Stuck in Phase 1, Haldimand-Norfolk finding creative ways to vaccinate more residents

·7 min read

When it comes to distributing the COVID-19 vaccine, Haldimand-Norfolk may be a victim of its own success.

Because the rural health unit moved quickly and had a relatively small number of residents to vaccinate in Phase 1 of the province’s vaccination rollout, the region is essentially done first doses while larger health units are playing catch-up.

The province’s recent order for all health units to stop second doses and focus on getting first shots to everyone in Phase 1 forced Haldimand-Norfolk to cancel 6,000 second-dose appointments and look for creative ways to use up their existing vaccine stock.

“The science is there. We understand that the more people we can get the first vaccine into, the higher level of immunity we’re going to get across the province,” said Norfolk EMS chief Sarah Page, who leads Haldimand-Norfolk’s vaccine task force.

“The unfortunate part is because we were so advanced into Phase 1, we did have quite a number of bookings done for the second dose.”

The news raised the ire of residents whose elderly relatives had their appointments cancelled.

“My 92-year-old mum has just had her first shot. Now she has to wait four months until she is fully immunized,” Dunnville native Joy Faulknor said on social media.

“Why not at least get second shots into the arms of the most vulnerable population?”

Dr. Shanker Nesathurai, Haldimand-Norfolk’s medical officer of health, says he is “comfortable” that delaying second doses of the Pfizer-BioNTech and Moderna vaccines for up to four months would not reduce their overall effectiveness.

“We have to stick with the science that they’re providing us, saying that after your first dose you are 90 per cent immunized against the effects of COVID,” Page added, noting that suppressing the disease’s most severe symptoms should help reduce the number of patients who end up in the ICU.

According to Page, Haldimand-Norfolk has vaccinated “90 to 95 per cent” of those currently eligible to receive the vaccine.

As of Wednesday, approximately 12,600 people had received their first dose, and 1,613 people — long-term-care and retirement home residents, and some front-line staff — had received their second.

The health unit has vaccinated 570 of roughly 610 adults who live on Mississaugas of the Credit First Nation, with plans to reach band members living off-reserve.

By the end of this week, the health unit expects to vaccinate any seniors over 80 who were unable to attend a past clinic due to scheduling or illness, and any newly arrived long-term-care residents.

Page said the health unit is also fielding calls from residents over 80 who do not have a family doctor in Haldimand-Norfolk, or at all, and have not yet been vaccinated.

More than 4,400 vaccine doses remain in freezers, with more due to arrive. Thus far the health unit has used 76.4 per cent of the total 18,834 doses received.

“We do have additional vaccine in the freezer that we had allotted for second shots,” Page said, adding it was “inevitable” that Ontario’s health units would move at different speeds.

“A smaller, rural-based community has the advantage of rolling out a vaccination program at a faster pace” than larger urban centres, she said.

“Our neighbours around us have vulnerable people at high age levels that may not be vaccinated. So for us to continue at a very rapid pace and get down to, say, 50-year-olds, when our neighbours we may interact with are only at the level of 75- or 80-year-olds, it does bring out some inequity in the system.”

Nesathurai said the Health Ministry wants “some level of uniformity” regarding what age groups receive the vaccine in different regions, adding that his preference would be for the health unit to always be “close to exhausting our vaccine supply.”

Premier Doug Ford acknowledged the disparity between health units during a news conference on Tuesday.

“We have 34 public health units all going at a different pace. Some are more efficient than others,” he said.

“I’m encouraging every public health unit (to) take care of the most vulnerable. Let’s just get the 80-year-old-plus done and then move on to the next stage.”

Despite Haldimand-Norfolk being ahead of other health units, Page said the government has not rerouted any doses.

“At no time has there been mention of any vaccine leaving our area to go service another area. Our next two deliveries have been confirmed, and there are approximate dates for delivery in the future, based on our population rolling through Phase 2,” she said.

Page said her team is busy searching for ways to “interpret” the Phase 1 eligibility guidelines and take advantage of “flexibility” within the framework to get more doses into arms.

The task force will vaccinate every possible health-care worker who is eligible, a list that includes pharmacists, massage therapists and chiropractors.

Seniors living in supportive housing will get the vaccine, as will residents of social housing complexes and 79-year-olds who are turning 80 this year.

A pilot project will give family doctors practice in administering the Moderna vaccine, and community paramedicine clinics will reach homebound and “highly vulnerable” community members whose mobility issues prevent them from going to a standard clinic.

And on Thursday, the health unit invited residents between 70 and 74 years old to sign up online for a waitlist so they can be called to future clinics if there are extra doses available at the end of the day due to cancelled appointments.

Family doctors will continue booking appointments for residents in the 75 to 79 age bracket.

“There has been a lot of flexibility from the province to move forward and ensure vaccines aren’t sitting in the freezer,” Page said.

Despite these efforts, Page admits there will soon come a point when her team runs out of people they are allowed to vaccinate.

“Come next week, we may have to get permission of the province to expand moving forward, or there is the potential that we may be waiting a few days until we have that authorization,” she said.

Looking ahead, the health unit is lobbying the province to move vaccinations for migrant farm workers — who the task force considers a “population at risk” — up to the beginning of Phase 2, rather than later in the phase as currently scheduled.

“We are advocating to get an allotment (of vaccines) and start doing some clinics geared specifically to our higher-risk essential workers,” Page said, noting it would be ideal to speedily vaccinate the “significant number” of farm workers now arriving at area farms.

“There has to be interpretation of the phases on a local level to address risk,” she said. “We’ve had large farm outbreaks that have occurred here. We’ve had a death, unfortunately, from COVID that occurred on a farm outbreak here.”

Page has her fingers crossed residents who had their appointments for second shots cancelled will end up getting them before the end of the new waiting period.

“We hope that as we roll through and finish the phases of immunization, we may be able to come back to second doses before that four-month period,” she said. “That of course is all contingent on vaccine availability and official word from the province.”

Residents who have been offered the vaccine are by and large taking it and feeling no ill effects.

Page estimated only five to 10 per cent of Phase 1 recipients turned down the vaccine, which she attributes to elderly residents understanding the risk posed by the virus and, therefore, having little objection to getting inoculated.

So far, Page said those getting the vaccine have reported few adverse reactions.

“In the 14,000 (doses) we’ve given, we have less than one per cent with side effects. That’s been great for us,” she said.

“Roughly 11 per cent of our population is done, so we’re really happy with how the rollout has gone, and the feedback and support from the community has been really fantastic.”

If Haldimand-Norfolk was assured of enough supply and allowed to dictate its own pace, Page said vaccination numbers could increase in a hurry.

“We have the capacity that we could be running six to seven days a week. At our highest rate in the seven days, we did just over 7,200 doses,” she said.

“If we had carte blanche of rolling out the vaccine at all levels, and had unlimited supply, we would be working 24-7 to try and get everyone vaccinated so that we have this level of immunity and there are more possibilities of returning to a more normal lifestyle. I think that would be the ideal for everyone.”

J.P. Antonacci, Local Journalism Initiative Reporter, The Hamilton Spectator