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Pharmacist Zaineb Hassan prepares COVID-19 vaccines to administer at a pharmacy in Ottawa on April 23, 2021.Adrian Wyld/The Canadian Press

As soon as she heard that the eligibility for AstraZeneca’s COVID-19 vaccine was being opened up in Ontario to people as young as 40, Nadia Hoult got to work.

“I was on a mission,” she said of her quest last Monday to book an appointment for herself and her husband. Ms. Hoult, a 44-year-old in Etobicoke, Ont., started on the Ontario government’s website, which provided a list of nearby pharmacies administering the vaccine.

But each pharmacy had a different system: She registered for online waitlists, combed through different retailers’ websites looking for appointments and started making calls. She eventually found an appointment for the following day at a local, independently owned pharmacy. But the process took several hours.

“I’m lucky enough that I’m able to work from home,” Ms. Hoult said. “But for someone else – who couldn’t be sitting at a desk, or was working, or who can’t navigate the system on a computer or smartphone – it’s terrible.”

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As the availability of vaccines has begun to expand, some Canadians have been expressing frustration with the fragmented and confusing system for finding an appointment for a shot.

Booking procedures vary province to province. In Quebec and Nova Scotia, appointments are made through centralized systems. But in Canada’s most populous province, a government website takes bookings for mass vaccination clinics – which are handling Pfizer and Moderna shots – while redirecting people to pharmacies’ websites for AstraZeneca vaccines that are available under different eligibility criteria.

The pharmacies all run their own bookings. Even within the same chain – such as Shoppers Drug Mart – some locations will book appointments over the phone, while others direct customers who call to a website to sign up for a waitlist.

In Alberta, too, residents can use a central website to find out which pharmacies are offering which vaccines. But bookings are handled individually by each pharmacy or chain.

For some provinces, the fragmented booking systems were by design. In others, such as Ontario and Alberta, there were plans to build centralized booking tools that did not get off the ground quickly enough, and the governments asked pharmacies to use their own systems, said Marie-Claude Vézina, vice-president and general manager for pharmacy at Empire Cos. Ltd.

“Speed was of the essence,” Ms. Vézina said. Empire owns the Lawtons drugstore chain in Atlantic Canada, as well as pharmacies in its grocery stores such as Sobeys and Safeway across the country. “It was more important to get vaccines in the arms of citizens as quickly as possible. … I think it was the right thing to do, instead of waiting three or four additional weeks to have the perfect system.”

Many pharmacies already had systems to manage flu shots, and they could use them to spread out appointments and avoid crowding during the pandemic.

Those individual systems already had data security features ironed out, said Sandra Hanna, chief executive officer of the Neighbourhood Pharmacy Association of Canada. But she recognizes the fragmented approach has had some challenges.

“There does seem to be some confusion,” she said. “Everybody is desperately hunting for vaccines.”

Ontario and Alberta have just announced that walk-ins will also be available at some pharmacies, which Ms. Hanna said will provide flexibility to people looking for a shot, and to pharmacists who need to manage supply and may have no-shows or cancellations.

But some provinces’ systems are more manageable than others. Centralized systems provide clearer information about where bookings are available. Meanwhile, on social media, ersatz “vaccine hunters” have arisen to help people navigate the rollout.

Rexall’s senior vice-president of pharmacy services, Mona Sabharwal, said that where pharmacies are managing bookings, it is clear many people are registering with multiple pharmacy websites to ensure they get an appointment.

“That is a challenge,” she said. “It can look like we have a lot of people on our waitlist, but when you invite them to make an appointment, they may not respond, or tell you they’ve received it elsewhere. It makes the planning piece a bit trickier.”

Shoppers Drug Mart, which is owned by Loblaw Companies Ltd., has observed people booking multiple places, and noted that stores are calling people on their waitlists when there are missed appointments.

“At this point, we generally have just had more demand than we do doses, and we understand that some customers have been frustrated with the delays,” Loblaw spokesperson Catherine Thomas said in an e-mail.

In B.C., pharmacy owners have also seen a rush of people registering at multiple pharmacies. Chandra Erant, the owner of JC Pharmacy in Victoria, estimated he had 300 messages on his phone inquiring about the AstraZeneca vaccine, and at least 500 people on a waitlist. B.C. Health Minister Adrian Dix said on Wednesday the 610 pharmacies in the province that were provided with AstraZeneca vaccine have very little left.

There are indications that Alberta is planning to move appointment bookings for pharmacies into its centralized system, Ms. Vézina said. But she added this would present a high risk of losing bookings in the transition, and of further confusing people.

When asked about the possibility of a centralized system, Alberta Health spokesperson Tom McMillan said in a statement that the department is “exploring ways to improve the booking approach in the future.”

Alexandra Hilkene, a spokeswoman for Ontario Health Minister Christine Elliott, declined to answer questions about whether the province is considering centralized bookings for vaccines in pharmacies.

Centralized systems have had their problems as well. In Quebec, where pharmacies are administering the Moderna and AstraZeneca vaccines, pharmacists complained some people were booking multiple appointments to try to find the best option, resulting in no-shows. The government has now closed that loophole.

The biggest challenge is irregular supply, said Benoit Morin, president of the Quebec association of pharmacist-owners. “We will have very few shots to administer in coming weeks,” he said. “It makes it very difficult to plan.”

The COVID-19 vaccine rollout has highlighted the importance of pharmacies to the health care system, Ms. Hanna said. Pharmacists have been addressing hesitancy around the safety of the AstraZeneca vaccine, answering customers’ questions and giving them more information about the symptoms to watch for in case of very rare side effects such as blood clots.

Pharmacies can also provide more geographic reach than mass immunization clinics, and Justin Bates, CEO of the Ontario Pharmacists Association, said they want to be allowed to administer vaccines outside of pharmacy locations – in order to do pop-up clinics that could reach more neighbourhoods where access to health care services is limited. That would require more vaccine supply, he said.

Ms. Hanna added that pharmacies are asking to administer the Pfizer and Moderna vaccines as well, as they are already doing in Alberta, for example.

Some provinces are not there yet: Saskatchewan is still finalizing its plans for vaccine rollout in pharmacies.

Ms. Hoult, who received her first shot on Tuesday, said she is concerned people with fewer resources may be falling to the back of the line. After she booked her own appointment, she helped a friend in Stratford, Ont., to find an appointment at a Walmart 40 minutes away. Ms. Hoult turned to the Vaccine Hunters Canada Twitter account – which is not run by a government, or by pharmacies, but had the easiest information to access.

“Two days later, she had an appointment,” Ms. Hoult said. “But at first, she had said, ‘They don’t have appointments where I am.’ … It should be easier than this.”

With reports from Pratyush Dayal, Les Perreaux and Carrie Tait

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