Despite Premier Brian Pallister touting his government's COVID-19 vaccine rollout plan, Manitoba has been one of the slowest jurisdictions in Canada to get jabs into the arms of its residents.
While everyone expects the program to ramp up quickly, the current vaccination pace means it would take until June 2024 to get all 1,068,553 adults in Manitoba immunized.
"We can't use middle-of-the-pack or mediocrity as being our threshold for success. We should be doing better than this," said Dr. Jason Kindrachuk, a University of Manitoba virologist. "It's been slow across the country."
Manitoba says it is about to implement plans to drastically scale up the effort. Here are four ways it can do so:
1) Dish out leftovers
Israel, which is on track to lead the world in vaccinations, has numerous sites for people in priority groups to get COVID-19 vaccines. In addition, the public is allowed to pop by at the end of the day at some sites to get leftover shots.
Those opting to be on standby get a crack at the extra dose contained in some vials, which is meant to account for mistakes such as dropped syringes. It also prevents doses from being wasted when appointments are cancelled.
Kindrachuk says a similar system might work at Manitoba's vaccination hubs such as Winnipeg's downtown convention centre.
"Every dose that we get rid of is really a person that could get vaccinated. So I think we want to utilize all of that as well as we can," he said.
That’s especially pertinent with the Pfizer and Moderna vaccines, both of which are only effective for a few hours once they’ve been thawed, mixed and put into vials.
Kindrachuk added that officials would have to ensure those who unexpectedly get a first dose would still get a booster shot on time.
2) Lean on pharmacies
The president of Shoppers Drug Mart says his company has offered to help the Manitoba government with the first phase of vaccinations at provincial super sites, and the company would like to eventually help immunize Manitobans at its own pharmacies.
"We’ve offered up using some of our pharmacists in those centres for the first phase with the Pfizer vaccines (to help) with the refrigeration requirements," Jeff Leger told the Free Press.
Shoppers and its pharmacies in Superstores and No Frills stores managed to immunize two million Canadians with the flu vaccine in five weeks in the fall.
The industry believes it could administer 2.5 million COVID-19 vaccine doses per week across Canada.
Leger said pharmacies already notify patients about their booster shots and prescription refills using text messages, emails and automated calls, all based on province’s electronic billing systems. That system could ensure Manitobans don't miss their second dose.
Pharmacists Manitoba said in a statement that 1,000 pharmacists are trained to administer injections.
"Pharmacists will be an absolutely vital link in the safe and efficient distribution of a COVID-19 vaccine, especially in many rural and remote communities," wrote group head Pawandeep Sidhu.
"Pharmacies have made many changes to meet this year's increased demand for flu shots — including an online booking system to avoid crowding, PPE procurement, and extended clinic hours."
Kindrachuk said it’s an obvious choice. "Frankly, pharmacists have a pretty good insight into their communities and they have trust."
3) Make it seamless
The eligibility pool for COVID-19 vaccinations will continue to increase as criteria are expanded.
Manitoba is currently focused on booking appointments for health-care workers and getting doses to people who live in congregate settings, such as care homes.
74 per cent of Manitobans to be vaccinated by year's end: planClick to Expand
Posted: 8:03 PM Jan. 7, 2021
The Manitoba government has no idea how the federal government will manage its goal of immunizing all adults by September.
Its figures show that under current arrangements, only 74 per cent of the province’s population will be vaccinated by year’s end. The figure is in a document titled “Manitoba’s Immunization Rollout Plan” which cautioned its estimate was a “planning projection only.”
Some countries that immunize people in the broader population issue emails or app notifications to people who are eligible for a shot. That saves medical staff from having to do that time-consuming work.
Similarly, digital consent forms for the flu vaccine saved pharmacists from waiting for patients to fill out forms, and having to sterilize pens and clipboards.
Kindrachuk said these methods could save time as long as they don’t prevent people from accessing shots, such as those who lack access to computers.
He said it will be important to ensure nurses and pharmacists are certain the person to be vaccinated is eligible for the shot.
"I don't think we want to put them in the position of having to decide independently who fits in a category," said Kindrachuk, arguing inconsistently applied criteria would undermine public trust.
"It's difficult. We don't have an algorithm to be able to plug in some of these components and say: these are the groups where you should fit in, perfectly."
Leger said that can usually be achieved if a government issues a standard questionnaire for use in pharmacies.
"Pharmacies are happy to help with whatever the (government) sets out as a priority," he said. "We're there to help and give extra resources to make it as easy to get to as many people as possible."
4) Build trust
Kindrachuk says now is the time for governments and community groups to help people get comfortable with vaccines.
"Vaccination is going to get us out of this, but we really have to provide information to people to help them understand what vaccines are, how they work, what they can and can't do, and frankly what the vaccines are," he said, citing the example of how an mRNA differs from an inactivated-viral vaccine.
"All these things are important so that people feel that they are educated and knowledgeable about what they're getting."
In Manitoba, confusion about the 2009 H1N1 swine flu led to Indigenous people being hesitant to get the vaccine, despite being a priority group because the flu disproportionately killed them.
Kindrachuk said he rejects the idea that getting more Manitobans immunized will naturally resolve questions from those who are hesitant about vaccines, and that could be a barrier to achieving herd immunity.
"We have to actively engage those communities and be quite up front about what we know and what we don't know about the vaccine."
— With files from Michael Pereira