Progress in vaccine distribution: Updates, issues and concerns

RNAO remains heavily involved in the COVID-19 vaccine rollout process in Ontario.

Major information resource on COVID vaccines

As mentioned earlier, RNAO is participating in a collective effort to develop a comprehensive information resource on COVID-19 vaccines led by the Centre for Effective Practice. To see this valuable resource, go here. This week, you will find the latest information on the availability, rollout and prioritization of vaccines in Ontario, as well as the vaccine ingredients in the Pfizer-BioNTech and Moderna vaccines. If you are a health provider who discusses hesitancy with your clients, check the section on addressing patient questions about vaccines. If you are engaged in the administration of either vaccine, check the section on point-of-care-guidance for each of the vaccines.

Webinar with Dr. Dirk Huyer

On January 11 RNAO held its latest Health System Transformation and COVID-19 Webinar Series with Dr. Dirk Huyer on COVID -19 vaccine distribution: Progress to date, with over 850 attendees via Zoom and several hundred more via Facebook live stream.  

Dr. Huyer is member of the Lead Clinical Guidance and Surveillance Work-Stream, COVID-19 Vaccine Distribution Task Force. You can watch a recording of the webinar here and see the slides here. The vaccine rollout plan in Canada can be found here. The Ontario vaccine rollout plan is here and the technical document is here.

We thank Dr. Huyer for providing us with a summary of his presentation, next:

The Ontario government has developed a three-phase implementation plan to receive, store and administer COVID-19 vaccines to Ontarians as soon as they are received.

Safe and reliable vaccines can help protect everyone from COVID-19. They will be an important tool to help stop the spread of the virus and allow individuals, families and workers to safely resume normal life.

When a large percentage of the population becomes immune to COVID-19, the spread of the virus will slow down or stop.

As recommended by the COVID-19 Vaccine Distribution Task Force and aligned with the National Advisory Committee on Immunization, on January 13, 2021 the province announced that it has mapped out the next steps for transitioning into Phase Two of vaccination rollout and has adopted an approach for identifying the next groups to receive the vaccination as early as March 2021, following the vaccination of Phase One populations.

Phase One populations include:

• Residents, staff, essential caregivers, and other employees of congregate living settings (e.g., long-term care homes and retirement homes) that provide care for seniors as they are at higher risk of infection and serious illness from COVID-19;
• Health care workers, including hospital employees, other staff who work or study in hospitals, and other health care personnel;
• Adults in Indigenous communities, including remote communities where risk of transmission is high; and
• Adult recipients of chronic home health care.

Because demand for COVID-19 vaccines among Ontario’s health care workers and other care staff will initially exceed available supply, priorities for voluntary vaccination must be set among health care workers and will be phased. 

A stepwise approach to prioritization has been developed which considers multiple factors including the sectors and settings that people work in, local and community factors as well as individual factors. Each step should be performed in sequence to gradually refine from the broad sector/setting level down to the individual level.

Groups eligible to receive vaccines as part of Phase Two of the Ontario immunization program will include:

• Older adults, beginning with those 80 years of age and older and decreasing in five-year increments over the course of the vaccine rollout;
• Individuals living and working in high-risk congregate settings;
• Frontline essential workers (e.g., first responders, education workers, food processing industry);
• Individuals with high-risk chronic conditions and their caregivers; and
• Other populations and communities facing barriers related to the determinants of health across Ontario who are at greater COVID-19 risk.

Steps are underway to identify the subpopulations within each Phase Two category, including essential workers, followed by a plan for sequencing vaccination within the categories.

Phase Two is expected to be completed by end of July 2021 and Phase Three for the general population could begin as early as August 2021, pending availability of vaccines. Vaccination of populations in Phase One will continue until all vaccinations are complete.

As the COVID-19 vaccination rollout continues, it remains critically important that all Ontarians continue following public health advice to protect our communities and most vulnerable populations, and to stop the spread of COVID-19.

Once again, our thanks to Dr. Huyer for his contribution.

RNAO’s concerns about the vaccine rollout

Since the start of the vaccination, RNAO has been pushing the government to ramp up the initial slow pace of vaccinations, and not keep large stocks in the freezers. If the supply is there, vaccinations should be carried out 24-hours-a-day, seven-days-a-week, starting with those at highest risk of severe disease or death – residents of long-term care homes –, as well as their essential care partners and staff in those homes. Other health-care workers must also get the vaccine, but in the view of RNAO – long-term care must be the top priority sector. We have also been steadfast in urging that only health providers who are facing patients get the vaccine. We are troubled by revelations that staff not facing patients have received the vaccine in hospitals, and have raised those concerns with the minister of health and the premier’s office.   

Getting the vaccine rollout into the hands of community providers

On January 14 RNAO issued a media release jointly with three home care providers  – SE Health, VON, Bayshore HealthCare – entitled Distribute COVID-19 Vaccines Through Community Providers NOW. Here is the text:

The priority for government right now is to get vaccinations out as effectively and efficiently as possible. The Registered Nurses’ Association of Ontario (RNAO) and three of the largest home care providers in the province – SE Health, VON, Bayshore HealthCare – are calling on the government to get the COVID-19 vaccinations into the hands of community providers including nurses, physicians and pharmacists, immediately. By making immediate use of existing community care providers and their existing infrastructure, we can rapidly accelerate the rate of vaccination across the province. There is no need to reinvent the wheel.

Every year, thousands of nurses, physicians and pharmacists provide routine vaccinations through public health and established networks including primary care, pharmacies and home care. For example, home care nurses vaccinate vulnerable populations who are homebound or in congregate settings, such as shelters, as part of their regular job. These community-based infrastructures and their health-care professionals using practiced and perfected distribution systems for vaccination – must be put to work immediately to deliver what is urgently needed – COVID-19 vaccinations.

“The current approach to vaccine roll-out has been painfully slow and is delaying a life-saving shot for those who need it most, including long-term care residents and homebound frail seniors who cannot or ought not travel to access care,” says Dr. Doris Grinspun, CEO of RNAO. Going forward, Grinspun adds, “RNAO wants to see existing community resources such as primary care physicians, nurse practitioners, registered nurses, registered practical nurses  and pharmacists being fully utilized to get the broader population inoculated by end of July, without drawing away the already overwhelmed hospital resources. For example, nurses working in home care could be vaccinating the patients they visit, as well as vulnerable populations they serve every year during the flu season.”

“We can do this. With our competent nurses and a distribution network already set up, we are ready to go,” says Shirlee Sharkey, CEO of SE Health. “If we were given access to the vaccine today, our nurses would be vaccinating seniors in their homes tomorrow. It’s that simple.”

The COVID-19 vaccination roll-out cannot overlook the opportunity for vaccine distribution in community care sectors that already serve vulnerable populations. In home care alone, hundreds of thousands of homebound clients and frontline health-care professionals could be vaccinated rapidly using existing systems and practices. Vaccinating family caregivers at the same time would allow for an efficient roll out of vaccines for a very significant portion of the population using existing visits and infrastructure.

The COVID-19 vaccine, in concert with public health measures, represents our best opportunity to defeat COVID-19 and end its devastating impact. We urge the government to leverage opportunities already existing in community care for rapid vaccine roll-out to those at greatest risk, 24x7.