BC public health officials on Monday unveiled details of the start of their mass immunization program. It will first target people living in the community that are above the age of 80, and Indigenous peoples over the age of 65.

The current plan will allow people to call their health authorities to book their appointments starting March 8, with clinics administering their first doses starting March 15.

The announcement also included two major updates: BC is expecting to receive about 60,000 doses of the newly approved AstraZeneca vaccine in the week of March 8. Public health officials have also made the decision to delay second doses of the Pfizer and Moderna vaccines to four months after the initial shot. 

Combined, these factors will speed up the timeline for everyone in BC to be immunized against COVID-19. It is now estimated that the entire population over the age of 18 will receive at least one dose of vaccine by mid-to-late July. 

Capital Daily took a look at today’s announcements, the factors that went behind the decisions that were unveiled, and a comparison of BC’s approach to other jurisdictions in Canada and around the world. 

Alberta’s off-the-rails rollout

When the Alberta government launched its COVID-19 vaccine registration portal for seniors over the age of 75 last week, Calgary resident Elizabeth Buchanan was at once elated and vexed.

“Essentially, I spent about six hours trying to call through to 811 and get on the portal, which was not working correctly,” Buchanan told Capital Daily. “And unfortunately, they didn't have it set up properly.”

She was finally able to book the life-saving shots for her elderly parents over the weekend, but not without some trepidation about what the clinics might look like.

“There was quite a bit of video and photos going around on social media of really long wait lines even though you've got an appointment time booked,” she said, referring to posts shared online on Friday. 

The province launched its booking system on Wednesday, allowing residents to book both doses of a COVID-19 vaccine for people aged 75 years old and above. Yet within two days, the chaotic situation online and at the immunization clinics prompted Alberta Health Services (AHS) to issue an apology.

“We underestimated the number of Albertans 75 years and over who would call 811 and go online to book at launch time. We had planned for tens of thousands at a time, and demand far exceeded that, leading to technical issues that took several hours to resolve,” wrote Dr. Verna Yiu, President and CEO of AHS. 

“Some of the clinics are behind schedule because we are taking time with each person, and we may need to extend the 10-minute allotment for each immunization.”

Around the same time last week, British Columbia’s provincial health officer, Dr. Bonnie Henry, was asked why the province decided to delay sharing details about their immunization rollout plan for people over the age of 80 until March 1.

“I think all of us across the country were thrown for a loop when our vaccine dried up for a few weeks,” said Dr. Henry on Feb. 23

“We’ve been using that time to put our system in place, to get the lists of people, to make sure we know exactly how and who we can reach out to, and we’re providing that information as we go along.”

BC’s immunization strategy 

On Monday, BC public health officials officially unveiled the process by which the first group of people living in the general population can receive a COVID-19 vaccine.

“The scientific evidence has proven that the single most important risk factor for becoming seriously ill or dying from COVID-19 is age. The older you are, the more at risk of severe illness or death you are,” said provincial health officer Dr. Bonnie Henry at a press briefing.

“That is why here in BC, like many jurisdictions around the world, the foundation of our immunization program is an age-based approach… We are starting with our oldest and most vulnerable and working from there.”

The province is beginning their mass vaccination campaign by focusing first on seniors aged 80 and over, and Indigenous people aged 65 and over. These groups will be able to call in to a booking centre—each health authority will have its own unique phone line—starting March 8 to book appointments as of March 15. 

Only people in the Fraser Health region will be able to book their appointments online in this phase of the immunization rollout because of the larger population concentrated in that region. 

To stop call lines from being overloaded, like in Alberta, the age cohort above 80 years is further divided into segments by which they are asked to book appointments on a staggered basis. 

Seniors will be able to either call in themselves or have a friend, family member or support person call to book an appointment on their behalf. They will be asked to provide their name, date of birth, postal code, and contact information to do so, and then will be pointed to the site of their nearest immunization clinic. 

The populations being targeted first amount to approximately 400,000 people and the plan is to vaccinate everyone in these groups by April 11. 

Accelerated timeline in BC

Two important new factors are expected to push immunization timelines up by months and allow the entire population to get vaccinated much sooner than expected. 

First, since Health Canada approved the AstraZeneca vaccine for use in the country, BC expects to receive approximately 60,000 doses some time next week. 

These shots will be used to launch a parallel immunization program targeting some key priority populations.

