TORONTO — Increased demand for the flu shot has put unprecedented pressure on medical clinics and pharmacies to address fears of an impending “twindemic.”
But while the possibility of simultaneous COVID-19 and influenza outbreaks is real, experts urge an anxious public to be patient, plan ahead by calling providers to check on stock, and book appointments where possible.
Ian Culbert, executive director of the Canadian Public Health Association, says distribution of the influenza vaccine is typically a complex and drawn out process that means availability will vary in the short-term.
He suggests outsized demand has made it seem like there’s less supply than there really is, and stresses that more doses are coming.
“This is early for the flu vaccine to be delivered but there’s heightened awareness and demand for the flu vaccine this year, which has been taken into consideration in the overall volume that will be produced and distributed,” says Culbert.
“The system is flexible but cannot respond so immediately to unpredictable demand.”
Here’s a look at some common questions that have emerged as the fall chill sets in and Canadians prepare for a cold and flu season like no other.
Why did some provinces seem to start their flu shot program earlier than others?
Each province and territory determines their own schedules and delivery plan, although many start their programs in October or early November, the Public Health Agency of Canada explains by email.
Staggered deliveries started in mid-September this year, and manufacturers will deliver most of their orders by the end of October, says PHAC. Health-care workers and long-term care residents are among the first in line.
“This year, because of a large increase in orders, some vaccine will only be supplied in November and December,” the agency adds in a statement.
The Canadian Medical Association has said further variance can emerge at each stage of the distribution chain, including when supplies are dispersed to depots, when individual allotments make their way to each provider, and when that provider — be they a doctor or pharmacist — is ready to receive patients and deliver the shot safely.
I see complaints on social media and in the news that some providers are already running out. Should I be worried?
Demand has certainly been high, and some Shoppers Drug Mart outlets have already run out of initial supplies, a spokeswoman acknowledges. But Julie Dunham says the chain is replenishing regularly and can notify patients of new stock if they sign up for online updates. She says they “expect there to be adequate availability throughout the season.”
Things are less certain for Ottawa family Dr. Alykhan Abdulla, who says he’s only received 110 doses in his first shipment, when he typically receives 500. On a normal season, Abdulla says he receives three shipments of 500 doses for his 7,500 patients.
He has begun rationing shots because he’s uncertain when the next batch will arrive and how much it will include. He also encourages some patients to go to the pharmacy if they’re able, believing the private sector has received more stock than most Ontario public clinics, and received it earlier.
“Tell us where the distribution site is, and every doctor I know will drive there and pick them up,” Abdulla says in a direct address to the health ministry.
Ontario Health Minister Christine Elliott insists supply is not an issue, touting 5.1 million doses that will be available — 700,000 more than what was used last season.
“We do not have a shortage of flu vaccines,” Elliott said Friday. “We are receiving them from several global manufacturers on a regular basis.”
Why can’t clinics and pharmacies get the entire season’s allotment now?
It would be impossible to deliver all doses to all providers at once, says Culbert, who points to a complicated chain involving multiple manufacturers and a fragile product that requires refrigeration and careful handling.
Neither is it possible to deliver the flu shot to everyone who needs it at the same time, he says, noting varied capacity exists even within a pharmacy chain.
“Many of them are independently operating franchises so they have different capacities and different systems, and there’s not a lot of flexibility when it comes to a vaccine that has to be kept at a certain temperature consistently,” he says.
“Very few pharmacies will have the large refrigerators for this. They will have refrigeration systems but they can only probably receive so much vaccine, even on a daily basis.”
Does Canada have enough doses?
Collectively, the provinces and territories have ordered more than 13.9 million doses for this season — an increase of 2.7 million doses over last season.
Public Services and Procurement Canada says 10 per cent of that is the high-dose influenza vaccine for those older than 65 — about 25 per cent more than the number of high-dose influenza vaccine doses ordered last season.
In addition, Canada’s Chief Public Health Officer Dr. Theresa Tam says a small reserve has been created and will be available to provinces and territories if needed.
What if we need more doses?
This year’s orders were placed way back in February and vaccine production for the northern hemisphere is generally over by October, says PHAC. However, the agency says it is possible to get more.
“Discussions are continuing with Canada’s influenza vaccine suppliers to identify any additional vaccine that they may have available for Canada,” PHAC says in an emailed statement.
Additional vaccine may become available if the number of doses produced for the batch intended for Canada is greater than expected, or if some doses intended for foreign markets can be diverted to Canada.
If available, those doses likely wouldn’t land until November or early December, says PHAC.
Canada has supply contracts this season with AstraZeneca Canada Inc., BGP Pharma ULC, GlaxoSmithKline Inc., Sanofi Pasteur Ltd. and Seqirus Canada Inc.
How soon should I get the flu shot, or, how long can I wait?
Experts encourage people to get their flu shot by the end of November, noting it takes about two weeks for immunity to build up.
“And we absolutely want everyone to have that coverage before the holiday season,” says Culbert.
Those at higher-risk to influenza and COVID-19 complications should be prioritized, Culbert and Abdulla agree, but note those over the age of 65 are supplied by a separate, higher dose version of the vaccine.
Still, there are many more people who are considered priority groups: those with underlying chronic health conditions, pregnant women, and anyone whose immune system may be compromised.
While everyone is encouraged to get a flu shot, Culbert suggested some people can afford to wait longer for their turn.
“If you’re a healthy 20 to 50-year-old and you’re following public health guidance as far as physical distancing and wearing a face covering when in public, you have a lower risk of contracting influenza and maybe you want to wait.”
This report by The Canadian Press was first published Oct. 16, 2020.
Cassandra Szklarski, The Canadian Press