Breaking down walls: Teamwork key to effective vaccine rollout
Since Canada approved our first COVID-19 vaccine, our attention has been focused on ensuring adequate vaccine supply, figuring out distribution and storage and deciding who gets it first. There’s been little discussion, though, about who will be giving the vaccine and where.
This fall’s flu shot campaign offers important lessons. Flu immunization was more important than ever because of COVID-19 but there were still needless hiccups in execution – worry and confusion about the supply, lack of clarity on whether to prioritize those at highest risk and, at times, finger pointing instead of collaboration.
But we have the opportunity to learn from our past. Key to the vaccine rollout’s success will be exceptional collaboration between primary care teams, community pharmacists and public health units – the three sectors that deliver the majority of vaccines in Canada.
Each sector plays a unique role. Family doctors and their teams have longstanding relationships with patients. These relationships are built on foundations of trust from which we can relay scientific information and directly address patients’ fears – from missing out on the vaccine to adverse effects. We can also use our records to identify priority groups and proactively reach out to them.
But not all Canadians have a family physician. Community pharmacists are in virtually every neighbourhood and represent a low-barrier access point for getting a vaccine. They too can use medication records to help identify priority groups. Public health units often focus efforts on reaching those at high risk who face barriers to care, like those living in shelters and those without health insurance.
Yet, even in our hyperconnected world, communication between these three groups is often limited. For example, family physicians are not routinely notified when their patients get flu shots at a pharmacy. And if they are notified, it’s via 1980s technology – the fax machine.
Still, we have a chance to get this campaign right – to leverage our collective strengths to rapidly immunize Canadians and save lives.
First, we will need a common record that notes when and where the COVID-19 vaccine was given – a particularly important tool for vaccines that require more than one dose. The record should be accessible to patients directly and, with permission, to all professionals in a patient’s circle of care.
We will need clear public messaging and rapid education for health professionals who, along with the public, will need to understand the use, benefits and safety profile of the vaccines. Professionals will need to work together to counter vaccine hesitancy – starting by getting vaccinated themselves in unprecedented numbers.
We will need transparency around the supply chain and the number of vaccines available in any region. Ideally, the public can check a single website to know how much of the vaccine is available in which locations and who is being prioritized at any given time.
Crucially, we will need creativity and collaboration to develop ways of reaching priority groups and vaccinating efficiently. There are ready examples from flu immunization efforts. In the fall, many primary care teams extended hours and organized drive-thru clinics to meet demand for flu shots while maintaining physical distancing requirements. Some family doctors collaborated with public health and community agencies to deliver the vaccine in large, accessible neighbourhood spaces.
Can we go further for the COVID-19 vaccine, for example, by using family doctor and pharmacy records to identify priority groups and our collective networks to more effectively conduct outreach?
In all cases, we will need to go beyond our walls and work with communities most affected by COVID-19, including low-income and racialized neighbourhoods, working side by side with residents to design a strategy that is respectful of diverse perspectives and needs.
Rapidly providing all Canadians with the COVID-19 vaccine is an unprecedented challenge but one we can meet if we work together and learn from past experience.
Tara Kiran is a family physician at St. Michael’s Hospital and the Fidani Chair of Improvement and Innovation at the University of Toronto.
Jeff Kwong is a family physician at the Toronto Western Family Health Team, a professor of Family Medicine and Public Health at the University of Toronto, and the interim director for the Centre for Vaccine Preventable Diseases at the University of Toronto. Twitter: @DrJeffKwong
Noah Ivers is a family physician at Women’s College Hospital and the University of Toronto and holds a Canada Research Chair in Implementation of Evidence-Based Practice. Twitter: @NoahIvers