The first time I heard about a pharmacy offering up COVID-19 vaccine shots to anyone with an OHIP card, I didn’t think much of it. It had come from a post on a Facebook page. Facebook is, to put it mildly, an unreliable source of pandemic-related information. But then I heard an announcement over the public-address system at a pharmacy: due to cancellations, there were shots of vaccine that were open and at risk of spoiling if not administered. Would anyone want one?
That got me interested. And I got only more interested when I heard three more similar stories, including one from someone I know directly; she’d been shopping at a pharmacy and heard a similar announcement but, sadly, had to leave to pick her kids up from school. Others quickly lined up.
That’s five similar stories, one of them from a direct witness. But I was still curious: Is such a thing even allowed? I called Justin Bates, the president and CEO of the Ontario Pharmacists Association, and described to him what I’d heard. Is it possible this is happening? Should it be?
Yes, it’s possible, he said. As to whether it should be? That depends.
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“Age-related restrictions were put in place by the government through an executive notice, and it clearly stated that, at least up until Monday of this week, only those between the ages of 60 and 64 would qualify for a vaccine through the pharmacies,” Bates explained. “On Monday, that shifted to be everyone 60 and above. So while I can't comment on what an individual store is doing, I can say that those are the rules and that everybody should be abiding by them.”
“But,” Bates continued, “there's certainly a degree of professional judgment that health-care providers need to exercise in order to make sure that there are no shots left behind. We don't want wastage. So there is some degree of flexibility built into the system if indeed there was something that could go to waste. And we saw some controversies when the pilots in the hospitals first started with the Pfizer and Moderna vaccines. Once you puncture the vial, it's only good for a certain amount of hours, and you have a set number of doses to get out of it. There are always one-off cases where you want to use your professional judgment. At pharmacies, that's true in the case of walk-ins versus appointments. At the end of the day, if you've got extras and somebody there that qualifies, get that shot into the arm.”
Bates noted that the vaccines differ in their storage requirements and thus have different constraints to avoid waste. The Pfizer and Moderna vaccines are notoriously fickle and must be kept very carefully chilled. Once a vial has been punctured, the clock is running to use it all — it is considered spoiled in hours. Ontario’s pharmacies, at this time, are using only the AstraZeneca vaccine, which is a little more stable: according to the guidance pharmacists have been offered, Bates said, it can be stored in a refrigerator for up to 48 hours after having been punctured.
Still, when a bottle has been punctured, there is very little left, appointments have been missed, and there are Ontarians in the store who need vaccine, the public-health urgency of this current moment means that getting another person vaccinated right away will sometimes be the right call. This is an especially acute pressure on Ontario pharmacies right now, Bates noted, because the recent shipments of AstraZeneca doses are near to expiration — we have less than two weeks left to use them up.
Would a pharmacist be punished for vaccinating someone who is out of the framework? I asked Bates what would happen if vials had been opened, all the appointments had been served, anyone else present at the end of the day who was within the appropriate age group had also been served, and there was one dose left and one random 40-something hanging around the store. If the pharmacist were to give that last dose to the 40-something, would they be disciplined in some way?
Bates didn’t know. “I honestly don’t know what enforcement would look like, if any,” he said. He did say that, at the very least, the pharmacist would need to explain the circumstances and why, in their professional judgment, they’d chosen to proceed with the vaccination. “As an association, our role is to make sure that everything's a level playing field and that we increase access and convenience for this to ultimately raise the vaccination rates. There are occasionally stories that suggest there was slippage [away from the provincial framework], but there may have been some circumstances that would justify it.”
That seems entirely fair. There’s also the out-of-sight, out-of-mind issue. The government is not likely even to notice this until it becomes a huge issue, and that’s unlikely to happen if the pace of vaccine shipments remains fast enough for us to continue dropping the age of those officially eligible. This will probably remain an issue at the margins, and while a few excited souls, below the official age, may excitedly tweet that they got their jab at a local pharmacy, unless that tweet lands right on Doug Ford’s smartphone, who cares? We are getting into “if a tree falls in a forest” territory here.
I support the age-based framework. I suspect most of us do. I’d also happily take a jab if a pharmacist had one to spare and I happened to be in the store buying toothpaste. There’s nothing incompatible about sticking to the framework but also bending the rules, slightly, to make optimal use of a limited, fast-expiring supply. Bates said he wasn’t sure what enforcement there would be in the case of a young Ontarian getting a shot. So long as such incidents remain justifiable rarities, there shouldn’t be any.