Michael Rachlis MD

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Canadian H1N1 vaccine rollout hits a pothole

2 November 2009, 4:52 PM

I did interviews with nine CBC morning shows today on the troubled roll out of the H1N1 vaccine. Canadians are rightfully enraged at the chaos of last week’s H1N1 vaccine clinics. There must be a better way to run a vaccine program. There are two main reasons why the vaccine roll out looks like rush hour at a Mexican bus terminal.

Late last week, vaccine manufacturer GlaxoSmithKline notified the federal government that it would not meet its production quotas and would temporarily have to reduce the amount of vaccine delivered.  As a result, BC had no vaccine over the weekend and Alberta has no vaccine today.

However, there is a worldwide problem producing the vaccine. The horror stories in Canada are matched by those in the US. And the federal government has shipped 6 million doses of H1N1 vaccine which should be enough to vaccinate those at high risk — pregnant women, children 6 months to less than 5 years of age, people under 65 with chronic conditions, people who live with or care for infants under 6 months old and immuno-compromised people, and health care workers. The real problem is delivering the vaccine to those who need it.

There are some places in Canada which are delivering vaccine expeditiously to those who need it and we can learn something from these communities. For example, in Sault Ste. Marie, the Group Health Association Clinic is using its computerized appointment system to book patients for H1N1 vaccinations from throughout the Algoma Health Unit. Eighty percent of “the Soo’s”  residents get their health care from Group Health. The appointments schedulers have access to Group Health’s electronic medical record so they can ensure that the patients they book are indeed high risk. Patients arrive at the clinic and get their needle within 10 minutes. No waiting

Group Health has over 60 doctors and 300 other staff and is cooperatively run by a community board and the Algoma District Medical Group. It has been a national leader in health care innovation since it first opened in 1963. The Centre has had a computerized appointment system for 20 years and a comprehensive medical record since 1997. Roy Romanow referred to it as a “the jewel in the crown of Medicare.”

In other parts of Ontario, public health is now delivering the vaccine to selected family doctors offices. Some might ask why public health didn’t simply give the vaccine to family doctors in the beginning. In fact, Ontario Medical Association president and family physician Dr. Susan Strasberg and other family doctors have been asking this question. In fact, Ontario and some other provinces have been quietly distributing the vaccine to clinics and shelters dealing with very high risk populations such the homeless, AIDS patients, and drug addicts.

What held public health authorities back initially was the concern that much of the vaccine could be wasted in family doctors’ offices. Most Canadian family doctors still work in small offices with one or two doctors, a non-professionally trained receptionist and no electronic records. Many family doctors don’t even have adequate refrigerators to store the vaccine and with the vaccine packaged in multiple dose vials, public health authorities were understandably concerned that much of the precious vaccine would go to waste in doctors’ offices. On Friday Ontario announced that like some other provinces and distribute vaccine to certain family doctors who met criteria and requested it. As the Globe notes this morning, Ontario and BC have both (perhaps inadvertently) sent vaccine to for profit, exclusive family practices which charge their patients extortionate and likely illegal annual “club fees”.

Some family practices have the vaccine and are distributing it to their high risk patients. In the midst of Toronto’s complete chaos and confusion one of the province’s new family health teams is advertizing this week’s vaccination clinics for its high risk patients. No fuss no muss no waiting. That’s how Canada should have rolled out the vaccine if we had a decent system of primary health care. Family doctors offices and community health centres would have vaccinated the patients they knew to be at high risk from their electronic health records. Public health then could have focussed on groups like the homeless who otherwise wouldn’t have been vaccinated.

If there were a Group Health Centre in every Canadian community, our H1N1 vaccination campaign wouldn’t make us look like a third world country. We need more effective primary health care in Canada and we need to effectively link primary health care to public health. Let’s not wait 50 years for the next pandemic to make this a reality.

I coordinated a workshop for the Public Health Agency of Canada four years ago on how to improve collaboration between public health and primary health care. I’m sorry to say the previous Liberal government was lukewarm to follow up my work and the current Conservative government sees little role for the federal government in health care. No national leadership and little provincial leadership. Fortunately, there are still enough local examples of excellence to provide us with prototypes for a better future.

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