Ask anyone who braved the long and winding lineups and the verdict is already in: our immunization rollout was horribly bungled. How, after all, can the same plan that contemplates the parking needs of Mennonites allow pregnant women to stand in the rain?
But to suggest that the entire effort has been a universal debacle isn’t fair either. While it’s clear that many mistakes—and assumptions—were made, pinpointing the culprit is not as easy as opposition politicians like to proclaim. “Pandemics occur three times a century,” says Dr. Arlene King, Ontario’s medical officer of health. “There are going to be bumps in the road.” Some of those bumps should have been spotted well in advance. Others were unavoidable.
Any debate about what’s happened over the past few weeks must be framed by one scientific fact: a pandemic influenza virus is not a seasonal flu virus. It is a never-before-seen strain that spreads rapidly from country to country, and no matter how swiftly the experts act, it takes time to create a vaccine. Unlike a typical flu shot, which can be produced months before the flu season actually arrives, a pandemic strain appears out of nowhere, just as H1N1 did in April. “Even if everything works perfectly, it takes about six months from the time you have a virus until the time you can produce a vaccine,” says Dr. Tim Brewer, an infectious disease specialist at McGill University. “And there were some production problems with this virus. It didn’t grow as well in the egg cultures as they had hoped. That was a real challenge.”
Adding to that challenge was the fact that this year’s seasonal vaccine was in the final stages of production when the H1N1 vaccine was ready to be made. Rather than cancel the seasonal version (the regular flu kills thousands of people, too), the World Health Organization (WHO) recommended that every country complete its production runs before pumping out the new H1N1 vaccine. Canada heeded that advice. “No one jettisoned their seasonal vaccine production lines,” says Dr. Earl Brown, a virus expert at the University of Ottawa and adviser to the country’s chief public health officer. “You really would have to say: ‘Gee, there’s not going to be any need for seasonal flu vaccine. Let’s forget about it this year and tell the companies to throw the stuff in the garbage.’ ”
Looking back, some experts are now convinced that was a fatal error. “It was a terrible mistake,” says Dr. Richard Schabas, Ontario’s former medical officer of health. “We’re not seeing any seasonal flu, which I think was predictable, and we are seeing an early flu season from H1N1, which I think was also predictable. Whether it was a reasonable decision or not at the time, it’s turned out to be a very wrong decision.”
Another controversial decision was Ottawa’s sole-source contract with GSK. The rationale was sensible enough. In 2001, Jean Chrétien’s Liberals believed that in the event of a global flu outbreak, it would be prudent to have a vaccine produced by a Canadian factory on Canadian soil. That way, if the borders were ever shut down, the shots would flow.
But last week, amid production interruptions at GSK’s plant in Sainte-Foy, Que., federal officials confirmed that they will consider buying future vaccines from multiple suppliers in order to avoid potential shortfalls. The numbers speak for themselves. In the first three weeks of the rollout, from Oct. 12 to Nov. 1, the feds distributed an average of 1.95 million doses per week to the provinces. Last week, the provinces received only 711,000 shots—barely one-third the usual amount. Some flu clinics had no choice but to shut their doors.
Common sense suggests that more suppliers would equal more supply, but Scheifele is not convinced. “It’s the virus that’s the villain here, not the logistics of vaccine purchasing,” he says. “One would have to split the expected target numbers between the two companies, and the reality would have both of them struggling to meet their quotas.” Even the U.S. is suffering through shortages. “It’s been an across-the-board struggle.”
A few weeks ago, the struggle actually had nothing to do with supply. Public health officials across the country were not worried about running out of vaccine; they were worried that nobody would show up for the shot. Governments peppered the airwaves with TV and radio ads, urging Canadians to roll up their sleeves. “A few days before our clinics opened, I was being asked questions by the media about how we were going to persuade people to be immunized,” says Dr. David McKeown, Toronto’s medical officer of health. “Polls were telling us that many people did not want to be immunized, and we were planning for that.” One survey conducted in late October found that only 49 per cent of Canadians planned to get the shot.
