A video of a virtual town hall at the University Health Network reveals internal pushback over who is being prioritized for COVID-19 vaccines and a sense of urgency among hospital leadership to secure future shipments — even as some hard-hit regions await their first vials.
In the video recorded Tuesday, UHN president and CEO Dr. Kevin Smith addressed recent controversies and questions over the vaccine rollout at Ontario’s largest hospital network. On Sunday, UHN offered surplus vaccines to a wide range of staff at its hospital and four other centres, including those who don’t interact with patients — an incident that sparked media reports over vaccine queue-jumping.
Smith said UHN was doing its best to follow “the rules we’ve been dealt by the vaccine task force” while also taking provincial direction to get “vaccines in arms” as quickly as possible. Unintentional errors are expected in a vaccination campaign of this size and scale, he said, and many other hospitals are also facing media scrutiny over how doses are being distributed.
But the uneven nature of Ontario’s vaccine rollout so far — some hospitals are already offering doses to researchers or volunteers while others are still waiting to vaccinate long-term-care residents in their regions — is drawing criticism from experts and ethicists alike who say the province’s plan is failing to address the most urgent needs.
“We’re kind of starting to lose sight of the big picture and what it is we’re trying to accomplish,” said Kerry Bowman, a bioethicist at the University of Toronto. “Our goals are to keep vulnerable Canadians from dying.”
Vaccine doses in the first phase of the province’s rollout are being distributed through select hospitals. The Ministry of Health told the Star that while the priority is to vaccinate all of Ontario’s long-term-care and high-risk retirement home residents, as well as staff and essential caregivers, it is encouraging its hospital and health-care partners to use leftover doses, such as those from a missed appointment, to vaccinate others such as health-care workers, to ensure all doses in a given day are used.
“We are committed to ensuring every Ontarian who wants a vaccine gets one in a timely and ethical manner,” said a ministry spokesperson in an email.
The current vaccine rollout excludes regions with some of Ontario’s worst current infection rates. As of Wednesday, both the Niagara and Lambton health units had worse population-adjusted incidence rates than Toronto, Peel and York — three of the province’s four target regions.
Twelve other health units had incidence rates above 100 cases weekly per 100,000, the threshold for the highest level in the province’s colour-coded response plan.
In Lambton, a small health unit near Sarnia, the weekly incidence rate has now reached 263 infections per 100,000 people — the second-highest in the province.
But Lambton isn’t expecting its first shipment of vaccines until the first week of February, and the public health unit has yet to receive confirmation on delivery schedules or even the number of doses, medical officer of health Dr. Sudit Ranade said in a press call Thursday.
“I can’t really speak to whether or not (vaccines) should be transferred from other places,” Ranade said. “Having said that, the need is very urgent here and the sooner we can get vaccine the better, especially for that really vulnerable population that we’re trying to protect right now.”
Niagara has also been hit especially hard since the winter holiday. The health unit’s infection rate has nearly tripled since Boxing Day and its 109 reported deaths since that time, adjusted for population, are more than double that in Toronto, York or Peel.
Niagara’s acting medical officer of health, Dr. Mustafa Hirji, says his region was expecting doses of the Moderna vaccine last week before the province inexplicably cancelled them right around the time it announced it would target long-term-care homes in Toronto, Peel, York and Windsor-Essex.
“We suspect that the vaccine may have gone to those regions and this was part of facilitating that goal,” he told the Star on Thursday.
He added that people deemed lower-risk already vaccinated in other regions like Toronto will soon require a second dose. “so some of the future supply now has to be dedicated again to these lower-risk persons rather than being allocated to places like ours, where we could potentially vaccinate high-risk people.”
The ministry of health said the hot spots of Toronto, Peel, York and Windsor-Essex were initially targeted because they had the highest transmission rates of COVID-19 and could serve as logistical testing grounds for the Moderna vaccine.
But Toronto hospitals have gone through their shipments at different rates, sparking questions over how doses should be distributed once front-line staff are covered. At Michael Garron Hospital, vaccines are now being offered to all staff, including executives.
At Humber River Hospital, a memo on Jan. 4 offered vaccines to all staff, physicians and volunteers. Humber did not respond to the Star’s questions about the memo, but sent a statement saying it was “proud to take a key role in vaccinating health care workers and essential caregivers.”
During UHN’s town hall, hospital officials said if they receive adequate supply, the goal is to vaccinate all employees within the month. But in a question-and-answer period, one of the most popular questions from staff — receiving 144 online “votes” — was whether UHN had a responsibility and mandate to first vaccinate community health workers at greater risk of COVID-19.
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“Unfortunately it’s not our call to make,” Smith said. “The province of Ontario has made that decision.”
When addressing whether people in “red zones,” or hot spots, should be prioritized over front-line workers in less-impacted regions, Smith said that “until we inoculate the majority of people in those zones, it’s not protected.”
“Red zones need to get done before other parts of the province have vaccine redirected because of community spread,” he said.
Smith said after recent public outcry over vaccines sitting idle in freezers, there was pressure from the province to “get those needles in arms.”
“Frankly, if we slow down, we will not be the hospital that gets the next shipment. You have to be pretty close to being out when everybody wants it this badly,” he said in the video. “The best way we can get you more is by being efficient in (the vaccine’s) delivery.”
In an interview Thursday, Smith said that when he made this comment, he was referring to a slowdown threatening new shipments at the national level, not to his hospital specifically.
He said the town hall was an “internal recording” with staff “to have a frank conversation.” While the video is accessible on YouTube to anyone with the link, it is not searchable.
“Everybody in the world wants this vaccine, so if there’s a perception that Canada, or Ontario or Toronto or UHN has a bunch of vaccines sitting in freezers, when everybody in the world is screaming for this, we will not get prioritized as a priority zone for more vaccine to be shipped to.”
Smith said he felt there was “a little bit of a misunderstanding” in recent days over what UHN’s role should be in the vaccine rollout, and the hospital is just following the province’s guidelines.
He said that when UHN received the offer of surplus vaccine doses from Southlake Regional Health Centre on Sunday, UHN first reached out to front-line workers before expanding the callout to a wider group, which included researchers.
The controversy prompted a call from the Ontario Provincial Police, Smith told the town hall. They called UHN after reading media reports of vaccine queue jumping, which may be a reportable offence, Smith said.
He said he isn’t aware of any cases of “queue jumping” and the rollout is operating under an honour system, since they lack the technical systems to verify whether employees who sign up are actually front-line. “Ideally we wanted them to be patient facing,” he said, but “for us the importance was, don’t waste a single slot.”
OPP spokesperson Staff Sgt. Carolle Dionne said in an email she was unable to confirm that an OPP officer had contacted UHN, “nor that we have an ongoing investigation.”
Smith added that it’s not for UHN to decide where the next shipment goes, and if other areas are quickly becoming new hot spots, then it’s up to the provincial task force to redirect resources as necessary.
But U of T’s Bowman says he believes that UHN should have had a better contingency plan for unused doses, and that he’s not convinced that hospitals, rather than public health units — which have extensive experience with vaccinations — should be leading the rollout.
Hot spots “need attention” but don’t change the ethical mandate of the vaccine rollout, he said.
“We have to be much more nimble about this, especially if the variant is really doing what it may be doing, we’re going to have to change gears very quickly.”
With files from Ed Tubb
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: [email protected]
May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @maywarren11
Jennifer Yang is a Toronto-based health reporter for the Star. Follow her on Twitter: @jyangstar
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