Ontario pediatricians say their calls for the financial and logistical support needed to do more flu vaccinations during the COVID-19 pandemic have so far gone unheeded and fear an “imminent crisis” lies ahead.
“We … would like to express our urgent concerns regarding an imminent crisis in influenza vaccination,” said an online petition launched on Change.org Saturday by the pediatrics section of the Ontario Medical Association.
“Right now, Public Health seems to expect the status quo from years past, when individual doctor’s offices and scattered flu clinics gave flu vaccines.”
Public health officials and health-care experts have stressed the importance of getting the flu shot this year to avoid burdening the health-care system even more during the pandemic.
Pediatricians say the coronavirus outbreak makes it more critical than ever for children to get flu shots, not only because influenza can make them very ill, but also because they can easily spread the virus to vulnerable people, such as the elderly, for whom both flu and COVID-19 can be very dangerous.
But health-care providers won’t be able to give nearly the normal number of flu vaccinations in their offices and clinics this year, they say, because of COVID-19 safety protocols such as eliminating crowded waiting rooms, seeing patients by appointment only, and the time needed for rigorous cleaning and disinfecting of exam rooms between each vaccination.
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The solution, they say, is “planning large scale, community-based province wide flu vaccination clinics,” which would be held in large venues that allow for physical distancing, as well as outdoor or drive-through clinics.
“These would ensure that we can safely administer flu vaccine universally throughout the province in large numbers, quickly and efficiently,” the petition says.
Logistical hurdles for flu shots
Doctors are anxious to get such clinics up and running as soon as this year’s flu vaccine becomes available in October — but it’s not something that community-based medical practices can set up their own, said Dr. Jacob Rosenberg, a pediatrician in Woodbridge, Ont.
“We can’t just bring in droves of people to line up and get flu shots the same way that we’ve done in our office in the past,” he said in an interview with CBC News.
Rosenberg estimated that his office alone vaccinated 4,500 to 5,000 children against influenza last year — largely through weekend flu clinics that would see more than 150 kids in a three- to four-hour period.
After COVID-19 struck, Rosenberg and his colleagues reached out to York Region’s public health department to ask for logistical help in organizing outdoor clinics or renting a large venue. They also asked for nursing support and supplies, such as portable refrigeration to keep vaccines at the right temperature.
Public health departments ‘stretched thin’
York Region Public Health responded with a guidance document and checklist on how to plan and operate a COVID-safe flu clinic, but said it was unable to provide additional logistical support.
The response was frustrating, Rosenberg said.
“What we’re saying is we don’t think we can do it on our own. We need help.”
In an interview with CBC News, Dr. Karim Kurji, York Region’s medical officer of health, said he sympathizes with community physicians.
“We certainly applaud their efforts to step up to the challenge this year,” he said.
But public health departments are also “stretched thin” as they manage the COVID-19 crisis and ramp up efforts to deliver the flu vaccine to primary-care providers, Kurji said.
Public Health will also hold immunization clinics in long-term care homes and vulnerable populations that are harder to reach, he said.
“We like to work as co-operatively as possible … but ultimately, when it actually comes to the provision of nurses or when it comes to the provision of dollars, that is not part of our mandate,” Kurji said.
Look to province for more resources, public health says
Any additional logistical and financial support for physicians during this year’s flu campaign needs to come from the Ontario health ministry, Kurji said. Toronto Public Health echoed that response.
CBC News asked the ministry if it would provide funding or other resources to primary-care providers to help them set up COVID-safe flu vaccination clinics.
In a response emailed Sunday, the health ministry did not answer specifically, saying only “more details on the influenza vaccination program will be available in the coming weeks.”
Toronto Public Health will run some flu vaccination clinics of its own, said Dr. Vinita Dubey, Toronto’s associate medical officer of health, in an email to CBC News. Just as in physicians’ offices, those clinics will require appointments and physical distance to prevent COVID-19 spread, she said.
Pharmacists will also help ease the load by administering the flu vaccine, she said.
But pharmacists in Ontario currently aren’t allowed to give the flu vaccination to children under five years of age, leaving much of the burden for immunizing a critical age group on physicians and nurses.
Young children considered high risk
Very young children are considered a high-risk group to become seriously ill from flu and should start receiving the influenza vaccine at six months of age, pediatric guidelines say.
This is also the first fall in Canada where COVID-19 and influenza will both be circulating, which leads to “the great unknown” for children, Rosenberg said.
“Children seem to get milder cases with COVID-19, they seem to get it less than the general population, but what happens if you have influenza and then an otherwise healthy child gets COVID-19?” he said.
“The answer is we don’t fully understand.”
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The Ontario Medical Association has been in talks with the provincial government for over a month to try and come up with a flu vaccination plan “that everyone could get behind,” said OMA president Dr. Samantha Hill.
“Everyone’s aligned that this needs to happen. The government is absolutely aligned that the flu vaccines are going to be important,” she said.
But Hill said she’s not optimistic that the Ministry of Health will come through with the logistical support that will ease physicians’ fears.
“I don’t have a lot of great feedback from those meetings as to where we are now,” she said.
“The ‘how you get from here to there’ part seems to be missing. And that’s what’s causing all that anxiety on behalf of physicians.”