'We have to pick up the pace': Concern over vaccine rollout intensifies as third wave worsens

It's become a polarized debate: is Doug Ford hoarding Ontario's vaccines in freezers or is the province doing everything it can despite limited supply from the federal government?

According to Dr. Isaac Bogoch, an infectious disease physician who's on the province's vaccine task force, neither is quite right: Ontario must use its supply to vaccinate high-risk people more quickly but the frequently heard concerns over "vaccines in freezers" aren't a fair reflection of the rollout in Ontario so far.

"Number one: of course we have to pick up the pace of vaccination," he told QP Briefing in a phone interview on Monday morning, right before heading into the COVID ward of Toronto General Hospital.

On a good day, the province is vaccinating over 80,000 people but by now should be at 100,000 people per day and ready to escalate to 150,000 people a day and more when supply is truly no longer an issue, he said.

But, Bogoch said, emphasizing that his expertise is infectious diseases, not supply chain logistics, the debate raging in some online circles about the number of vaccines Ontario has in freezers doesn't take into account the on-the-ground realities of the vaccine rollout. Ontario receives vaccines in large shipments and it takes time for them to get to vaccination sites and into arms, creating a gap after large shipment.

"The freezer narrative doesn't tell the whole story, because oftentimes you hear about vaccines in freezers on the day of delivery," he said. "If you get 800,000 vaccines delivered in your freezer and then you take a snapshot in time, right when they're delivered, yes, there are 800,000 vaccines in your freezer. So that narrative isn't entirely ... reflective of the ground truth."

It's also entirely reasonable for the province to keep enough supply to cover appointments booked days in advance as a buffer to protect the rollout from some of the supply disruptions that have occurred, he said.

"I'm not saying everything's OK," he added. "Because it isn't. We need to vaccinate faster, we truly need to vaccinate faster."

By QP Briefing's calculation, Ontario's "vaccination gap" — the number of vaccines distributed to the province, minus those administered — hit a record high of more than 1 million doses on April 1.

That's in part because the province received well over a million doses in the past week: 583,400 AstraZeneca doses on April 1, 225,600 Moderna doses during the Easter weekend, and 466,830 Pfizer doses at the end of March, according to figures from the provincial government. Meanwhile, the province only administered about half a million shots over the course of that time, with a dip in daily numbers over the Easter weekend.

With some 2.5 million shots in arms of 3.5 million received, the province has some catching up to do. And the deliveries will keep coming — this week the province is scheduled to receive 396,630 Pfizer doses, 122,900 AstraZeneca doses and possibly another 303,100 Moderna doses, although officials expect the latter to be delayed.

(Editor's note: After this article was first published, the federal government confirmed the latest Pfizer shipment has arrived, bringing Ontario's vaccine total to over 4 million doses and expanding the vaccine gap to nearly 1.5 million doses.)

But protecting the province as the third wave worsens is not just about speed.

Bogoch and other experts have been stressing the need to get vaccines to front-line workers — a concern that's received more public attention recently as the variants of concern have spread dramatically putting younger people at higher risk, and as stories of workers and their families have made the news.

He also stressed it's long been a priority and part of the province's phased vaccine distribution plan.

"I'm really happy that people are suddenly paying attention to essential workers," he said. "Many of us have been discussing this for months, so it's wonderful that there's suddenly a lot of attention focused on this area. But I think that's also a little bit too narrow. We should be looking at not only essential workers but the communities that they live in."

The plans the province released show that essential workers, outside of health care, who cannot work from home will be prioritized in Phase 2 — initially indicated in the latter half of the phase — and the province hasn't officially announced the start of that phase.

However, the plan was always subject to vaccine ability and targeting those workers is already happening to some extent, even though that's mostly flown under the radar and been poorly communicated, Bogoch said.

Toronto and Peel have begun targeting postal codes with the highest rates of COVID-19, offering shots to people in younger age groups. This captures many front-line workers and, importantly, the people they'd likely spread the virus to if infected, he said.

The hot-spot strategy is also part of the racial equity built into the province's rollout plan — the province committed to prioritizing Black and other people of colour and is doing so by targeting hardest-hit neighbourhoods, recognizing the overlap between race, essential work and geography.

Bogoch cited another example of targeting front-line workers: Niagara vaccinating 1,500 special needs teachers who work closely with students who may be unable to wear masks.

"It's slow, but it started," he said. "Some front-line workers have already been vaccinated and you're gonna watch that massively expand as we move through Phase 2. So I appreciate people's concerns [about essential workers] and I totally agree with them. But that's the plan. The plan is being operationalized."

Vaccinating additional congregate settings, including homeless shelters, is also an important feature of Phase 2 that is already being operationalized in some places, he added.

Bogoch said he expects the start Phase 2 to be officially announced shortly, especially now that the new chair of the vaccine task force has been announced, opening up eligibility among more of the general public. But, in the meantime, he thinks it's fair to say Ontario is already transitioning from Phase 1 to Phase 2.

The question of why the vaccine rollout isn't moving faster is more complex.

The short answer it's a problem of access, as there's plenty of demand, he said.

Part of the issue he described — public health units are just beginning to operationalize Phase 2 plans to vaccinate front-line workers and congregate settings — and that should be taking off soon, he said. Ensuring age-based spots at mass vaccination sites don't go unfilled would help as well.

The Ontario Science Table, experts who are advising the province on its COVID response, recently released a brief saying barriers to access, particularly for homebound seniors, are one reason why appointments at mass clinics are going unfilled.

It found that as of March 29, more than a quarter of Ontarians aged 75 years and above had neither received one dose of a COVID-19 vaccine nor booked an appointment to receive one, even though mass vaccination clinic bookings for that age group were declining.

"With the overwhelming majority of older Canadians expressing an intent to receive the COVID-19 vaccine, there may be a substantial proportion of older Ontarians who want to get vaccinated but are unable to attend a vaccination clinic," it found.

The brief included strategies for bringing vaccines to homebound seniors and noted they have already been prioritized in the provincial framework.

In a statement, a spokesperson for Health Minister Christine Elliott said public health units have been directed to consider accessibility issues in their plans and have local solutions to improve uptake in at-risk communities. Alexandra Hilkene also rejected the assertion that vaccines are "sitting in freezers."

"Every single vaccine dose received has been allocated to a waiting Ontarian who has booked an appointment through public health units, hospitals, primary care physicians, and over 700 pharmacies across Ontario," she said in an emailed statement. "We will continue to bring more vaccination sites online as we receive the supply from the federal government."

"Pharmacy chains are delivering allocations to individual locations as quickly as possible and many locations have already started to administer doses. Primary care also received their shipment of vaccines [on April 4]."

(Photo credit: University Health Network)