Ontario’s pandemic vaccine program was a classic case of supply-demand mismatch, a new report on the province’s response to the H1N1 outbreak suggests.
There wasn’t enough vaccine when the public was clamouring for it and by the time supplies had swelled, demand was fading, according to a report from Dr. Arlene King, the province’s chief medical officer of health.
“To be blunt, from Oct. 26 — the date of the launch of our H1N1 immunization program — there was never an alignment between H1N1 vaccine supply, demand and our capacity to deliver it,” King said during a news conference Wednesday called to release her report.
King said a variety of factors were to blame, not least of which was the fact that the province didn’t know from one week to the next how much vaccine it would be getting from the federal government.
“We were hearing in real time — literally in real time — how much vaccine we were going to get and planning our programs accordingly,” she said.
“And I can tell you that literally every day we were sitting down determining whether or not we could expand our priority group list, depending on how much vaccine we thought we were going to get and how much we thought we had left.”
Provincial Health Minister Deb Matthews supported her chief public health official.
“I think everybody has to take a share of the responsibility,” Matthews said when asked who was to blame for the lengthy lineups that dogged the early days of the vaccine rollout.
“I think for sure, not having the supply of vaccine and not having a certain supply of vaccine made it very, very difficult to sequence ... the distribution of the vaccine. So the certainty of supply was a huge factor.”
King estimated about 38 per cent of Ontarians were vaccinated, which is near the low end of vaccination rates among provinces and territories.
But even within Ontario there was wide variation from region to region, she said, adding further study will be needed to try to understand why some areas managed to vaccinate far more people than others.
For instance, Ottawa appears to have vaccinated twice as many people — on a percentage basis — as Toronto did, King said.
King insisted on a whole Ontario fared well in its H1N1 response. But she said things could be improved for future disease outbreaks and she called for several changes to help ensure a smoother response in future.
For one thing, King is asking the provincial government to give her office more powers, so that the chief medical officer of health can issue directives to local health boards in the case of a public health emergency.
During the pandemic, King had no authority to insist the province’s 36 health boards follow vaccine priority groups recommended by the World Health Organization and set by the federal and provincial governments.
The fact that different regions were taking different approaches in their vaccination campaigns contributed to the public’s confusion, she said.
“They resulted in, I think, in really frankly shaking some public confidence in terms of how the pandemic was being managed. And I think ultimately those kinds of things result in concerns around public safety as well.”
Matthews said the province has heard King’s call for additional powers and will likely act on it. “Yes, we are actively looking at legislation for the fall session” of the legislature, the minister said.
King also called for a review of the provincial immunization system, saying the province needs to learn from the H1N1 experience.
And she expressed frustration that vaccine tracking technology that has been in development since the SARS outbreak of 2003 hasn’t yet been put in place.
The program, called Panorama, would allow for both the tracking of supplies of unused vaccine and provide a real-time picture of who was getting vaccinated. If it had been in use last fall, officials would have been able to assess how well they were doing in efforts to target people with chronic health conditions, for instance, or pregnant women.
“In too many critical ways, we didn’t have the details we needed about how the immunization program was unfolding,” King said. “In an era where there is much talk about electronic health systems and patients records, we do not have in this province the capacity to electronically manage and track our immunization programs.”
The system, which has faced a series of delays, is being developed for use across the country.
“This is a frustrating system challenge made all the more frustrating by the fact that the technology exists to overcome it,” she said. “There have been delays. There must be no more delays.”