A $2-billion campaign to protect Canadians against an influenza pandemic failed dramatically in parts of Ontario, Manitoba and Alberta, newly obtained figures show, with one of the country's top doctors acknowledging that public health officials neglected to properly organize a mass immunization program.
Just over a third of residents in Alberta, Manitoba and Ontario were inoculated against H1N1, with a vaccination rate as low as one in four for residents of Hamilton, Ont., according to local health authorities. Quebec, the Atlantic provinces and the three territories, meanwhile, successfully inoculated more than half of their citizens. Newfoundland vaccinated about 70 per cent of its population.
Public health officials and medical experts, taking stock of the country's response to the pandemic, point to three reasons for the low vaccination rates: a failure to communicate the risks of the pandemic and the safety of the adjuvant; sequencing guidelines that gave priority to high-risk groups and were not followed by some provinces, confusing the public; and Ottawa's inability to fully inform provinces of the weekly vaccine supply, which stalled planning.
"The messaging was confusing, and the natural thing to do in a state of confusion is to go for the conservative option," said Ross Upshur, director of the University of Toronto's Joint Centre for Bioethics and a primary-care physician.
Canadian health officials boasted about the years spent on pandemic planning, but the regional variations in vaccination rates point to huge gaps. Even though millions of dollars were spent on advertising the vaccine's effectiveness - $9.4-million in Ontario alone - and people lined up for hours at flu clinics in the early days of the rollout, the majority of the general public remained uninterested or wary.
Ontario's chief medical officer of health, Arlene King, estimated that about 38 per cent of Ontarians were vaccinated, which is at the low end of rates among provinces and territories. She has called for a review of the provincial immunization program, similar to the one taking place in Alberta.
"We underestimated the logistics of organizing and delivering a mass campaign in extraordinarily tight time-frames across a vast province, in the glare of intense media coverage and in the face of fluctuating demand," Dr. King said Wednesday in releasing her assessment of H1N1. "We underestimated lineups and demand surges."
Paradoxically, provinces where people seemingly clamoured loudest for the flu vaccine had the lowest vaccination rates. Public health officials say the main problem is that vaccine supply was inadequate when people wanted it, and was in surplus when demand dropped. Dr. King said there was little information coming from the federal government around vaccine supply. In one instance, she learned from a reporter how much vaccine Ontario would receive.
"We simply did not know from week to week how much vaccine we were going to get," she said.
David Butler-Jones, Canada's chief public health officer, argued that the federal government was in daily contact with provinces and territories. "We were watching it evolve in real time. They knew what we knew pretty much as we knew it," he said in an interview Wednesday.
Dr. Butler-Jones said the federal government would not get involved in the delivery of vaccine, as that remains a provincial and territorial responsibility. He said governments are studying and trying to understand the regional variations in vaccination rates.
Health experts say the low rates point to failings on the part of provinces. Alberta, for example, initially ignored an agreed-upon priority list and said it would vaccinate anyone who showed up, forcing clinics to close abruptly. Ontario did the same, resulting in waits as long as six hours. Experts say confusion reigned, and the lack of co-ordination shook public confidence in how the pandemic was being handled.
What is more, anti-vaccine advocates or doctors expressed skepticism about the severity of the pandemic. As much as they tried, health officials, mainly in larger provinces, could not persuade the public to get vaccinated.
"In a small province you can control the message much easier than in a larger place where … you will always find a professor of something or a previous chief medical officer of health or someone else to say they disagree, the vaccine is not safe or the adjuvant is not properly tested or the pandemic is not so bad so why bother and so on," said Paul Van Buynder, deputy chief medical officer of health in New Brunswick, a province that vaccinated 65 per cent of its population.
"I think it's very difficult to get 75 per cent of the public to go and do something if the message they're getting is actually a mixed message."