehbiel says for months authorities have been admonishing Canadians to take this virus seriously and get the vaccine when it became available. But when that happened, willing arms met with lineups and confusion.

"So assuming that it's really, really important, then one would have thought that the ... vaccination system would have been quite well organized," he says.

He gives the effort so far a C-minus. "I don't think they've totally failed. But they sure didn't do their homework."

Public health leaders in several provinces admit things could have gone smoother and say their teams and their counterparts in local public health units are working hard to fix them.

"We saw some challenges, obviously with respect to lineups - lineups that were unacceptable to us and to the public," says Dr. Arlene King, Ontario's chief medical officer of health and until last spring the Public Health Agency of Canada's point person on pandemic influenza.

Ontario has responded by expanding clinic hours and doubling the number of clinics open in comparison to the first week of the rollout. Some of that expansion was planned as part of a staged vaccine delivery ramp-up, but some of it is an unplanned increase in capacity brought on to deal with high levels of demand.

The province is looking at special lines for pregnant women and giving people appointments or at least time windows during which they can come back to a clinic and get vaccinated.

"We're really learning from the best practices that worked in other parts of the province as well and applying those to the experience."

Though the multi-hour lineups have dominated the news coverage, there have been places where operations have run smoothly.

The Assiniboine Regional Health Authority in Manitoba activated a call centre it uses for seasonal flu shot delivery - a system that allows them to gauge how much vaccine they'll need in various parts of the region.

People call a toll-free number, are asked questions designed to determine if they are in a priority group and they are given an appointment to get their shot.

Sault Ste. Marie, Ont., has also used appointments. North Bay Parry Sound health authorities moved a local clinic to a larger facility when demand exceeded expectations. Other places too have adapted on the fly, giving out numbers to people in line.

But in other places, things haven't gone by the playbook. Alberta authorities jettisoned plans to call in people by priority groups - and saw their clinics swamped.

"I don't think anyone had a perfect rollout. More importantly, I don't know why anybody would have expected to have a perfect rollout," says Dr. Joel Kettner, Manitoba's chief medical officer of health.

"I think there are lots ... of lessons learned, lessons we are learning and there's more lessons that we are going to learn. And that's the spirit that I think we need to be doing this in."

One of the lessons Kettner believes public health needs to take onboard doesn't relate to managing lineups or scheduling clinics. It's about psychology - what drives people to line up for hours for a shot that polls taken a week earlier suggested most didn't want.

He and others say the enormous impact of the death of 13-year-old Evan Frustaglio of Toronto caught them off-guard.

Public health was expecting a "tepid" demand for vaccine, says Dr. Perry Kendall, chief medical officer for British Columbia.

But the day most clinics opened - a week earlier than planned and without all the kinks worked out - people heard the heartbreak of a father and saw the photo of a smiling, normal and now dead kid. Seven-hour lines formed outside some clinics.

Planners hadn't anticipated the abrupt shift but should have, Kettner says.

"This is something we need to learn in public health," he suggests.

"We . . . work with statistics and numbers and we try to be rational and evidence(-based) and all that. And that's all important. We have to do that. But what really motivates people are stories, are real-life events that bring this to life for them."

The reset efforts appears to be paying off in places.

Toronto Public Health reported Tuesday that the wait time at the majority of their clinics was less than an hour and some clinics had no lineups at all.

Kendall admits there have been bumps and missteps, things that can be and are being improved. Still, he insists, the program isn't going that badly.

By the end of this week, he notes, an estimated 20 per cent of Canadians will have received an H1N1 shot. That's not bad, Kendall says.

"Did it all go smoothly? No. Would you expect it would all go smoothly? No. Have we ever tried to do this before? No."

"Does anybody have experience to build on? Now we do."