Mixed messages from provinces on flu vaccine stoke confusion

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On Sunday, Ontario and Quebec finally responded to the Health Canada decision to halt distribution of flu vaccines manufactured by Novartis, revealing that it will have no impact on their plans. The announcements are the latest in a patchwork of responses from the provinces that include everything from suspending vaccination clinics to moving full steam ahead.

While Health Canada is to be commended for its swift action after problems with the Novartis vaccine cropped up in Europe, crucial provincial follow-up has been disjointed, leaving large parts of the population wondering if flu vaccine is a) available; and b) safe.

When are public health officials in this country going to recognize that, in the 21st century, the single most powerful weapon they have at their disposal is language?

In the era of instant communication, you need to get messages out clearly and swiftly, especially when you are dealing with emotion-laden issues such as vaccination.

Vaccination rates in this country are abysmal, despite the fact that influenza kills thousands of Canadians annually – between 2,000 and 8,000 Canadians die of influenza each year, depending on the severity of the season, according to the Public Health Agency of Canada. The last thing we need to do is provide people with excuses to not get a flu shot.

So let's examine the timeline of this story and see how we could have done better.

Last Wednesday morning, Italy announced that it was halting the sale and use of influenza vaccines manufactured by Novartis. (This action came less than a week after reports from nurses and doctors that the normally milky-white liquid vaccine had small clumps in it.)

While Switzerland acted immediately, and Germany and France followed Italy's lead on Thursday, temporarily pulling the Novartis products, Health Canada announced Friday that it was suspending distribution of Novartis flu vaccines, sold under the brand names Fluad and Agriflu. (These products are manufactured in Italy.)

Decisive action from Health Canada was refreshing. But, still, the move cranked up public fears a couple of notches.

Dr. Paul Gully, a senior adviser at Health Canada, did his best to provide some reassurance, doing the media rounds and delivering clear, no-nonsense explanations. There are, he said, tiny clumps of virus particles in some batches of the Novartis vaccine but the shot appears to work fine. In other words, the issue is about aesthetics rather than safety. Dr. Gully also revealed that only 20 per cent of Canada's flu vaccine supply came from Novartis so there would not be severe shortages, at least in the short term. (The dominant supplier of flu vaccine in Canada is GlaxoSmithKline, and Sanofi also has a small share.)

But Canada has a highly decentralized health system. The provinces needed to take the baton and run with it. Unfortunately, when they did, they all ran in different directions at varying speeds, instead of in a co-ordinated fashion.

Saskatchewan announced that it was suspending its flu clinics because it purchases most of its vaccines from Novartis. B.C. said it would stop using Novartis vaccine – about 30 per cent of its supply – but continue with clinics. Alberta, Manitoba and Nova Scotia said their flu clinics would proceed because they purchase very little product from Novartis.

But the governments of Ontario and Quebec – home to 3 in 5 Canadians – remained silent until they issued laconic statements on Sunday afternoon. Do health officials in these provinces not watch or read the news? Do they not monitor social media such as Facebook and Twitter?

If they did it would be clear that there were storm clouds of doubt gathering, articulated best by a woman on CBC's flagship The National, wondering aloud if the flu shot was safe.

There should be no doubt – and no delay in saying so.