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One of the first Pfizer-BioNTech COVID-19 vaccine doses in Canada sits ready for use at The Michener Institute in Toronto on Dec. 14, 2020.Frank Gunn/The Canadian Press

While the start of Canada’s COVID-19 vaccination efforts has been slowed by a limited supply, a much larger challenge awaits as provinces plan to inoculate millions of people in the coming months: who will administer those shots.

Provincial governments and local health authorities are expanding vaccination clinics in hospitals and other health care facilities, planning to launch mobile vaccination sites, and eventually will lean on family doctors and pharmacies to hand out the shots.

But experts say it will be incredibly difficult to shift resources around in an already strained health care system as provinces mount a vaccine program that will dwarf yearly flu-shot campaigns. An added wrinkle will be preventing large numbers of health care or long-term care workers from being off at the same time because of potential side effects.

André Picard: COVID-19 didn’t take a holiday, and the vaccine rollout should not have been allowed to either

And the pressure is increasing to ensure those vaccines are used as soon as they arrive, amid concerns that a more contagious variant discovered in Britain could become more widespread. In addition, record-setting infections in several provinces are reaching further into the long-term care system.

In Ontario, retired general Rick Hillier, chair of the province’s vaccine task force, acknowledged staffing will be a significant issue as the province works toward its goal to have 8.5 million people vaccinated by the end of July.

“The pressure of having enough staff to vaccinate will grow,” Mr. Hillier told a news conference on Tuesday. “It is a challenge, but there are a variety of ways to meet it.”

Mr. Hillier said that will include health care workers taking on extra shifts and bringing back people who have recently retired or left their jobs. Eventually, the province could use neighbourhood pharmacies, he said.

Provinces have been limited in where they can administer the first approved vaccine, from Pfizer-BioNTech, owing to the extreme low temperatures at which it must be stored. The approval of the Moderna vaccine, which can be stored at refrigerator temperatures, will allow that vaccine to be used in more locations and, crucially, in long-term care homes.

Toronto’s University Health Network, which administered the first vaccine in Ontario, has the capacity to vaccinate 400 people a day, or 2,800 in a week, with space for nine to 12 immunization staff working in the clinic.

Leanna Graham, UHN director of professional practice and policy, said that as the vaccine program ramps up, one of the biggest challenge will be securing staff for the centre. The network plans to move into a larger space next week that will double its capacity while the province attempts to build up to 150,000 vaccinations a day across the province.

Registered nurses, many from external agencies, are currently administering doses at the vaccination centre. The hospital is considering bringing in staff from surrounding hospitals and retired physicians.

“It’s a lot of these same groups of people that would [provide] support in our hospitals, and everyone knows our hospitals are struggling, so we want to make sure that in doing this it doesn’t take away from other dire situations in the hospital,” Ms. Graham said.

Ontario’s Associate Chief Medical Officer of Health, Barbara Yaffe, said health care and long-term care staff should be away from work for two or three days after receiving the vaccine to monitor for symptoms. Public-health units will help those facilities navigate staff and supply needs.

“Human resources are an important element but should not be a limiting factor,” Dr. Yaffe said.

Alberta will initially rely on public-health nurses and other staff who are normally involved in delivering influenza vaccines, said Laura McDougall, senior medical officer of health for Alberta Health Services. The province also intends to recruit retired and student nurses.

Barry Pakes, clinical physician and professor at University of Toronto’s school of public health, said the vaccine program will add to the pressures facing the health care system. He said caring for all patients has been more taxing during the pandemic, while some health-care workers have been off with COVID-19 themselves or after exposure to the virus.

“If it’s public-health nurses who are going to be giving it, those public-health nurses are extremely busy and overtaxed with case and contact management and infection management,” he said.

“So it means reorganizing not only those nurses, but there are probably just as many people who are needed to organize those nurses and handle the logistics. That takes a lot of people.”

Many provinces have already delayed surgeries and cancelled other services because of the increased workload due to COVID-19 patients.

Kelly Grindrod, who teaches at the University of Waterloo’s pharmacy school, said bringing community pharmacies and family physicians into the vaccination system quickly could alleviate some of the staffing challenges. She said it would also make it easier for people to get vaccines where they live.

“Hospitals are only going to be able to take on so much capacity to vaccinate people because they’re already dealing with the actual effects of COVID,” she said. “There are 40,000 pharmacists in Canada and a similar number of family doctors. There are so many nurses. We actually have an enormous work force.”

At the same time, she said expanding the number of people administering vaccines brings its own hurdles, such as tracking which vaccines patients receive and scheduling follow-up appointments for booster shots.

Long-term care providers are also concerned about the impact on their staffing, said Terry Lake, CEO of the BC Care Providers Association. He said operators in his province are still waiting for more details about exactly how staff will be vaccinated and how the government intends to mitigate the impact of side effects among workers.

“This is a real concern for us,” he said. “We have not seen any plan to deal with that.”

Alberta said it received 16,900 doses of the Moderna vaccine on Tuesday. B.C. also received its first Moderna shipment, but did not say how many doses.

Ontario expected to receive 50,000 doses on Wednesday. Shipments will increase, with Ontario, for example, projecting 80,000 doses a week of the Pfizer vaccine by mid-January and 50,000 doses of the Moderna vaccine in the second week of January.

Officials in Alberta and Ontario promised to speed up vaccinations after slower-than-expected rollouts. Alberta had vaccinated 7,000, despite initially expecting 29,000 by the end of the year. About 14,000 people were vaccinated in Ontario, where the province has faced criticism for closing vaccine clinics for Christmas Day and Boxing Day.

In B.C., 12,000 people have been vaccinated, while Quebec has administered 22,500 doses.

Health Canada declined to answer questions about how many vaccine doses have been distributed and how many more are expected in the coming weeks. The department said more information would be released on Wednesday.

Some provinces have been holding back doses of the Pfizer vaccine to ensure booster shots are available when patients need them. Ontario announced on Monday that it would no longer hold back vaccines to ensure more people can get that first dose – a practice already in place in B.C., Saskatchewan and Nova Scotia.

Alberta announced on Tuesday that it, too, would no longer hold back vaccines for booster shots.

With reports from Xiao Xu in Vancouver and Emma Graney in Calgary

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