Quebec Premier Francois Legault watches a man get his COVID-19 vaccine at a clinic in Montreal's Olympic Stadium on, Feb. 23, 2021.Paul Chiasson/The Canadian Press
Pharmacies, doctors and other key health care providers say they aren’t fully looped in on some provincial plans for COVID-19 vaccination efforts, adding to concerns that when vaccine shipments do ramp up in the coming weeks health systems could soon become overwhelmed.
Provinces are beginning to lay the foundations for the mass inoculation campaign. Vaccination sites will include stadiums and drive-thru clinics at amusement parks. People in professions such as massage therapy and acupuncture will be trained to deliver jabs.
But some provincial governments are farther along than others: Alberta and Quebec are accepting bookings for its oldest seniors starting this week, while Ontario and British Columbia have yet to provide exact details as to how older adults will get in line for their shots.
With millions of vaccine doses set to arrive in Canada over the coming weeks, experts say the provinces will have to move to get needles in arms as fast as possible, with particular attention to those at highest risk.
COVID-19 is caused by a virus called SARS-CoV-2, and as it spread around the world, it mutated into new forms that are more quickly and easily transmitted through small water droplets in the air. Canadian health officials are most worried about variants that can slip past human immune systems because of a different shape in the spiky protein that latches onto our cells. The bigger fear is that future mutations could be vaccine-resistant, which would make it necessary to tweak existing drugs or develop a new “multivalent” vaccine that works against many types, which could take months or years.
Not all variants are considered equal threats: Only those proven to be more contagious or resistant to physical-distancing measures are considered by the World Health Organization to be “variants of concern.” Five of these been found in Canada so far. The WHO refers to them by a sequence of letters and numbers known as Pango nomenclature, but in May of 2021, it also assigned them Greek letters that experts felt would be easier to remember.
ALPHA (B.1.1.7)
- Country of origin: Britain
- Traits: Pfizer-BioNTech and Moderna vaccines are still mostly effective against it, studies suggest, but for full protection, the booster is essential: With only a first dose, the effectiveness is only about 66 per cent.
- Spread in Canada: First detected in Ontario’s Durham Region in December. It is now Canada’s most common variant type. Every province has had at least one case; Ontario, Quebec and the western provinces have had thousands.
BETA (B.1.351)
- Country of origin: South Africa
- Traits: Some vaccines (including Pfizer’s and Oxford-AstraZeneca’s) appear to be less effective but researchers are still trying to learn more and make sure future versions of their drugs can be modified to fight it.
- Spread in Canada: First case recorded in Mississauga in February. All but a few provinces have had at least one case, but nowhere near as many as B.1.1.7.
GAMMA (P.1)
- Country of origin: Brazil
- Traits: Potentially able to reinfect people who’ve recovered from COVID-19.
- Spread in Canada: B.C. has had hundreds of cases, the largest known concentration of P.1 outside Brazil. More outbreaks have been detected in Ontario and the Prairies.
DELTA (B.1.617 AND B.1.617.2)
- Country of origin: India
- Traits: Spreads more easily. Single-dosed people are less protected against it than those with both vaccine doses.
- Spread in Canada: All but a few provinces have recorded cases, but B.C.’s total has been the largest so far.
LAMBDA (C.37)
- Country of origin: Peru
- Traits: Spreads more easily. Health officials had been monitoring it since last August, but the WHO only designated it a variant of concern in June of 2021.
- Spread in Canada: A handful of travel-related cases were first detected in early July.
If I’m sick, how do I know whether I have a variant?
Health officials need to genetically sequence test samples to see whether it’s the regular virus or a variant, and not everyone’s sample will get screened. It’s safe to assume that, whatever the official variant tallies are in your province, the real numbers are higher. But for your purposes, it doesn’t matter whether you contract a variant or not: Act as though you’re highly contagious, and that you have been since before your symptoms appeared (remember, COVID-19 can be spread asymptomatically). Self-isolate for two weeks. If you have the COVID Alert app, use it to report your test result so others who may have been exposed to you will know to take precautions.