“We do believe that we will start to target essential workers, particularly our first responders and our key essential workers who are not able to work from home,” said Dr. Henry.

“Our BC immunization committee will be looking at, how do we best use the doses that we have coming in?”

Once the AstraZeneca vaccine supply is confirmed, the province will provide more details on how this program will work. For now, what we know is that people in these essential groups who are under the age of 65 will have the option to receive the AstraZeneca vaccine when it becomes available, or wait until they become eligible for the Pfizer or Moderna shots based on their age. 

The other factor that will free up more shots for the general population is the province’s decision to delay second doses of the mRNA vaccines to four months after people receive their first dose.

This decision was made over the weekend, based on data from BC and other jurisdictions that suggests one dose of the vaccine is effective against COVID-19 for at least four months. The delay is also based on advice to the BC Ministry of Health from the National Advisory Committee on Immunization (NACI).

Public health officials estimate that this delay will free up approximately 70,000 doses of the vaccine that can be administered to people who haven’t received any shots yet.

With a new supply of the AstraZeneca vaccine and the four-month delay for second doses, everyone in BC over the age of 18 is expected to get their first shot administered by mid to late July—a major change from the original timeline that anticipated this milestone to be reached in September. 

“This is amazing news,” said Dr. Henry. “These vaccines work. They give a very high level of protection and that protection lasts for many months.” 

After the first cohort of age-based vaccinations are in full swing towards the end of March, BC will launch an online registration portal and a singular designated provincial phone line for people in the next cohort—seniors aged 75 and up and Indigenous people aged 60 and up—to start booking their shots in April. 

More information about the rollout will be revealed in coming weeks.

Despite a delay in informing the public about the system that will drive BC’s largest mass immunization rollout, the work to put that system in place began last week after the PHO issued a new public health order.

This order, issued on Tuesday, allows people working in a number of different healthcare roles—including dentists, midwives, pharmacy technicians, paramedics, retired nurses, and others—to work in immunization clinics over the next six months after a period of training.

Two days after that order was issued, Registered Nurse and North Vancouver-Seymore MLA Susie Chant announced on Twitter that she had completed her training to administer the vaccines, and had already inoculated her first patient. 

State-by-state in the US

Canada and the US administered their first doses of the Pfizer/BioNTech vaccine on the same day: Dec. 14, 2020. 

As of Feb. 25, the CDC reports that 13.9% of Americans have received one or more doses of the vaccine. In comparison, as of Feb. 20, only 2.86% of the Canadian population had received their first dose. 

Most of that disparity can be chalked up to differences in vaccine availability. The country experienced a lag in supply after signing deals with European manufacturers rather than the US, fearing vaccine export bans would be implemented by former US President Donald Trump. 

Public health officials across Canada are confident that those agreements will be honoured despite initial delays. Still, Premier John Horgan addressed the unpredictability of the supply chain on Monday. 

“Although there is fantastic news on the horizon, it depends on supply,” said Horgan. “We are dependent on offshore supplies of vaccines to meet our targets. The federal government has been working overtime to ensure we get access to those vaccines but there is no domestic supplier that we can put pressure on.

“This is a scarce commodity that is in high demand in every corner of the planet.”

But states have fared differently on delivering vaccines based on what systems they had in place and when. Like in Canada, most US states have their own unique system and model for rolling out vaccines. 

An NBC News analysis released last week shows that states like Alabama lagged behind others in their rollout due to technical glitches like the ones in Alberta, where authorities failed to gauge just how many people would be calling to book a shot upon availability.

New Mexico, where 11.5% of the population has received at least one dose of the vaccine, owes part of its success to a user-friendly online and over-the-phone booking system that gets residents to create a profile whether or not they’re eligible to receive a vaccine yet. Once they become eligible, the system notifies them and points them to the nearest immunization provider. 

Other successful states like Alaska, where 13.35% of the population has been vaccinated, attribute their ability to immunize people more efficiently to a centralized system of public health distribution. 

The state receives vaccines each month, which makes it easier for authorities to plan their distribution, and they are connected to Indian Health Services—a federal agency that has its own allocation of shots—to vaccinate Native American populations. 

BC is much more fractured in comparison, divided into six health authorities—including the First Nations Health Authority, which does not have its own separate vaccine allocation—that rely on provincial authorities to determine how much vaccine is allocated to which region. 

