Ontario hospitals fighting for their share of COVID-19 vaccine

With a limited number of COVID-19 vaccines available in Ontario, some hospitals are fighting for their share.

This week University Health Network CEO Dr. Kevin Smith seemed to outline the organization's strategy for staff — get doses in arms as quickly as possible to ensure the hospital network receives new shipments when they come in.

“And frankly, if we slow down, we will not be the hospital that gets the next shipment," Smith told employees at an information session posted online. "Right, you have to be pretty close to being out when everybody wants it this badly. So, the best way we can get you more is by being efficient in its delivery.”

We’re out of vaccine @UHN on Friday and have 3000 people booked per day Sat, Sun, Monday. Urgently need vaccine. https://t.co/lqS6GA0eE8

— Dr. Kevin Smith (@KevinSmithUHN) January 8, 2021

Smith is also a key adviser in the province's COVID-19 response. In an interview with QP Briefing about his comments to staff, he said he didn't intend to send the message that UHN was trying to get its share of vaccines ahead of other Ontario hospitals. Instead, he is trying to secure more vaccines from the drug companies for Canada by proving that they're being used quickly. He denied that there was any jockeying for doses among hospitals in Ontario.

Indeed, Smith had told his employees the vaccines are the most valuable commodity in the world. "Everybody wants it and we are fighting for our share," he said.

Meanwhile, physicians at Niagara Health said they are concerned about the prioritization of hospitals in other areas over their region. They wrote to community leaders about their urgent need for more vaccines, given that Niagara has among the highest rates of COVID-19 in the province and severe outbreaks in its nursing homes.

"It has been particularly disheartening for us in Niagara to see that we are not being treated equitably with other areas in the province," they wrote. "Shockingly, some people in other jurisdictions have received their second dose of the Pfizer vaccine before a single dose made its way into our community. Our older adults and health-care workers deserve better."

The Niagara doctors also wrote that a shipment of Moderna they were expecting for use in nursing homes didn't arrive, decrying the "inexplicable diversion" of doses that "would have gone to the most vulnerable population that we care for in Niagara."

They wrote their "frustration is multiplied by regular reports of individuals, who are not eligible under the government’s own criteria, being vaccinated against COVID prior to those who desperately need it in Niagara."

Some of those reports stem from UHN's vaccine rollout. In his update to employees, Smith addressed the news stories about non-front-line hospital staff getting vaccinated ahead of vulnerable people, outlining how the hospital "really did beat the trees" to reach front-line staff to fill the hundreds of spots that were available before turning to other staff, and defended researchers who receive the vaccine because they work with the live COVID virus.

He also spoke about the "hue and cry" from the public shortly after Christmas about how many vaccines were sitting in freezers and said Premier Doug Ford and vaccine task force head Retired Gen. Rick Hillier told him they need to get vaccines out of freezers and into arms quickly, so that’s what they did.

In response to criticism from some health-care workers that the rush to vaccinate shouldn't mean vaccines go to the wrong people, he replied, "The right arms are absolutely the arms at UHN, at Sinai at SickKids. These are the tertiary hospitals of Canada."

Smith's comment about needing to have run out of the vaccine in order to get more came in response to a question from an employee concerned that spots were going to high-level UHN staff with easy access to computers over other employees without computer time, like personal support workers. Smith said the hospital is looking into it but did not want to overcomplicate and slow things down.

Overall, technology has contributed to some of the issues with the rollout, he said, because there aren't lists available of COVID-patient-facing people, he later told QP Briefing.

Smith also describes a “red zone” strategy that says everyone in a red zone should be prioritized before patient-facing people, such as ICU nurses and family doctors, in areas where there are no cases.

“It's because they're red zone. And really until we inoculate the majority of people in those zones, it's not protected," he said at the information session, adding that front-line health-care workers aren't as likely to start an outbreak in areas with lower prevalence.

However, speaking with QP Briefing he acknowledged that the red zone strategy is becoming more and more challenging as rates rise across the province and more areas join the red zone.

"As I see it, the only solution to that is to get more vaccine, and to get it quickly," he said, adding that extra supply is unlikely to come from Pfizer and Moderna which are producing at capacity but rather with other vaccine candidates being approved.

One group that has been critical of the vaccine rollout is the Registered Nurses' Association of Ontario (RNAO), which is calling on the province to shift its strategy from hospitals to community care providers like nurses, physicians and pharmacists, so that they can vaccinate Ontario's most vulnerable people, including home care recipients and caregivers who aren't currently eligible.

RNAO CEO Doris Grinspun said that non-front line workers anywhere should not get the vaccine ahead of front line staff that see COVID patients, whether they're in a red zone or not.

"The RNAO means it when we say we're all in this together," she said. "This is not a competition about who gets the next shipment."

Meanwhile, UHN laid out its schedule for quickly vaccinating its workforce. 

"Our aim is to try to finish vaccinating staff who are working in high-risk patient care areas, and then other patient areas within the next few weeks with the goal of then vaccinating everyone within team UHN within the next month," said Emily Musing, a vice-president at UHN and the chief patient safety officer at the information session. She said that so far UHN has taken up approximately 47 per cent of the vaccinated Ontarians in the hospital category so far.

In response to question about which UHN family members could be vaccinated after staff, Smith said that would be up to the provincial government's vaccine task force and he would raise the issue of potentially using UHN's capacity to vaccinate family members who belong to eligible groups if the mass vaccination sites expected in the next stage of the rollout become exceptionally busy.

Overall, Smith said his remarks at the information session were for an internal audience, so the messaging was really "focused on the anxiety of those people."

"They've been at it for 11 months. They're really tired. They've been through two major waves. We know the future weeks look even more daunting, particularly from our critical care perspective. And so giving some people hope, that's what this vaccine does," he said.

"And getting it to them as quick as we can is my responsibility. And I take that responsibility seriously both working at UHN and working at provincial tables that I'm privileged to be at, but my objective is an equitable distribution of this vaccine based on science."