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‘Extremely frustrated’: B.C. family docs shut out of vaccination drive

Left out of this year’s flu-shot campaign, some B.C. family physicians say the province’s recently announced vaccine blitz comes too late to protect their patients.

This flu season has been unusually early and intense, leading to strained hospitals and emergency departments. The dominant circulating flu strain is H3N2, which tends to cause more severe illness, particularly in children under the age of 5. Six children and youth have died.

The surge of cases comes on the heels of the rollout of a new flu-shot booking system, which Penny Ballem, executive lead for B.C.’s vaccine operations program, admitted at a press conference got off to a “shaky” start, with many patients unable to book due to technological issues.

Instead of dropping into a pharmacy or visiting their family physician, patients were encouraged to register in the province’s Get Vaccinated system, developed for the COVID-19 vaccination program. Patients then wait for an invitation to book their flu shot at a pharmacy or public health clinic.

Manya Sadouski, a family physician on Salt Spring and Saturna Islands, says this year she and her colleagues in the Island Health Region were not allowed to order the thousands of flu shots that they would normally administer to their patients. 

Sadouski said that the province ordered 30 per cent fewer flu shots than last year; according to an internal memo obtained by CTV News, this was done to prevent waste because uptake the previous year had been less than expected. Due to the limited supply, she and her colleagues were told they could only order a small number of doses in extraordinary circumstances for patients with barriers to accessing public health clinics or pharmacies via the Get Vaccinated system.

After her colleague, Clare Rustad, advocated through the media, they were provided with some doses and were able to vaccinate 200 people in a single day, far fewer than the 1,500 patients they did in a weekend two years ago or the 1,000 they vaccinated in a mass clinic last year.

‘Primary Care Provider Influenza vaccine ordering should be the ‘exception’ and not the ‘norm’ this season.’

Though Ballem noted that 2,000 family physicians were provided with flu shots this year, many say they were left out. The Island Health Region’s website states that the vaccine was prioritized for access at pharmacies and public health clinics over doctors’ offices “to allow individuals access to COVID-19 and influenza vaccine at the same time.” According to a Times Colonist article, Island Health sent family physicians a memo saying “Primary Care Provider Influenza vaccine ordering should be the ‘exception’ and not the ‘norm’ this season.”

Ballem has said the province encouraged use of the Get Vaccinated program for logistical reasons, and to allow patients to access their vaccination records through the Health Gateway. There is currently no mechanism for doctors’ offices to input the doses they administer into the registry.

“It’s outrageous,” said Sadouski. “We’ve always partnered in influenza vaccination and used our offices and our knowledge of our patients and the local community to facilitate vaccination. And we were utterly shut out.”

Sadouski’s patients were surprised and couldn’t understand the change. Many patients registered but did not receive invitations to book their flu shot. The online booking system “built a higher barrier” for patients without access to technology. Her patients on Saturna Island had to either go off island or be vaccinated at an Island Health vaccination clinic, which is only held every 2-3 months.

“To have a basic preventative tool withheld from us is extremely frustrating, and to be picking up the pieces of acute respiratory illness is so discouraging,” she said. “There’s so much preventable suffering.

“Any other year, we would have been doing this in October. Why have this in December, after our children’s hospitals are absolutely overwhelmed? It defies explanation.”

To be sure, despite booking-system glitches and many family physicians not receiving vaccines, a record-setting 1.5 million British Columbians have gotten their flu shots this year. At the start of December, Henry emphasized that the typical flu season lasts about 6-8 weeks, and that there is still time to see benefit from vaccination. She said this year’s shot appears to be a good match for the H3N2 strain, which normally confers 50 per cent to 70 per cent protection against infection and illness.

Claire Snyman, a Vancouver-based health-care advocate with lived experience with chronic illness, says that it’s important to consider patients who already face barriers and may be disproportionately affected by the shift to a centralized online booking system.

“What burden are you already carrying on your shoulders?” she asked. “If you’re already a super complex patient, you already have a ton of medications to manage, you have four specialists on your team, you already have a lot. Now this is just another thing for you to figure out how to navigate.”

Previously, she would get vaccinated as early as possible by dropping into a pharmacy or visiting her family doctor. This year, she wasn’t sent an invite until the first week of November. The earliest appointment was two to three weeks away. She wanted to have her flu and COVID shots at separate visits but couldn’t book a second visit until she had received the first vaccine.

“I felt like I was playing a bit of Hunger Games to try and figure out how to get it done.”

Alex Nataros, a family physician in Port Hardy, said that family physicians and their team members have an important role to play in immunizations, particularly for patients with vaccine hesitancy and young children.

Prior to the province holding drop-in clinics for children two weeks ago, parents needed to register children on the Get Vaccinated system and wait to be invited to book. But on Dec. 5, Ballem said that only 50,000 of 200,000 kids ages 6 months to 4 years were registered on Get Vaccinated. In previous years, flu shots were also readily available for children at doctors’ offices.

‘It’s a big deal that I’m not allowed to routinely give flu vaccines.’

About 30 per cent of kids are typically vaccinated. This year, coverage rates for children under the age of 5 remain low at 26.3 per cent as of Dec. 12, even after a weekend blitz of public health walk-in clinics.

Facing a community and hospital outbreak of influenza, Nataros recently collaborated with a pharmacist to hold a drop-in clinic where they immunized more than 70 patients in a single day, including children under the age of 4.

“From my perspective, in terms of primary care, when I’m not in the emerg, vaccines are the most important single thing that I can do in my day to day,” he said. “It’s a big deal that I’m not allowed to routinely give flu vaccines.”

Vaccine delivery needs to be as easy and straightforward as possible, he said, including primary care provider offices, public health clinics, pharmacies, street outreach teams and offering vaccine to hospitalized patients.

“Vaccine hesitancy is only increased with any small friction that makes it more difficult to get a shot,” said Nataros. “Decrease the friction and make it as seamless as possible.”

A spokesperson for Island Health declined an interview request and suggested contacting BC’s Ministry of Health. The Ministry did not provide a response to written questions prior to publication.

Detailed statistics for B.C. were not available, but nationwide, nearly 1 in 4 adults get their flu shots at a doctor’s office, making it the second-most common location after a pharmacy.

“It’s infuriating because we are ready to act. We’re ready to collaborate,” said Sadouski. There are many health conditions family physicians are powerless to prevent, she added.

“But goddammit, we can vaccinate people.”

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Liana Hwang

Contributor

Liana Hwang is a family physician with obstetrical surgical skills who divides her time between Calgary and Canmore, Alberta. She has a special interest in reproductive health and refugee health. She is currently a fellow in the Global Journalism program at the Dalla Lana School of Public Health, University of Toronto. 

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