So you got your first dose. What’s Ontario’s plan for the second?

OPINION: We need to establish a clear plan for when we’ll begin transitioning to second doses, who’ll qualify for them first, and what those people need to do to get the shots
By Matt Gurney - Published on May 25, 2021
People line up to get their Oxford-AstraZeneca COVID-19 vaccinations in Toronto on March 11, 2021. (Rachel Verbin/CP)



Sometime in the next few weeks, an amazing thing is going to happen in this province. It’s inevitable. It’s close at hand. And it’s going to be good news. But it will also pose challenges that we must be ready to meet.

The provincial vaccination effort is going well and has ramped up as supply has increased. As of this moment, roughly 55 per cent of the eligible population — everyone 12 and up — has received at least one dose of a COVID-19 vaccine. Indulge me in a bit of back-of-napkin math. With just under 13 million Ontarians in that 12-plus age group, and with daily vaccination levels generally above 130,000 per day, let’s seize upon some conveniently round numbers and agree that, so long as supply remains stable, the province can vaccinate about 1 per cent of this group per day, with some left over for those Ontarians prioritized for second doses. (This is a small group for now, but it will expand.) 

Now, and still just sticking with round numbers, if we have 1 per cent per day being vaccinated, and if we’re already at 55 per cent of the eligible population with a first dose done, in the next few weeks, we’re going to start hitting the ceiling for the first-dose effort. No doubt we’ll continue giving first doses for many, many months. New people will age into the eligible categories; people who were originally hesitant will change their minds.

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There won’t be some clear dividing line here — no ceremonial cannon will blast confetti into the air after the final first dose is given. (I hope we’ve all learned our lesson regarding gigantic MISSION ACCOMPLISHED banners.) But sometime in the near future, perhaps the very near future, there just won’t be as many first-dosers looking for that jab. Supply will exceed demand.

What do we do then?

The answer is easy in the abstract: we move on to second doses. But that’s going to be more complicated in practice. When do we deem the second-dose phase to have begun? Who’s up first in the general public (again, there are certain groups that already qualify)? Do we do it by hot spot? By age, in descending order? Essential workers? What? 

None of the above should be read as exasperation — which is normally how a bunch of sequential questions would be read! These really are just questions, but they’re important ones, and we’re going to need answers for them sooner than we think. 

The most logistically challenging part of this whole operation, and likely the most confusing for the public as well, is going to be the transition from the (mostly) first-dose-only phase to the (mostly) second-dose-only phase. In the (mostly) first-dose phase, it was easy: with some narrow exceptions, everyone showing up was just getting their first jab. In the (mostly) second-dose phase, with the exception of those marking birthdays or overcoming their hesitancy, it’ll just be a matter of finishing all the first-dosers off. 

It’s that middle period — when we’re still hoping to get more first-dosers in the door while those waiting for second doses grow ever-more impatient — that’s going to suck to live through. Since we don’t know precisely how many Ontarians will take a first jab, we naturally can’t know with certainty when we’ve got the last one.

I don’t think I’m revealing any state secrets when I point out that a problem for us throughout this pandemic has been a lack of preplanning and foresight. We have been caught totally by surprise, utterly flatfooted, at every turn. It’s a big, big problem we have yet to solve. This might be just about our last opportunity to get one of these things right. 

We’re not off to a great start. Ontario recently announced that it would release the rapidly expiring stockpile of unused AstraZeneca doses to give second shots to those who’d already received first doses. This has not gone particularly smoothly: days elapsed between the announcement and any real guidance about what could and should happen next. Justin Bates, the CEO of the Ontario Pharmacists Association, and a man who’s been kind enough to give me his time for interviews during this pandemic, was doing the media rounds on Tuesday and tweeting, too, giving the public updates on what to expect and when they might expect to get more information. This was good! It also shouldn’t be up to him. 

But it’s basically impossible to be surprised by such things at this point. It would almost be more surprising if we did a good job, to be honest. But hope springs eternal, or something like that. I just can’t quite get over my stubborn insistence that better is always possible. 

So let’s do better. Let’s establish, like, right now, a clear plan for when we’ll begin transitioning to second doses, who’ll qualify for them first, and what those people need to do to get the shots. Let’s establish clear benchmarks for when that transition can happen and when it can be expanded to other groups — and what those groups are and what those people should do. Let’s set some targets. And exceed them.

We can do this. It’s possible. It’s necessary! This is going to be the most complicated and messy part of this vaccine process, but it’s not beyond our capabilities — or at least it ought not to be! The second-dose era is coming. Let’s please, please be ready for it. If only for a change. 

Go Leafs Go.

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