How do the vaccines reach you? Inside Ontario’s complicated distribution network

For Kieran Moore, Kingston’s medical officer of health, managing the flow of vaccine doses comes down to a simple philosophy — “freezers empty.”That’s what he wants to see every week when his public health unit, known as KFL&A for Kingston, Frontenac, Lennox and Addington, receives a new allocation of vaccines from the province.The health unit has vaccinated 45 per cent of its population, according to covid19tracker.ca, a slightly higher proportion than many of the province’s other health units.Moore attributes the lead in part to vaccines that were administered during a pilot in Kingston that was used to teach pharmacies and the ministry how to use the COVaxON tool (the provincial software system that tracks vaccine inventory and doses administered), as well as vaccine storage and handling, and how to run an immunization clinic with appropriate infection prevention control.“That gave us a little extra boost. And then it’s our ongoing philosophy of needles in arms,” said Moore. “Nothing in the fridge on Mondays.” Public health units such as Kingston’s have undertaken the massive task of co-ordinating with multiple health partners to deliver the vaccine, although this can differ according to health unit.In Toronto, for instance, vaccine distribution is being co-ordinated by the COVID-19 Immunization Task Force, and not by the health unit on its own. And Ontario Health Teams, which replaced Local Health Integration Networks in 2019, are running many of the city’s mobile clinics and pop-ups.Here, the Star talks to Moore about how the massive effort to deliver vaccines is carried out. This interview has been edited for brevity and clarity.How do vaccines flow from the province to each public health unit?We get notified by the Ontario Government Pharmacy (the traditional source for all vaccines) of when a shipment is coming in. We receive both Moderna and Pfizer. (Pfizer shipments come directly from the manufacturer and not through the government pharmacy.)What happens after that?We have -20 C, -80 C freezers here at the health unit. And from there we distribute it to our immunization partners maintaining the cold chain along the way. We traditionally have done this for all vaccines. Not all health units have done this. Toronto Public Health has never been a distributor of vaccines, whereas most other local public health agencies are the distributor of all vaccines for primary care and health system partners.Do some hospitals get their supply of vaccines directly from the government, independent of a health unit? That is correct. If a hospital is a designated vaccination partner, the hospital can negotiate to get vaccines directly from the province, independent of the local health unit. How does the local public health unit decide how many doses a hospital would get?We are on a committee with all of our immunization partners and together we talk about our strategy, the distribution needs, the populations that they’re going to serve. Hospitals started by prioritizing their highest risk workers and then high-risk workers for vaccinations. And then we’ve had them move on and partner with us on high-risk medical conditions. Our hospitals are now vaccinating through oncology clinics, through the dialysis unit to anyone that is immune suppressed and through our transplant clinics. Hospitals can tell us exactly how many people there are in those priority groups.Hospitals are highly centralized and specialized. They’re the best ones to work with their patient population, because sometimes you have to time the dosing as per the immune suppression of cancer therapy and/or rheumatological therapy. So working with them is actually the best way to approach those high-risk patients. And we found that to be a terrific partnership.Are you also running mobile and pop-ups?We run the pop-up clinics and target specific locations like a shelter, a high-risk employment area, vulnerable populations, so consumption treatment sites (for substance users), certain seniors residences or lower-income areas when we know that they can’t access mass immunization clinics.And how do you decide how many doses go to that population?So we’ll call the shelter and then we’ll mobilize that amount of doses because we don’t want to waste. And certainly the product that we typically bring to those areas is Moderna, because it’s allowed to be transported. It’s pre-diluted and it can be mobilized. Pfizer (which needs to be mixed with a diluent on site) is not a product that’s allowed to be mobilized right now. So Moderna was our go-to for that population and it’s worked very well. Are you immunizing the residents or the workers at the shelters or both?Absolutely both. And obviously not everyone is there at the same time. So we do go back and bring supply back on a frequent basis to all of those areas. We have had outbreaks in our shelters, so they were very, very much high risk. We’ve also gone to our provincial prisons and detention centres. And we’ve wo

How do the vaccines reach you? Inside Ontario’s complicated distribution network

For Kieran Moore, Kingston’s medical officer of health, managing the flow of vaccine doses comes down to a simple philosophy — “freezers empty.”

