H1N1 Deployment - Public Concerns

[Michael Hardner]

The first deployment of H1N1 vaccines happened this weekend and it didn't go smoothly.

There were complaints about lack of communication, there were lineups, and confusion.

Today's Toronto Metro included an admission that the Public Health Agency 'couldn't anticipate the number of people interested' in the vaccine. This statement opens the door to the public to ask 'what went wrong'. In fact, it's our duty to ask that question because Canadian Health Services require intensive public participation in order to work properly.

To my delight, I found a page within the Public Health Agency web pages (thank you Google) that allow you to email the Contact the Chief Public Health Officer (CPHO).

Here it is, and here's my note.

http://www.phac-aspc.gc.ca/contact_cpho-eng.php

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Hello Dr. Jones,

I read in the Toronto Metro today that your were quoted as saying the Public Health Agency of Canada couldn't anticipate the number of people who were interested in the H1N1 vaccine.

I realize that it may be a little early to assess what went wrong in the planning process, but I have a few questions:

On this web page you stated that 50.4 million doses were ordered. As such, why were there lineups early on ?

http://www.phac-aspc.gc.ca/alert-alerte/h1...rg_h1n1-eng.php

What was the planning process and how were the estimates you alluded to arrived at ? Is that information publicly available on the web ?

Are there plans for any kind of post-mortem on the H1N1 deployment ?

Thanks for your consideration.

Let's see how well this works:

Thank you for your enquiry which has been forwarded to the appropriate section at the Public Health Agency of Canada for response.

Public Enquiries

Public Health Agency of Canada

[GostHacked]

As if they could not predict the amount of people wanting to get the vaccine. The media overhyped and blew it all out of proportion sending people to the clinics in massive waves. Of course they were going to be flooded with people wanting to get the vaccine.

If they were surprised then, I would not trust their response to be very forthcomming.

[Michael Hardner]

I'd just like to see somebody explain how they predicted it. I'm sure that there was more to it than throwing a dart at a dartboard but it's hard to understand why it was so difficult.

[eyeball]

If they were surprised then, I would not trust their response to be very forthcomming.

Yes I suspect the public is feeling a little needled to say the least.

I'm just left wondering what sort of response we could expect in the face of something like an airborne Ebola virus. They'd probably be throwing nukes at the dartboard.

Edited November 2, 2009 by eyeball

[M.Dancer]

The vaccine must be refrigerated and has a shelf life of 24 hours. You would be wrong to think all 50 million doses were made at once.

I got the impression that the first days the officials were vacinating everyone who lined up, there by creating problems when it was supposed to be only the priority groups.

[Michael Hardner]

MDancer,

I got the impression that the first days the officials were vacinating everyone who lined up, there by creating problems when it was supposed to be only the priority groups.

I got that impression too. Too bad we only get impressions and not answers.

[GostHacked]

The vaccine must be refrigerated and has a shelf life of 24 hours.

Wrong. That would render the vaccine usless as soon as it's made. For the fact it can take more than 24 hours for the vaccine to go from manufacturing plant to hospital/clinic whathave you. Most flu vaccines have a shelf life of about one year.

http://www.hc-sc.gc.ca/dhp-mps/prodpharma/...-vaccin-eng.php

Shelf Life

The antigen suspension is stable for 18 months.

The adjuvant emulsion is stable for 3 years.

After mixing, the vaccine should be used within 24 hours. Although it is recommended to maintain the mixed product between 2°C and 8°C, it may be kept at room temperature during this period if required. However, if the product is refrigerated, it must be brought to room temperature before withdrawal. The chemical and physical in-use stability has been demonstrated for 24 hours at 30°C.

After mixing it yes there is the shelf life of 24 hours, and recommends it being refrigerated, but it's not crucial.

You would be wrong to think all 50 million doses were made at once.

True.

I got the impression that the first days the officials were vacinating everyone who lined up, there by creating problems when it was supposed to be only the priority groups.

The media ran with the hysteria and facilitated the people going in droves to get vaccinated. I call these people sheep for not taking a second to step back and assess the situation.

[eyeball]

I wonder if it would be better if the much smaller high-risk population and their families were advised to stay home when these flu pandemics occur and let the authorities bring the vaccine to them. It might simplify things and the rest of us could just carry on as usual.

I also wonder about the moral pressure that has been building for everyone to get a shot ASAP to cut down the chance of passing infections on to the high-risk people. This could be a troubling development that might morph into something rather ugly if we're not careful. That said I wouldn't want to see people in a high risk group being stigmatized either.

The combination of disease, public fear and outrage is usually not a good thing.

Edited November 2, 2009 by eyeball

[wyly]

I'd just like to see somebody explain how they predicted it. I'm sure that there was more to it than throwing a dart at a dartboard but it's hard to understand why it was so difficult.

it was predicted, health advisors recommended treating at risk patients first, in Alberta the govenment ignored the expert advice and opened vaccinations to all...

[wyly]

The media ran with the hysteria and facilitated the people going in droves to get vaccinated. I call these people sheep for not taking a second to step back and assess the situation.

the hysteria is in your own personal perception, I saw none in media reports...