Need more answers? Email audience@globeandmail.com
Saskatchewan Premier Scott Moe tours the COVID-19 mass immunization clinic and drive-thru immunization space at International Trade Centre in Regina on Feb. 18, 2021.Michael Bell/The Canadian Press
“I think the leaders of provincial vaccine campaigns understand that what worked for flu has to be scaled up for COVID-19. I still worry, however, that the need for speed is being underestimated,” said David Naylor, co-chair of the federal government’s COVID-19 Immunity Task Force and a professor of medicine at the University of Toronto.
“It looks like the federal government will have over 20 million mRNA vaccine doses in play for the second quarter. If some other approvals and deliveries come through, the total could rise by many million doses. And no matter how you cut it, that’s a truly unprecedented pace required in every jurisdiction.”
Provinces have taken varied approaches to vaccine distribution, with an immediate focus on the most vulnerable populations such as long-term care residents, front-line health care workers and Indigenous populations. Age will also be a determining factor in who gets the jab next, with some provinces already inoculating the oldest seniors.
A senior arrives to register for a vaccination at the IWK Health Centre in Halifax on Feb. 22, 2021.Andrew Vaughan/The Canadian Press
Nova Scotia opened a community clinic this week in Halifax for those older than 80, while Alberta is accepting appointments for those older than 75 starting on Wednesday. Quebec will start vaccinating about 200,000 people born in 1936 and earlier in Montreal next week, with the rest of the province following over the second week of March. The province plans to expand to the rest of the 80 and older cohort afterward. More than 73 per cent of Quebec’s deaths have taken place among people 80 and older.
British Columbia recently delayed releasing details of its plan until more vaccines arrive in the province, with more information on how seniors over 80 will get their shots to come on Monday. Ontario has said it is setting up an online and telephone booking system with the goal of starting to vaccinate the over-80 population by mid-March.
In Ontario, the province’s 34 public-health units have prepared their own vaccine rollout plans, with government officials saying they are best placed to understand the needs of the population they serve. York Region, north of Toronto, is even planning a drive-thru clinic at Canada’s Wonderland, the country’s largest theme park.
Ontario officials recently suggested family doctors will be reaching out to seniors over a certain age to book appointments, but that information caused confusion among physicians, said Samantha Hill, president of the Ontario Medical Association.
“Let’s just say doctors may have been caught unaware,” Dr. Hill said. “We don’t really have any of the details regarding what information should be collected from the patients or to whom this information needs to be provided, ultimately. Nor do we have any information about how patients will be notified or where they will be vaccinated.”
But, she said, family doctors are eager to help – and are well-placed to assist across the country. “We know the patients better than anyone else does and we have the infrastructure that successfully immunizes more people against the flu every year.”
A nurse prepares to give the first COVID-19 vaccine to be distributed in Edmonton on Dec. 15, 2020.JASON FRANSON/The Canadian Press
There have also been delays in information provided to the public in Alberta. Phase two of that province’s immunization effort, which will take place from April to September, includes in group 2B people over the age of 18 who have underlying health conditions – but which conditions qualify people to be in that group will only be specified closer to the start date.
“Everyone thinks they’re going to be vaccinated in 2B, because they don’t know which conditions fall into that and how they’ll be verified that they even have that condition,” said Kirsten Fiest, an epidemiologist and assistant professor of critical care medicine, community health sciences and psychiatry at the University of Calgary. “Transparency and openness about who is going to be vaccinated is absolutely crucial.”
Part of ensuring that transparency also means providing more resources that give people information on the vaccine and the ability to navigate the system in their own languages, said Leighanne Parkes, an infectious disease specialist and microbiologist at the Jewish General Hospital in Montreal.
“If you’re not marketing to the population in multiple languages, and ways that are reachable to people that don’t have access [to information] via internet, telephone or television, it might not be as successful an approach,” Dr. Parkes said.
Vaccine rollouts by province
Cumulative single doses administered per 100 people, as of Feb. 22
National average
Province
218,726
B.C.