That’s what he wants to see every week when his public health unit, known as KFL&A for Kingston, Frontenac, Lennox and Addington, receives a new allocation of vaccines from the province.

The health unit has vaccinated 45 per cent of its population, according to covid19tracker.ca, a slightly higher proportion than many of the province’s other health units.

Moore attributes the lead in part to vaccines that were administered during a pilot in Kingston that was used to teach pharmacies and the ministry how to use the COVaxON tool (the provincial software system that tracks vaccine inventory and doses administered), as well as vaccine storage and handling, and how to run an immunization clinic with appropriate infection prevention control.

“That gave us a little extra boost. And then it’s our ongoing philosophy of needles in arms,” said Moore. “Nothing in the fridge on Mondays.”

Public health units such as Kingston’s have undertaken the massive task of co-ordinating with multiple health partners to deliver the vaccine, although this can differ according to health unit.

In Toronto, for instance, vaccine distribution is being co-ordinated by the COVID-19 Immunization Task Force, and not by the health unit on its own. And Ontario Health Teams, which replaced Local Health Integration Networks in 2019, are running many of the city’s mobile clinics and pop-ups.

Here, the Star talks to Moore about how the massive effort to deliver vaccines is carried out. This interview has been edited for brevity and clarity.

How do vaccines flow from the province to each public health unit?

We get notified by the Ontario Government Pharmacy (the traditional source for all vaccines) of when a shipment is coming in. We receive both Moderna and Pfizer. (Pfizer shipments come directly from the manufacturer and not through the government pharmacy.)

What happens after that?

We have -20 C, -80 C freezers here at the health unit. And from there we distribute it to our immunization partners maintaining the cold chain along the way. We traditionally have done this for all vaccines. Not all health units have done this. Toronto Public Health has never been a distributor of vaccines, whereas most other local public health agencies are the distributor of all vaccines for primary care and health system partners.

Do some hospitals get their supply of vaccines directly from the government, independent of a health unit?

That is correct. If a hospital is a designated vaccination partner, the hospital can negotiate to get vaccines directly from the province, independent of the local health unit.

How does the local public health unit decide how many doses a hospital would get?

We are on a committee with all of our immunization partners and together we talk about our strategy, the distribution needs, the populations that they’re going to serve.

Hospitals started by prioritizing their highest risk workers and then high-risk workers for vaccinations. And then we’ve had them move on and partner with us on high-risk medical conditions. Our hospitals are now vaccinating through oncology clinics, through the dialysis unit to anyone that is immune suppressed and through our transplant clinics. Hospitals can tell us exactly how many people there are in those priority groups.

Hospitals are highly centralized and specialized. They’re the best ones to work with their patient population, because sometimes you have to time the dosing as per the immune suppression of cancer therapy and/or rheumatological therapy. So working with them is actually the best way to approach those high-risk patients. And we found that to be a terrific partnership.

Are you also running mobile and pop-ups?

We run the pop-up clinics and target specific locations like a shelter, a high-risk employment area, vulnerable populations, so consumption treatment sites (for substance users), certain seniors residences or lower-income areas when we know that they can’t access mass immunization clinics.

And how do you decide how many doses go to that population?

So we’ll call the shelter and then we’ll mobilize that amount of doses because we don’t want to waste. And certainly the product that we typically bring to those areas is Moderna, because it’s allowed to be transported. It’s pre-diluted and it can be mobilized. Pfizer (which needs to be mixed with a diluent on site) is not a product that’s allowed to be mobilized right now. So Moderna was our go-to for that population and it’s worked very well.

Are you immunizing the residents or the workers at the shelters or both?

Absolutely both. And obviously not everyone is there at the same time. So we do go back and bring supply back on a frequent basis to all of those areas. We have had outbreaks in our shelters, so they were very, very much high risk.

