Canada's cohesive national vaccination strategy is starting to show cracks, with one province pointing its finger at others.
British Columbia's Health Minister Kevin Falcon took aim Monday at other provinces for allowing all comers to receive the H1N1 vaccine despite agreeing weeks ago to give the shots in order of priority.
"The evidence is supporting the approach we took in British Columbia. Some other jurisdictions that felt some political pressure and decided to open it up to everyone, that turned into a fiasco. I don't believe that is the way to go," he said.
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With the country's largest-ever immunization campaign in only its second week, some provinces, including Alberta and Ontario, have flip-flopped on plans not to turn people away, and are tightening rules because the vaccine supply is dwindling.
The nationwide shortage of flu vaccine comes at an inopportune time for health officials: A resurgent H1N1 virus, which has been most severe in the young, has a once-skeptical public suddenly rushing to get the shot. GlaxoSmithKline, Canada's vaccine supplier, told the federal government only Thursday that it will ship 436,000 doses to provinces and territories this week, far less than the roughly two million anticipated, because it had to interrupt production at its Ste-Foy, Que., plant to make a version of the vaccine for pregnant women.
The result: Some clinics are turning people away, others are closing and provinces are redrawing priority lists.
British Columbia rolled out the vaccine last week for pregnant women, people under 65 with chronic conditions, and those in remote communities, and has expanded the list to include some health-care workers, children under five and those who care for infants.
Alberta health officials said they would vaccinate whoever showed up. Ontario did the same, resulting in waits as long as six hours.
"It is absolutely safe to say that public health units across the province learned from last week," said Deb Matthews, Ontario's Health Minister. "... Some did a very, very good job of delivering the vaccine in a way that was respectful of the people who were lining up to get the vaccine. Can't say that happened right across the board."
The shortage of vaccine forced H1N1 clinics in Alberta to close abruptly over the weekend.
Health Minister Ron Liepert told the legislature Monday that the vaccination program has been "refocused" with priority given to high-risk groups, including pregnant women. "No one likes to turn away citizens of this province from receiving their vaccination, but, unfortunately with a limited supply, we are left with no choice," he said.
The country bought 50 million doses, enough to vaccinate all Canadians. Six million have been delivered so far, and another 400,000 are being distributed this week. The shortage this week stems from the fact that in late-September, GSK had to halt its production of the immune-boosting adjuvant vaccine to start making 1.8 million doses of unadjuvanted vaccine that the federal government ordered for pregnant women. There is no data on the safety of adjuvants in pregnant women. Although both vaccines contain the same active ingredient, or antigen, the unadjuvanted version requires far more, which mean GSK had to shift its production focus entirely to fill the order.
But health officials didn't foresee such a huge shortfall.
Critics blasted the federal government during Question Period Monday for botching the vaccination program, and called an emergency H1N1 debate in the House of Commons.
"Provincial and regional health authorities have been blind-sided by a lack of flu vaccine, and the public has been left confused and frightened. The federal government had seven full months to do two primary things: provide the vaccine and send a clear and consistent message to Canadians on H1N1," Liberal MP Todd Russell said. "How is it that the federal government could get it so wrong on both counts?"
Health Minister Leona Aglukkaq said guidelines to focus on vaccination for the most vulnerable were established over the summer with the provinces, territories and chief medical officers of every jurisdiction. She said the government launched the vaccination program a week early, and it affords protection to the most vulnerable.
Federal health officials say all who want to be immunized should be able to receive the shot before Christmas.
With reports from Patrick Brethour in Vancouver, Lisa Priest in Toronto, Katherine O'Neill in Edmonton and Daniel Leblanc in Ottawa