[Bryan]

the hysteria is in your own personal perception, I saw none in media reports...

You must not own a TV. Hyperbole has been king on virtually all media reports I've seen.

[Molly]

I'd be willing to bet they just assumed it would be exactly the same as opting for seasonal flu, and didn't bother to survey anyone to find out.

People know the risks associated with seasonal flu, where they fit in the continuum of risk, and overall, what to expect from it. When faced with an unknown, they respond differently.

Bad assumptions made bad results.

[M.Dancer]

I'd be willing to bet they just assumed it would be exactly the same as opting for seasonal flu, and didn't bother to survey anyone to find out.

They surveyed and saw that at that time only 30% of canadians wanted a shot. New polling shows that number has risen sharpley to 50%.

[Michael Hardner]

Although understandable, they should have been able to plan for quicker scalabilitiy.

[GostHacked]

the hysteria is in your own personal perception, I saw none in media reports...

You are kidding me??!?!?!?

THe Ottawa Sun (just one of many examples) ran it as the cover story that ended on page 6 for about 2 weeks before the vaccinations started. Now the 'pandemic' is backed up to page 3 or 4 with not even a full page story anymore.

[M.Dancer]

Although understandable, they should have been able to plan for quicker scalabilitiy.

Who? The gov or the pharma?

Personally I think the problems have been with the city. 10 centres for a pop of 3 million?

It is first a logistical problem. Perhaps they should have sought help from logistical experts, like the army.

[Michael Hardner]

Mo,

Who? The gov or the pharma?

Personally I think the problems have been with the city. 10 centres for a pop of 3 million?

It is first a logistical problem. Perhaps they should have sought help from logistical experts, like the army.

The gov - the provincial and city gov. Yes, 10 centres for 3 million seems like a bad start. If 30% wanted vaccination, that gives us 900K/10 locations... or 90K per location. It still seems askew, so I ask-yew (heh heh) what's wrong here ?

I'd say what's wrong is that government managers (I've met these people) see their title as just that, a title like "baron" or "governess". They don't see it as a set of tasks such as planning, coordinating and asking lots, lots, lots of people if their plan is correct. As I said, I've met these people and they seem to be the types who are above getting into the dirty details of work to be done.

[capricorn]

More than half of vaccine doses sitting in storage

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While blame for the lack of progress in getting needles into arms has fallen on everyone from the federal government to the provinces and the vaccine maker, public health officials said yesterday that the provinces weren't ready because they thought Ottawa's approval process would go more slowly.

Perry Kendall, British Columbia's public health officer, said delivery of the shots is lagging because of Ottawa's quicker than expected approval of the H1N1 vaccine. The infrastructure for administering the inoculations, which includes volunteers and vaccinators, was ready to begin rolling on Nov. 9, but Health Canada gave its approval the week of Oct. 26.

"We had to kind of flex around the date. We weren't at the capacity that we would have been had we not received the vaccine till Nov. 9 or even this week," Dr. Kendall said yesterday.

http://www.theglobeandmail.com/life/health/h1n1-swine-flu/more-than-half-of-vaccine-doses-sitting-in-storage/article1351752/

The Globe piece, which includes a table which shows how many doses were delivered to provinces and how many doses were administered by province, speaks volumes.

If the provinces can't increase the rate of vaccinations with their present supply, what on earth are they going to do when the next shipment of millions of doses arrives on their doorstep?

Seems to me an important component in fixing what went wrong with the H1N1 roll out is for the three levels of government to work out a seamless communications plan. Regardless if the feds devised a topnotch pandemic plan able to please the Auditor General, if the provinces and municipalities are unable to respond in a timely fashion we're doomed to a repeat performance sometime in the future.

Ian MacDonald sums up the constitutional relationship at play.

Beyond the anxiety in the country and the blame game in Ottawa over the availability of H1N1 vaccine, there's a fundamental issue of the constitutional division of powers.

It's both simple and subtle. Under Section 91 of the Constitution Act, Ottawa is responsible for "peace, order and good government." It is the central statement of the Constitution, and the ultimate trump of the federal government in running the country.

This means that Ottawa is ultimately responsible for the safety and well-being of Canadian citizens, including those standing in line waiting for flu shots. Except that the lines are run by the provinces.

Ottawa is also responsible for national health and safety standards, approvals for experimental drugs, and the purchase of drugs such as the H1N1 vaccine.

But the provinces, under Section 92 of the Constitution, are responsible for running the health-care systems across the country, including the distribution of vaccine and the determination of priorities.

In other words, Ottawa is responsible for assuring the supply, while the provinces are responsible for meeting the demand.

http://www.montrealgazette.com/health/Your+Constitution/2181340/story.html

[Michael Hardner]

Didn't I read somewhere that they ordered 50 million doses ? So 25 million doses sitting in storage, and how many people have had the vaccine so far ?

Dr. Kendall's assessment sounds plausible. I can't expect the City of Toronto, for example, to move their deadline up by one week and be ready to go.

[capricorn]

The number of those immunized across Canada is right there in the Globe article I posted above.