We’ve also gone to our provincial prisons and detention centres. And we’ve worked very closely with our federal partners in federal prisons. They immunize the inmates and we have immunized correction workers and health-care workers in those settings.

And who in public health is actually physically vaccinating people, administering the vaccine?

Even though we’re a small health unit, 200 employees, we have over 60 nurses, all of them trained to immunize. And then we’ve had a terrific uptake from volunteers in our community that have helped us run our clinics and also administer vaccines. Many of them are health professionals that are retired, whether they are nurses or physicians. We also are fortunate to have a medical school and a nursing school, and they’ve come forward to help us as well as our primary care partners.

And what about the AstraZeneca vaccine that is distributed to pharmacies? How is that allocated?

Pharmacies have an independent supply that’s negotiated with the government and they get it through their own distributors once that negotiation is finalized.

And AstraZeneca was also part of a provincial pilot that involved a select number of health units where family physicians and nurse practitioners could also administer the vaccine. Was Kingston part of that?

We only had 500 doses given to us for the primary care AstraZeneca strategy. But they did a drive-through in one evening and immunized 500 people.

And are primary care physicians involved in your immunization strategy in other ways?

Our primary care partners run their own clinics. We rent the space for them through Memorial (Centre) Arena, so a hockey arena-style mass immunization clinic. And they’ve been providing Moderna in those settings. And they’ll be providing Pfizer this month as well.

And is that work co-ordinated through KFL&A?

That’s correct. And so family health teams, independent physicians, they can all use that space and we’ll support them.

Are primary care clinics being run in every public health unit?

No. But traditionally, immunization is a core function of primary care. For example for influenza, over 60 per cent of the supply annually of influenza (vaccine) is administered through primary care, 30 per cent through pharmacies and only 10 per cent through a mass immunization clinic run by public health. We want to return to that normal ratio over the rest of this year.

Why do you want primary care more involved?

We think it will address any vaccine hesitancy. It’s more convenient to many patients to be seeing their own family physician and to ask any questions about it and for follow up of any adverse events following immunization. So our strategy has always been to partner with primary care and to have them at the table. And now to hand the strategy over to them over the summer months heading into the fall. And then it’s all anticipated that we’ll have another round of immunization for variants of concern. That potentially could all be delivered in primary care settings.

Is this a strategy for Kingston public health only?

This is our strategy within KSL&A. But I think the government is seeing the difficulty of running mass immunization clinics for the long haul and that we need to have some formal transition back to our traditional and typical distribution network, which is primary care and a very small number of mass clinics for those that don’t have access to a primary care provider.

Who else is involved in administering vaccines in your region?

Our community health centre has run a Pfizer clinic for us for months now. Community health centres are funded directly by the Ministry of Health. There’s over 50 of them distributed across Ontario. Typically, they provide medical services, family practice services to high-risk neighbourhoods and community groups.

And with all these different vaccine providers, can you tell me how the COVaxON system keeps track of vaccinations by all of these different providers?

COVaxON is the one central electronic database for immunization for COVID vaccines in Ontario. So it’s the truth for all Ontarians. We all get access codes. We all input the name of the individual we’ve immunized and attest to their eligibility, whether by age or by occupation or medical condition.

We asked the provincial government for data on the vaccine rollout by public health unit, but they said they wouldn’t provide it to us. Is it a good system?

Yes, it’s so important to have one record. And eventually it’s going to interact with an electronic medical record and it’s going to interact with our traditional public health information systems. But it was an essential component of the rollout to have one record for all Ontarians knowing that we’re going to have to provide a second dose.

And who has that system? So a pharmacy can use it? Or a doctor’s office?

Yes, it’s in the cloud. It’s run by the Ministry of Health and they control access. I get a daily record of needles in arms and also inventory left over (from the ministry). The most important thing for me is on a Monday, when we get new (weekly) inventory, I want to see our freezers empty. And that’s where I hold our partners accountable to “freezers empty” by the Monday. So we’re holding no doses back.

You mentioned that you think there could be a third booster shot?