Total doses:
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
Jan. 2021
Feb.
The plan so far: Long-term care residents were first in line in December and got their first doses by January. The next phase will expand to remaining seniors 80 and older, hospital staff and other vulnerable people in congregate living arrangements.
173,539
Alta.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Almost all long-term care residents and staff were vaccinated as of early February. As of Feb. 24, any Albertan 75 or older can book a vaccination appointment, and younger age brackets will be prioritized in one of four groups (A, B, C and D) in the second phase of the rollout in April to September. In the meantime, Albertans can sign up for notifications when it’s their turn to get shots.
61,730
Sask.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Saskatchewan is still in its first phase of vaccinations for long-term care residents, other seniors and front-line health workers. The next phases would work through the population in 10-year age brackets.
62,365
Man.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Manitoba managed to vaccinate all long-term care residents by January and is moving through the rest of its priority groups in health care and Indigenous communities. Stage 2, which hasn’t started yet, would expand to other types of health workers and Manitobans 80 and older.
569,455
Ont.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Supply shortages in January and February left Ontario lagging behind other provinces in its long-term care rollout. As of late February, it had only 3.9 vaccine doses per 100,000 people, lower than figures in most other populous provinces. The other priority groups in the current phase are front-line health workers and people in Indigenous communities.
353,894
Que.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Quebec was the first province to put long-term care home residents at the front of the line, and began to see dramatically lower infection and death rates by early February. As of Feb. 25, every Quebecker born in 1936 or earlier will be eligible to book vaccination appointments in all health regions, with younger cohorts of seniors to be covered later.
26,317
N.B.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
New Brunswick’s plan cautions that supplies of vaccine may be limited until mid- to late summer. For now, officials are still working through long-term care residents, health workers and First Nations communities.
10,691
PEI
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Health officials began their first vaccinations on Dec. 16 and managed to finish first doses for all long-term care residents by January. Front-line workers and seniors over 80 are also in the priority group for phase one, which continues through March. The next phase, from April to June, covers seniors over 70 and essential workers, plus anyone left over from phase one.
27,521
N.S.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Nova Scotia is still in the first phase of its rollout, focused on long-term care residents and health workers. The next phase will include all hospital staff, seniors in their 70s and 80s and workers who have to travel a lot, such as truckers.
16,458
N.L.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
The first phase of vaccinations is focused on seniors in congregate-living arrangements, people 85 and older, health care workers and adults in remote Indigenous communities. The rollout in long-term care got off to a slow start in February as vaccine shipments from Europe slowed down.
MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE:
PROVINCIAL GOVERNMENTS
Vaccine rollouts by province
Cumulative single doses administered per 100 people, as of Feb. 22
National average
Province
218,726
B.C.
Total doses:
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
Jan. 2021
Feb.
The plan so far: Long-term care residents were first in line in December and got their first doses by January. The next phase will expand to remaining seniors 80 and older, hospital staff and other vulnerable people in congregate living arrangements.
173,539
Alta.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Almost all long-term care residents and staff were vaccinated as of early February. As of Feb. 24, any Albertan 75 or older can book a vaccination appointment, and younger age brackets will be prioritized in one of four groups (A, B, C and D) in the second phase of the rollout in April to September. In the meantime, Albertans can sign up for notifications when it’s their turn to get shots.
61,730
Sask.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Saskatchewan is still in its first phase of vaccinations for long-term care residents, other seniors and front-line health workers. The next phases would work through the population in 10-year age brackets.
62,365
Man.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Manitoba managed to vaccinate all long-term care residents by January and is moving through the rest of its priority groups in health care and Indigenous communities. Stage 2, which hasn’t started yet, would expand to other types of health workers and Manitobans 80 and older.
569,455
Ont.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Supply shortages in January and February left Ontario lagging behind other provinces in its long-term care rollout. As of late February, it had only 3.9 vaccine doses per 100,000 people, lower than figures in most other populous provinces. The other priority groups in the current phase are front-line health workers and people in Indigenous communities.
