Will Ontario even know what to do with more vaccines?

OPINION: The province’s vaccination program is just starting to scale up — a sudden influx of other vaccines could push the system to its breaking point
By Matt Gurney - Published on Feb 25, 2021
The province aims to have an online-booking portal for vaccination ready by March 15. (Rachel Verbin/CP)

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An embarrassment of riches may soon actually embarrass Ontario. If the province doesn't get its act together, fast, to prepare for the coming arrival of vaccines, there will be hell to pay in this province. Premier Doug Ford won't be able to get away with blaming Ottawa if vaccines are piling up in freezers.

This is all in relation, of course, to Wednesday's announcement about when the general population will start to be vaccinated. Those over 80 are obviously up first; the province believes it will have a telephone- and online-booking portal ready by March 15, with vaccinations beginning the next week. Ontarians over 75 will start getting their jabs on April 15. Seventy-year-olds will become eligible on May 1, over-65s on June 1, and over 60s on July 1. This is all conditional, the province stressed, on adequate supply. But based on what it expects to receive, this is the plan.

I confess to having read the first reports entirely selfishly, translating these dates on the fly into when members of my family would be eligible. Assuming that all my loved ones get vaccinated on the last day of their month, and then adding four weeks to allow the vaccines to become effective, my grandmother will be liberated from her virtual house arrest by mid-May, my in-laws by July, and my parents and aunt sometime over the summer. Yes, we shouldn't lose sight of the bigger picture, but I couldn't help it. These dates lay out a roadmap of when my kids can hug their grandparents again without posing any danger — well, fine, while posing vastly reduced danger. No vaccine is perfect, after all.

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The immediate reaction to the announcement was somewhat skeptical. As noted here in past columns, Ontario has already been struggling to hit vaccination targets and to properly track vaccine efforts, even with the relatively modest supplies thus far made available through the federal government's procurement effort. We didn’t have much and still could barely handle it. But that’s going to change, and soon, or so we think. In my experience, taking a struggling system and working it even harder generally does not provide the desired performance gains. As often as not, it just breaks the system. But the government insists that it is getting ready and, in co-ordination with local public-health units, will get the job done.

It's a big job. Millions of Ontarians will need two doses each. We've struggled to vaccinate thousands a day. The plan to work with the local public-health authorities and to rely on mass-vaccination sites in the big cities will help. But it's going to be a challenge, and we shouldn't pretend otherwise. Nor should we take for granted that it will go smoothly. The government must be held to account here. We need to be planning for this, and rehearsing it, now.

Especially if, as noted above, an embarrassment of riches turns into a simple old-fashioned embarrassment.

Ontario's plan is based on current projected schedules for vaccine delivery — two vaccines in particular, from Moderna and Pfizer. Those are the two currently approved by Health Canada, and there have been delivery challenges with both. Pfizer needed to retool its facilities to ramp up production; Moderna has been less clear about why there have been delays, but reporting has suggested it’s had supply-chain challenges procuring essential ingredients for its production process. But as both companies overcome their challenges, production will ramp up and deliveries will accelerate. Ontario will have to move fast to keep up.

Perhaps even faster than it thinks. There are three other vaccines that are reportedly close to approval by Health Canada — the AstraZeneca vaccine, the Novavax vaccine, and the Johnson & Johnson vaccine. That last one is of particular interest because it is easily stored and transported, requires only a single dose, and has still proven spectacularly effective at preventing hospitalizations and deaths (if somewhat less effective at preventing mild illness). The other two are also dual-dose vaccines, but the British, in their rush to defeat their second, more contagious wave, extended the interval between the two AstraZeneca doses and found that the first dose, even in isolation, proved highly effective at preventing the worst COVID-19 outcomes.

We don’t know when Health Canada will approve these vaccines, but all are reportedly close to getting final authorization. We also don’t how quickly Canada will get first deliveries after approval, but it could be quite early. This would be good news, but if Ontario’s vaccination program is just starting to scale up and is struggling even to make use of what Pfizer and Moderna vaccines it expects to receive, a sudden influx of other vaccines — ones optimally suited for rapidly vaccinating the younger population — could cause the system to break down due to oversupply. That would be a political disaster for the government and would, in the end, cost lives, too.

I wrote here in a recent column that Ontario needs to be rehearsing its mass-vaccination campaign and planning for failure and breakdown. That’s still true. But we also need to factor into our plan the possible complications of good news — if we get a sudden bounty of newly approved vaccines, can we scale up our system fast enough to make full and effective use of them? You’d like to think so. But doubts are, alas, warranted.

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