That’s a potential if the variants of concern continue to be a risk internationally. It’s just something we should all consider, given that these mutations are occurring roughly at a pace of around two significant mutations a month ... it’ll pose an ongoing risk to us. And we may want to look at a strategy to further protect Canadians through a third booster that would be specific to variants, especially if there’s going to be international travel.

Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email: pwinsa@thestar.ca

Source : Toronto Star More   

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Today’s coronavirus news: The vaccine pipeline is about to turn on. Is Canada ready? Plus, a fifth of MLB teams relax COVID protocols

The latest coronavirus news from Canada and around the world Saturday. This file will be updated throughout the day. Web links to longer stories if available.7:10 a.m.: The vaccine pipeline is about to turn on. Is Canada ready?The Star’s Alex Boyd went inside Ontario’s vaccine rollout — and its biggest challenge yet7:05 a.m.: A fifth major league team has been able to relax coronavirus protocols after 85 per cent of its players and other on-field personnel completed vaccination.Major League Baseball and the Major League Baseball Players Association made the announcement Friday without identifying any teams and said seven additional teams had reached the 85% level of having received final doses and would be able to relax protocols within two weeks once they are fully vaccinated.The New York Yankees and Detroit said last weekend they were able to relax protocols, and Milwaukee said earlier this week it had been able to relax them. Relaxed protocols include dropping the requirements for facemasks in dugouts and bullpens, and loosening restrictions on mobility during road trips.MLB said Friday that more than 83% of all tier 1 individuals such as players, managers, coaches, athletic trainers and support personnel had been partially or fully vaccinated, up from 81% on April 30.There were no positive results among 10,330 monitoring tests in the past week and one among staff at an alternate training site, a 0.009% positive rate.Thus far this season, there have been 44 positive tests — 27 players and 17 staff — among 145,647 samples tested, a 0.03% positive rate. The positive tests are among 21 teams.4:05 a.m.: In Canada, the provinces are reporting 406,415 new vaccinations administered for a total of 15,325,183 doses given. Nationwide, 1,221,019 people or 3.2 per cent of the population has been fully vaccinated. The provinces have administered doses at a rate of 40,436.61 per 100,000.There were 51,642 new vaccines delivered to the provinces and territories for a total of 18,033,514 doses delivered so far. The provinces and territories have used 84.98 per cent of their available vaccine supply.Please note that Newfoundland and Labrador, P.E.I., Nova Scotia, New Brunswick and the territories typically do not report on a daily basis.Newfoundland and Labrador is reporting 17,703 new vaccinations administered over the past seven days for a total of 191,130 doses given. The province has administered doses at a rate of 365.009 per 1,000. In the province, 1.85 per cent (9,676) of the population has been fully vaccinated. There were zero new vaccines delivered to Newfoundland and Labrador for a total of 244,930 doses delivered so far. The province has received enough of the vaccine to give 47 per cent of its population a single dose. The province has used 78.03 per cent of its available vaccine supply.P.E.I. is reporting 6,556 new vaccinations administered over the past seven days for a total of 59,758 doses given. The province has administered doses at a rate of 376.715 per 1,000. In the province, 6.78 per cent (10,750) of the population has been fully vaccinated. There were zero new vaccines delivered to P.E.I. for a total of 76,725 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 77.89 per cent of its available vaccine supply.Nova Scotia is reporting 44,485 new vaccinations administered over the past seven days for a total of 356,978 doses given. The province has administered doses at a rate of 365.794 per 1,000. In the province, 3.86 per cent (37,630) of the population has been fully vaccinated. There were zero new vaccines delivered to Nova Scotia for a total of 450,600 doses delivered so far. The province has received enough of the vaccine to give 46 per cent of its population a single dose. The province has used 79.22 per cent of its available vaccine supply.New Brunswick is reporting 31,411 new vaccinations administered over the past seven days for a total of 293,550 doses given. The province has administered doses at a rate of 376.327 per 1,000. In the province, 3.78 per cent (29,476) of the population has been fully vaccinated. There were zero new vaccines delivered to New Brunswick for a total of 373,815 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 78.53 per cent of its available vaccine supply.Quebec is reporting 104,742 new vaccinations administered for a total of 3,550,899 doses given. The province has administered doses at a rate of 414.987 per 1,000. There were 51,642 new vaccines delivered to Quebec for a total of 4,110,859 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 86.38 per cent of its available vaccine supply.Ontario is reporting 144,724 new vaccinations administered for a total of 5,885,485 doses given. T