353,894
Que.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Quebec was the first province to put long-term care home residents at the front of the line, and began to see dramatically lower infection and death rates by early February. As of Feb. 25, every Quebecker born in 1936 or earlier will be eligible to book vaccination appointments in all health regions, with younger cohorts of seniors to be covered later.
26,317
N.B.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
New Brunswick’s plan cautions that supplies of vaccine may be limited until mid- to late summer. For now, officials are still working through long-term care residents, health workers and First Nations communities.
10,691
PEI
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Health officials began their first vaccinations on Dec. 16 and managed to finish first doses for all long-term care residents by January. Front-line workers and seniors over 80 are also in the priority group for phase one, which continues through March. The next phase, from April to June, covers seniors over 70 and essential workers, plus anyone left over from phase one.
27,521
N.S.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
Nova Scotia is still in the first phase of its rollout, focused on long-term care residents and health workers. The next phase will include all hospital staff, seniors in their 70s and 80s and workers who have to travel a lot, such as truckers.
16,458
N.L.
7
6
5
4
3
2
1
0
Jan. 2021
Feb.
The first phase of vaccinations is focused on seniors in congregate-living arrangements, people 85 and older, health care workers and adults in remote Indigenous communities. The rollout in long-term care got off to a slow start in February as vaccine shipments from Europe slowed down.
MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE:
PROVINCIAL GOVERNMENTS
Vaccine rollouts by province
Cumulative single doses administered per 100 people, as of Feb. 22
National average
Province
Total doses:
218,726
173,539
Alta.
B.C.
7
7
7
6
6
6
5
5
5
4
4
4
3
3
3
2
2
2
1
1
1
0
0
Jan. 2021
Feb.
Jan. 2021
Feb.
The plan so far: Long-term care residents were first in line in December and got their first doses by January. The next phase will expand to remaining seniors 80 and older, hospital staff and other vulnerable people in congregate living arrangements.
Almost all long-term care residents and staff were vaccinated as of early February. As of Feb. 24, any Albertan 75 or older can book a vaccination appointment, and younger age brackets will be prioritized in one of four groups (A, B, C and D) in the second phase of the rollout in April to September. In the meantime, Albertans can sign up for notifications when it’s their turn to get shots.
61,730
62,365
Sask.
Man.
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
0
Jan. 2021
Feb.
Jan. 2021
Feb.
Saskatchewan is still in its first phase of vaccinations for long-term care residents, other seniors and front-line health workers. The next phases would work through the population in 10-year age brackets.
Manitoba managed to vaccinate all long-term care residents by January and is moving through the rest of its priority groups in health care and Indigenous communities. Stage 2, which hasn’t started yet, would expand to other types of health workers and Manitobans 80 and older.
569,455
353,894
Ont.
Que.
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
0
Jan. 2021
Feb.
Jan. 2021
Feb.
Supply shortages in January and February left Ontario lagging behind other provinces in its long-term care rollout. As of late February, it had only 3.9 vaccine doses per 100,000 people, lower than figures in most other populous provinces. The other priority groups in the current phase are front-line health workers and people in Indigenous communities.
Quebec was the first province to put long-term care home residents at the front of the line, and began to see dramatically lower infection and death rates by early February. As of Feb. 25, every Quebecker born in 1936 or earlier will be eligible to book vaccination appointments in all health regions, with younger cohorts of seniors to be covered later.
26,317
10,691
N.B.
PEI
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
0
Jan. 2021
Feb.
Jan. 2021
Feb.
New Brunswick’s plan cautions that supplies of vaccine may be limited until mid- to late summer. For now, officials are still working through long-term care residents, health workers and First Nations communities.
Health officials began their first vaccinations on Dec. 16 and managed to finish first doses for all long-term care residents by January. Front-line workers and seniors over 80 are also in the priority group for phase one, which continues through March. The next phase, from April to June, covers seniors over 70 and essential workers, plus anyone left over from phase one.
27,521
16,458
N.S.
N.L.
7
7
6
6
5
5
4
4
3
3
2
2
1
1
0
0
Jan. 2021
Feb.
