Getting it right

The Ontario government must remain focused on vaccinating all Ontarians as quickly and seamlessly as possible.

As I write this article, I think about how much nurses and other healthcare workers have given to our province. I think about how many hours we all owe back, at some point, to our families. And I think about the lives lost, including those of our own loved ones. March 11 marked the first anniversary of the declaration of the pandemic by the World Health Organization. Such a sobering moment. So much has happened.

For RNAO, it has been 14 months of standing side-by-side with our nursing colleagues, advocating for their needs and supporting them in their challenges. It has been 14 long months of continuous, strong, evidence-based advice to the Ontario government. The latest urging: to maintain stringent public health measures to mitigate the spread of new variants and to accelerate the vaccine rollout plan. In mid-January RNAO raised important concerns about the vaccine rollout. Our Feb. 10 letter to the premier and minister of health got much attention. In it we detailed the priority areas the government must focus on, including: transparent and detailed plans on how the rollout will unfold; engagement of community providers to administer the vaccine; a focus on the elderly; and targeted efforts to vaccinate vulnerable populations.

Since sharing this letter on social media and issuing action alerts involving RNAO members and others, we have seen promising developments. We also received reassurances directly from the premier and minister of health during our Feb. 25 Queen’s Park Day. They promised the vaccine rollout will not distract us from public health measures that save lives. We insisted strong measures must continue if we are to preempt a catastrophic third wave.

Let’s take a closer look at some of these developments, and the work that remains ahead.

On March 3, the government announced it had signed an agreement with the province's pharmacists' association to have vaccines administered in pharmacies. Like nurses, pharmacists are among the community providers RNAO has been urging the government to rely on.  More than 35,000 nurses, physicians and pharmacists working in community care provide every year routine vaccinations through public health, primary care, pharmacies and home care. These established infrastructures use tried-and-true distribution systems. Home care nurses can also provide vaccination to clients who are home bound. These nurses and other community providers must be utilized fully to deliver vaccines 24-hours-a-day, seven-days-a-week.

On Feb. 28, just a few days before the agreement with the pharmacists was announced, the province unveiled its plan to prioritize the vaccination of people experiencing homelessness, fast-tracking them ahead of other priority groups in the second phase of the rollout. This is an important and often forgotten group of vulnerable individuals for whom RNAO continues to advocate. 

Studies identify older people, men, racial and ethnic minorities, and those with underlying health conditions among the most likely to die of COVID-19. These groups have higher levels of co-morbidities and face higher rates of hospitalization and death due to the virus. Vulnerable groups may face difficulty or hesitancy getting the vaccine due to language barriers, misinformation, lack of access to or difficulties using technology, historical injustice, mistrust of government and medical institutions, mobility restrictions, financial constraints, employment concerns and more. These barriers are not mutually exclusive and are often exacerbated by one another.

These barriers must be squarely addressed early in the second phase of the rollout. Targeted plans for each community need to fit the needs of these communities. This is the only way vulnerable populations will get what they require. The plans should be developed with leading involvement and active participation of members of the communities affected.

Also in March, the government announced it would accelerate the vaccination of individuals 60 to 64 following a decision to extend the time from three weeks to up to four months between the first and second dose of the vaccine, as well as the use of AstraZeneca for this age group. RNAO has been clear and strong in its advocacy for older Ontarians to receive the vaccine first. A top insight from science is clear: Age is the primary determinant of mortality.

Persons who are 80 or older are at least 20 times more likely to die from COVID-19 than those in their fifties. They are also hundreds of times more likely to die than those 40 or younger. Canadian data finds 96 per cent of those who died from COVID-19 by Feb. 9 were 60 years or older, and 71.2 per cent of hospitalizations had been in that age range. Elderly Ontarians are most likely to be hospitalized, admitted to ICU and/or to die from COVID-19. Vaccination of those 60 and older is vital to save their lives and to diminish the pressure on critical care in our province.

We have also seen movement on our call for an open and transparent plan on how Ontario’s rollout will unfold. The province is ramping up and preparing for large‐scale immunization starting this month. As of March 13, Ontario had administered 1,116,496 doses of 1,457,005 doses delivered to Ontario so far. That means that about 76.6% of the doses delivered have been administered while 23.4% sit in fridges. The proportion sitting in fridges has been falling so the effort is having results. There is a substantial ramping up in the 7-day rolling average of doses administered each day, reaching 36,600 today. Ontario is expected to receive about 1.66 million doses in March, so there is an urgent need to double, within days, the number of doses administered daily to 100,000. The rate of immunization must scale up even more in April and beyond, when five million doses are expected in Ontario each month – requiring us to deliver 160,000 doses per day -- until the campaign is over. Although recent developments are promising much work remains – in terms of logistics – to deliver speedily on this large-scale immunization.

Success will come only through an all-hands-on-deck approach and that means utilizing every available public health nurse (4,482), primary care nurse (10,905), and home care nurse (7,346) in the province – as well as family physicians and pharmacists.  Yet, at the moment, nurses and others are far from being fully utilized, despite our eagerness to help. 

Premier Ford, we want to lend our expertise to this profound, once-in-a-lifetime challenge.