Today’s coronavirus news: The vaccine pipeline is about to turn on. Is Canada ready? Plus, a fifth of MLB teams relax COVID protocols

The latest coronavirus news from Canada and around the world Saturday. This file will be updated throughout the day. Web links to longer stories if available.

7:10 a.m.: The vaccine pipeline is about to turn on. Is Canada ready?

The Star’s Alex Boyd went inside Ontario’s vaccine rollout — and its biggest challenge yet

7:05 a.m.: A fifth major league team has been able to relax coronavirus protocols after 85 per cent of its players and other on-field personnel completed vaccination.

Major League Baseball and the Major League Baseball Players Association made the announcement Friday without identifying any teams and said seven additional teams had reached the 85% level of having received final doses and would be able to relax protocols within two weeks once they are fully vaccinated.

The New York Yankees and Detroit said last weekend they were able to relax protocols, and Milwaukee said earlier this week it had been able to relax them. Relaxed protocols include dropping the requirements for facemasks in dugouts and bullpens, and loosening restrictions on mobility during road trips.

MLB said Friday that more than 83% of all tier 1 individuals such as players, managers, coaches, athletic trainers and support personnel had been partially or fully vaccinated, up from 81% on April 30.

There were no positive results among 10,330 monitoring tests in the past week and one among staff at an alternate training site, a 0.009% positive rate.

Thus far this season, there have been 44 positive tests — 27 players and 17 staff — among 145,647 samples tested, a 0.03% positive rate. The positive tests are among 21 teams.

4:05 a.m.: In Canada, the provinces are reporting 406,415 new vaccinations administered for a total of 15,325,183 doses given. Nationwide, 1,221,019 people or 3.2 per cent of the population has been fully vaccinated. The provinces have administered doses at a rate of 40,436.61 per 100,000.

There were 51,642 new vaccines delivered to the provinces and territories for a total of 18,033,514 doses delivered so far. The provinces and territories have used 84.98 per cent of their available vaccine supply.

Please note that Newfoundland and Labrador, P.E.I., Nova Scotia, New Brunswick and the territories typically do not report on a daily basis.

Newfoundland and Labrador is reporting 17,703 new vaccinations administered over the past seven days for a total of 191,130 doses given. The province has administered doses at a rate of 365.009 per 1,000. In the province, 1.85 per cent (9,676) of the population has been fully vaccinated. There were zero new vaccines delivered to Newfoundland and Labrador for a total of 244,930 doses delivered so far. The province has received enough of the vaccine to give 47 per cent of its population a single dose. The province has used 78.03 per cent of its available vaccine supply.

P.E.I. is reporting 6,556 new vaccinations administered over the past seven days for a total of 59,758 doses given. The province has administered doses at a rate of 376.715 per 1,000. In the province, 6.78 per cent (10,750) of the population has been fully vaccinated. There were zero new vaccines delivered to P.E.I. for a total of 76,725 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 77.89 per cent of its available vaccine supply.

Nova Scotia is reporting 44,485 new vaccinations administered over the past seven days for a total of 356,978 doses given. The province has administered doses at a rate of 365.794 per 1,000. In the province, 3.86 per cent (37,630) of the population has been fully vaccinated. There were zero new vaccines delivered to Nova Scotia for a total of 450,600 doses delivered so far. The province has received enough of the vaccine to give 46 per cent of its population a single dose. The province has used 79.22 per cent of its available vaccine supply.

New Brunswick is reporting 31,411 new vaccinations administered over the past seven days for a total of 293,550 doses given. The province has administered doses at a rate of 376.327 per 1,000. In the province, 3.78 per cent (29,476) of the population has been fully vaccinated. There were zero new vaccines delivered to New Brunswick for a total of 373,815 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 78.53 per cent of its available vaccine supply.

