On Christmas Eve, Ian Arra put his three-year-old daughter to bed and lined up her stuffed animals in order to test an idea he had about mass vaccinations.
“I just wanted to see if I could [simulate getting] consent and simulate injection within 30 seconds,” says the chief medical officer of health for Grey Bruce. It turned out he could — and that was the proof of concept Arra needed to pitch to his team a new mass-vaccination model he’d been thinking about for years.
The “hockey hub” model, named for the arenas it works well in, involves lining up patients and directing staff and shots to them, rather than the other way around.
“One vaccinator will give the vaccine to around 70 people per hour, versus six to 10 per hour in the traditional system,” Arra says. “That means five people can vaccinate 4,000 people per day.”
Arra was able to convince his team that the model would be successful, so in February and March, the Grey Bruce health unit worked with local municipalities to implement it, converting three arenas-turned-field-hospitals into mass-vaccination clinics. (Arra says a lack of demand meant that the field hospitals — located in Hanover, Kincardine, and Owen Sound — had never accepted any patients.) Partial funding was provided by local businesses.
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The model works like this: One end of the iceless hockey rink contains several lettered rows of individually numbered cubicles, and each cubicle contains a single chair. Registrants, who enter at the other end of the rink, are directed to a cubicle to sit down and await their jab.
“Off the bat, you really save a lot of resources,” Arra says, noting that because there's only one chair per cubicle, only one surface needs to be cleaned between shots. “But the main saving is in the health-care providers.”
Each provider is paired with a “runner” (who may be a volunteer) to support them. Together, they take a vaccine-laden cart down their assigned row, getting consent and administering shots one by one. A row of 30 pods takes 15 minutes to complete — meaning when the cart returns to its starting point, the first person in the row to have received their vaccine will have finished their required post-jab wait, and a new person can take their seat. For extra support, Arra says, a recovery nurse and two paramedics patrol the area to monitor patients.
Norfolk EMS chief Sarah Page, who leads her area’s vaccine rollout, says the hockey-hub model has made Haldimand-Norfolk’s clinics far more efficient. “Our problem is [being] a highly rural area with limited staff,” she says. “Human-resource-wise, we’re stretched thin, so we had to look at ways that would efficiently get more vaccine out to our community safely.”
After Page’s team implemented the model at a Cayuga arena, the clinic there went from issuing as few as 450 shots in an eight-hour shift to as many as 1,500 — “with very few additional staff,” she adds. The model increased capacity to the point that people as far away as Toronto were booking appointments in Cayuga earlier this month. “For a small county, this has allowed us to have a much greater output than we ever imagined,” she says.
Not only does the hockey-hub model get more jabs in arms — it also does so for less money, according to Grey Bruce Public Health. The system costs about $6,000 per 1,000 vaccines, while traditional large-volume models can cost about $26,000 per 1,000 vaccines.
It can also be scaled down to include fewer rows of cubicles, if necessary: Page says her team was able to adapt it for a clinic at Caledonia’s Gateway Church one weekend in June. “We managed to do almost 400 in a day, which at an auxiliary, smaller clinic is quite impressive.”
Arra acknowledges that the model requires more space than your average local pharmacy can provide, although he notes most municipalities have ready access to hockey arenas or similar facilities. And managing traffic can be a challenge, too: “If you're going to bring 5,000 people within 10 hours, that’s where the expertise of the police services is instrumental. They usually adjust traffic whenever there is a hockey game … This process is not much different.” Health-care providers also need a large enough supply of vaccines to justify the model. (Back in February, when Grey Bruce announced the initiative to the public, the health unit didn’t have enough shots to roll it out.)
On June 12, Arra and a team from the Grey Bruce Health Unit went to the mass-vaccination clinic at the CAA Centre in Brampton to oversee its use of the hockey-hub model. A spokesperson for Peel Public Health tells TVO.org via email that the clinic administered about 5,700 doses that day: “We have found it to be a very efficient model for running clinics that have the adequate footprint to accommodate this model.”
Not every health unit is on board, however: for example, in an emailed statement, Niagara’s acting medical officer of health, Mustafa Hirji, says he and his team found the model interesting but didn't send staff to witness it in action due to this spring's stay-at-home order. Now, with the region “perhaps more than half-way through the mass immunization phase,” Hirji says it wouldn’t make sense to change processes and retrain staff. He adds that his health unit didn’t want to download functions that would normally be performed by clinicians — such as educating patients about vaccines — onto volunteers.
That said, Hirji notes that his team does want to observe the hockey-hub system this summer “so that we can better understand it and incorporate it into future pandemic planning.”
Arra and Page both feel optimistic about the vaccine rollouts in their regions’ hockey hubs. Arra says administering vaccines quickly means freeing up staff for other tasks, such as contact tracing and case management, and reduces the need to develop prioritization frameworks.
“In public health, most of what we do is long-term benefit,” Arra says. But with a vaccine, “you can see the benefit at the end of the day, that these people are excited about getting the vaccine and protecting themselves and their families.”
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.