Canada is barely a few weeks into the biggest mass immunization campaign in the nation’s history, and by now everyone has heard—or worse, lived—a ﬂu shot horror story. “It’s been chaotic,” admits Dr. David Scheifele, director of the Vaccine Evaluation Centre in Vancouver, which is associated with the B.C. Children’s Hospital. His own experience is no exception. Recently, Scheifele ordered nurses at his hospital to administer the pandemic H1N1 vaccine to the highest priority health care workers, those in the emergency room, intensive care unit, and labour and delivery area. He knew there was a limited supply of shots, so nurses visited the targeted groups with a mobile cart. “We thought that was really smart. No advertising. This was a sensible way to interact with the people who needed the vaccines.”
But pandemonium erupted. “Legions of people were basically crashing the party,” he recalls, including non-priority clerical and medical staff. There was such a “clamour” and so many “irate people incensed that they were being turned away” that the nurses had to return the next day with a security guard. “It is preposterous, the notion that nurses delivering a vaccine would be mobbed and fear for their safety,” he says. “Who could ever have imagined a scenario like that?”
It’s a question public health ofﬁcials at every level should be asking themselves, given the bewildering events that have unfolded since the pandemic ﬂu shots started rolling out of the Quebec plant of GlaxoSmithKline (GSK) in mid-October. In Toronto, pregnant women and other vulnerable groups were forced to stand outside for up to seven hours, come rain or wind, to get immunized. In Calgary, a shuttered ﬂu clinic that had run out of vaccines detonated a chorus of profanities among the jilted—a manifestation of “ﬂu rage,” as psychologists have christened H1N1 anxiety. Some family physicians who tried to get their own vaccine rations for their most susceptible patients, including those with cancer, were denied. Yet NHL players, robust young men with strong immune systems, somehow managed to get their arms poked. As if all this weren’t surreal enough, then came the political rhetoric by Liberal party president Alfred Apps, who wondered in a rousing email to colleagues whether this ﬂu pandemic is Canada’s hurricane Katrina.
Indeed, it’s easy to feel like H1N1 has been wildly mishandled. “Botched” is the buzzword these days. Most of the provinces and territories have received only a fraction of the vaccine they were initially promised. British Columbia, for instance, expected its ﬁrst shipment to be a million doses; it got a quarter of that amount, and so far the ensuing weekly shipments have also fallen short. On the other hand, many of the provinces and health units have been accused of sitting on vaccines because they don’t have the manpower to administer all the needles at once.
Just making this ﬂu shot has been more trouble than anyone anticipated. The virus has been difﬁcult to grow in the lab (a necessary step in creating a vaccine), which experts say has slowed down GSK’s production rate. Critics are also enraged that Canada, unlike the United States and other countries, only hired one pharmaceutical company to produce the shots. And just when the vaccine-making got underway, GSK had to interrupt that production to create a different version for pregnant women. This short supply of ﬂu shots has forced governments to encourage “priority sequencing” so that the most at-risk populations get immunized ﬁrst—though many healthy people have jumped the queue. “I think we assumed we were indeed a civil society,” says Scheifele. “That’s not necessarily the case when people are scared.”
The growing sense of panic matches the rising death toll. Across the country, 135 people have been killed by H1N1 since last spring, when it was ﬁrst identiﬁed in Canada, including an alarming number of otherwise healthy, vibrant young people. Nearly three dozen deaths have occurred in the ﬁrst 10 days of November alone, which corroborates Canada’s chief public health ofﬁcer’s assertion that the “second wave” of the pandemic ﬂu is ramping up. “We expect to hear of more illness and deaths in the coming weeks,” says Dr. David Butler-Jones. “This is something we have to be prepared for, as much as it saddens us.”
But for most people, accepting that someone in their community—maybe their own family—could die of H1N1 seems incomprehensible, if not reprehensible. Amid all the deaths, dwindling vaccine supplies and talk of a potential third wave, most Canadians have reached the same conclusion: the country’s public health authorities—federal, provincial and local—have failed us miserably. What if this was the big one? What if we weren’t so lucky, and H1N1 turned out to be the virulent inﬂuenza strain that experts have been bracing for—the one capable of killing thousands of people in a matter of weeks? How many people would have perished while waiting in line for a shot?
We were supposed to be ready for this. The federal government spent millions of dollars and many years crafting an ofﬁcial “Pandemic Inﬂuenza Plan,” and at 550 pages, the latest draft tackles every imaginable what-if and what-to-do. The document is so detailed that it even includes a write-up about where to store ﬂu-infected corpses if the morgues run out of space. (Try the local hockey rink ﬁrst, the report says, and if that’s full, a refrigerated grocery truck will sufﬁce.) The provinces and territories seemed equally prepared—on paper, at least. Each one boasts its own pandemic road map, and like the national version, they leave little to chance. The Ontario plan goes so far as to point out that at some vaccination clinics, “Mennonite populations might need hitching posts for horses.”
So earlier this year, when a scary new strain of the inﬂuenza virus surfaced in Mexico and spread across the globe, health authorities in Canada were armed with a very thick playbook. Unfortunately, that same playbook points out what so many shot-seeking Canadians now know: “No plan is or will be perfect; in fact, it may only be in hindsight that areas of improvement can be identiﬁed.”