Quebec is reporting 104,742 new vaccinations administered for a total of 3,550,899 doses given. The province has administered doses at a rate of 414.987 per 1,000. There were 51,642 new vaccines delivered to Quebec for a total of 4,110,859 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 86.38 per cent of its available vaccine supply.

Ontario is reporting 144,724 new vaccinations administered for a total of 5,885,485 doses given. The province has administered doses at a rate of 400.671 per 1,000. In the province, 2.64 per cent (387,484) of the population has been fully vaccinated. There were zero new vaccines delivered to Ontario for a total of 7,056,415 doses delivered so far. The province has received enough of the vaccine to give 48 per cent of its population a single dose. The province has used 83.41 per cent of its available vaccine supply.

Manitoba is reporting 15,140 new vaccinations administered for a total of 534,647 doses given. The province has administered doses at a rate of 388.268 per 1,000. In the province, 5.45 per cent (74,988) of the population has been fully vaccinated. There were zero new vaccines delivered to Manitoba for a total of 686,160 doses delivered so far. The province has received enough of the vaccine to give 50 per cent of its population a single dose. The province has used 77.92 per cent of its available vaccine supply.

Saskatchewan is reporting 10,530 new vaccinations administered for a total of 491,440 doses given. The province has administered doses at a rate of 416.773 per 1,000. In the province, 3.87 per cent (45,655) of the population has been fully vaccinated. There were zero new vaccines delivered to Saskatchewan for a total of 542,935 doses delivered so far. The province has received enough of the vaccine to give 46 per cent of its population a single dose. The province has used 90.52 per cent of its available vaccine supply.

Alberta is reporting 59,730 new vaccinations administered for a total of 1,792,312 doses given. The province has administered doses at a rate of 407.154 per 1,000. In the province, 7.09 per cent (311,908) of the population has been fully vaccinated. There were zero new vaccines delivered to Alberta for a total of 2,002,215 doses delivered so far. The province has received enough of the vaccine to give 45 per cent of its population a single dose. The province has used 89.52 per cent of its available vaccine supply.

British Columbia is reporting 46,946 new vaccinations administered for a total of 2,042,442 doses given. The province has administered doses at a rate of 398.015 per 1,000. In the province, 1.94 per cent (99,461) of the population has been fully vaccinated. There were zero new vaccines delivered to British Columbia for a total of 2,330,040 doses delivered so far. The province has received enough of the vaccine to give 45 per cent of its population a single dose. The province has used 87.66 per cent of its available vaccine supply.

Yukon is reporting 299 new vaccinations administered for a total of 49,439 doses given. The territory has administered doses at a rate of 1,184.707 per 1,000. In the territory, 55.23 per cent (23,048) of the population has been fully vaccinated. There were zero new vaccines delivered to Yukon for a total of 55,920 doses delivered so far. The territory has received enough of the vaccine to give 130 per cent of its population a single dose. The territory has used 88.41 per cent of its available vaccine supply.

The Northwest Territories are reporting zero new vaccinations administered for a total of 48,007 doses given. The territory has administered doses at a rate of 1,064.009 per 1,000. In the territory, 48.04 per cent (21,674) of the population has been fully vaccinated. There were zero new vaccines delivered to the Northwest Territories for a total of 58,800 doses delivered so far. The territory has received enough of the vaccine to give 130 per cent of its population a single dose. The territory has used 81.64 per cent of its available vaccine supply.

Nunavut is reporting 133 new vaccinations administered for a total of 29,096 doses given. The territory has administered doses at a rate of 751.33 per 1,000. In the territory, 32.97 per cent (12,768) of the population has been fully vaccinated. There were zero new vaccines delivered to Nunavut for a total of 44,100 doses delivered so far. The territory has received enough of the vaccine to give 110 per cent of its population a single dose. The territory has used 65.98 per cent of its available vaccine supply.

Source : Toronto Star More   

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