Based on the plan released Monday, it is clear that the province’s approach is far less centralized. Each health authority has a separate phone line for people to book their immunization appointments, at least for the current phase of immunization rollout for people aged 80-plus and Indigenous people aged 65 and up. 

Fluctuations in vaccine supply, which is somewhat unpredictable as Canada relies on manufacturers based in other countries, could lead to logistical challenges that are not faced by American states that do have an in-house supply. 

Moreover, health officials also said on Monday that appointment and vaccination schedules in some smaller and remote Indigenous communities could differ slightly from the provincial schedule—a point that further differentiates BC’s plan from Alaska’s. 

In comparison to New Mexico’s approach, BC will be launching an online portal in late March. But it remains to be seen if it will be streamlined and user-friendly, or if it will crash when large numbers of people access the site all at once as happened in Alberta (or in BC when camping reservations opened).

According to public health officials, the vaccine booking line in Alberta got around two million calls when it first launched last week, despite there only being 175,000 people over the age of 75 who were eligible to book a shot at the time.

The strategy to prevent the same thing from happening in BC is to get the message out about who is eligible to book an appointment for immunization on what date, through campaigns on social media and elsewhere. 

Anyone who calls in to book a shot before they are eligible will be asked to call back when it is their turn. It remains to be seen whether this strategy will be successful in preventing the type of call system overload that Alberta experienced last week. 

The Israeli success story 

Worldwide, no country has received more praise for its successful immunization strategy than Israel. To date, the country has fully inoculated more than a third of its population against COVID-19, while 51.75% have received at least one shot. 

The results look promising. A Reuters report published in early February found that there was a 39% decline in hospitalizations and a 31% drop in severe illnesses from mid-January to Feb. 6, after the first rounds of immunization.

Science Table, the COVID-19 advisory group in Ontario, published a study on Feb 1, looking at some of the key elements that drove Israel’s vaccine success story. 

The researchers involved in that study came up with six key lessons that could be transposed to Ontario’s rollout strategy: 

These include using age as the only factor to determine who gets vaccinated first (with exceptions for healthcare providers and first responders); transporting the Pfizer vaccine in smaller shipments to rural settings; using communications strategies like endorsements from leaders to promote confidence in the vaccine; creating decentralized pop-up and drive-thru immunization clinics to supplement hospitals and pharmacy chains delivering the vaccine and thereby reach more people; building a streamlined IT system that makes it easy for people to book and follow up on their vaccination appointments and communicate with their local health authorities; and allowing community-based nurses, physicians, trained emergency medical technicians (EMTs) and paramedics to administer the vaccine.

So far, BC is following the majority of these rules while working with a smaller, more variable, and less predictable vaccine supply than Israel.

Besides the focus on healthcare workers and outbreaks at acute care facilities, age is the main factor that decides who gets a COVID-19 vaccine. The exception, as outlined in the plan unveiled Monday, is the creation of a parallel vaccination program for first responders essential workers under the age of 65, by designating AstraZeneca doses to these priority groups. This is where BC’s plan does not follow the model laid out in Israel.

It also remains to be seen whether the province will succeed in creating a user-friendly IT system that can withstand the large number of people it is guaranteed to attract, and whether the online registration system to be unveiled in late March can both allow people to book follow-up appointments and perform other tasks like disseminating updates.

On a national level, the model laid out in Israel cannot be followed to the letter in Canada because of some factors beyond the government’s control.

As described in a study published in the Israel Journal of Health Policy research in January, Canada’s vaccine rollout was slow to start partly because of its large geographical area and low population density. 

“These created a need for more storage facilities, greater investment in transportation, and a need for many more vaccination sites,” reads the paper.

Another factor is that while Canada has a national health insurance system, most hospitals and doctors operate independently rather than as part of integrated systems of care—unlike in Israel or the United States.

As we wait to see how BC’s new plan fares—a plan that includes some departures from models followed by jurisdictions that have been more successful in their early immunization rollouts—public health officials continue to stress the importance of following restrictions and public health orders that are currently in place .

“Now that we know… that there’s new vaccines coming online… I think it’s really good news. It means everybody moves up in line and we have such good protection from all of these vaccines after the first dose,” said Dr. Henry.

“But it does take some time. It takes three weeks on average before we have that maximum protection, so we’re not out of the woods yet.”