Jan. 2021
Feb.
Nova Scotia is still in the first phase of its rollout, focused on long-term care residents and health workers. The next phase will include all hospital staff, seniors in their 70s and 80s and workers who have to travel a lot, such as truckers.
The first phase of vaccinations is focused on seniors in congregate-living arrangements, people 85 and older, health care workers and adults in remote Indigenous communities. The rollout in long-term care got off to a slow start in February as vaccine shipments from Europe slowed down.
MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS
Vaccine rollouts by select countries
Cumulative single doses administered per 100 people, as of Feb. 22
Britain
U.S.
Canada
Germany
France
Italy
25
20
15
10
5
0
Jan. 1, 2021
Feb. 1
THE GLOBE AND MAIL, SOURCE: OUR WORLD IN DATA
Vaccine rollouts by select countries
Cumulative single doses administered per 100 people, as of Feb. 22
Britain
U.S.
Canada
Germany
France
Italy
25
20
15
10
5
0
Jan. 1, 2021
Feb. 1
THE GLOBE AND MAIL, SOURCE: OUR WORLD IN DATA
Vaccine rollouts by select countries
Cumulative single doses administered per 100 people, as of Feb. 22
Germany
Britain
U.S.
France
Italy
Canada
25
20
15
10
5
0
Jan. 1, 2021
Feb. 1
THE GLOBE AND MAIL, SOURCE: OUR WORLD IN DATA
Pharmacies and their professional associations have also been advocating to be involved in the rollout, arguing that Canada’s more than 42,000 pharmacists are spread out geographically and are used to organize immunization campaigns. During flu season, for example, Shoppers Drug Mart vaccinated 2.1 million people over the course of five weeks, with some pharmacies giving as many as 500 shots in a day.
But in some cases, pharmacies are still awaiting clear information about the role they will play – and say the earlier the details are ironed out, the better.
“We’ve seen with flu season, pharmacies can ramp up quickly, and can immunize a lot of people in a short amount of time,” said Bryce Wong, director of pharmacy practice support with the BC Pharmacy Association.
Horacio Barbeito, president and CEO of Walmart Canada, which has roughly 400 pharmacies across Canada, said the company took it upon itself to buy freezers “just in case,” noting that U.S. officials have relied on the retailer for distribution because it has many stores in rural areas. “Our geographical reach can play such an important role.”
Pharmacies are not the only sites that governments will be relying on: convention centres, stadiums and other entertainment venues are also pitching in. Others are still waiting for word on whether they can contribute.
A residential care aide at Providence Health Care is injected with a dose of the Pfizer-BioNTEch COVID-19 vaccine in Vancouver on Dec. 15, 2020.JENNIFER GAUTHIER/Reuters
Cineplex Inc., for example, reached out to public-health authorities in all of Canada’s provinces to pitch them on using its movie theatres as vaccination sites. The company has more than 160 theatres across the country, many of which have spacious lobbies and large parking lots, CEO Ellis Jacob said.
“I have offered a number of leaders the opportunity to use our facilities, because we are all over Canada. If they need to set up a clinic in Owen Sound, we are there. Brockville, we are there,” Mr. Jacob said. “We’ve gotten some pickup in eastern Canada as it relates to testing, but nobody has yet come forward [on vaccinations].”
Some provinces are also reaching out to non-traditional professions to help. Manitoba has passed an order to train workers such as massage therapists and chiropractors to give shots if necessary; B.C. says it will call upon midwives, paramedics and retired nurses; and Quebec has enlisted 21 occupations, including acupuncturists, dietitians and midwives. All three provinces have also indicated dentists or dental hygienists may be called upon to give vaccinations. Others, such as Ontario, have not done so, relying instead on nurses, pharmacists, and pharmacy students and interns.
“When we need to get needles in arms as quickly as we can do it, you do need all hands on deck,” said Aaron Burry, deputy CEO for professional affairs at the Canadian Dental Association. “The channels remain open.”
With reports from Justine Hunter in Victoria and Les Perreaux in Montreal
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