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A person fills out paperwork as they line up to receive a COVID-19 vaccine at a Loblaws grocery store pharmacy in Ottawa, on April 26, 2021.Justin Tang/The Canadian Press

The rollout of Pfizer’s COVID-19 vaccine to Ontario pharmacies will begin on Friday, with a pilot phase targeting virus hot spots in Toronto and Peel Region. But an initial recommendation to balance the pilot with an equal number of independently owned pharmacies and chain locations was not heeded by public-health authorities.

The three-week pilot will provide Pfizer shots to eligible people over 55 in hot-spot areas. Each location will receive 150 doses per week, and will continue to manage their own bookings, as they have done for AstraZeneca vaccines.

The pilot will include 16 pharmacies, half in Toronto and half in Peel. But just four of those pharmacies are independently owned, despite advice from the Ontario Pharmacists Association (OPA).

“We had made a recommendation to have an equitable split between pharmacy formats,” said Justin Bates, the association’s chief executive officer.

Both OPA and the Neighbourhood Pharmacy Association of Canada were consulted on identifying locations to be considered for the pilot, and the provincial ministry of health and local public-health units chose which locations would receive the initial shipment of doses.

Mr. Bates said that he expects the rollout will be equitable as more Pfizer doses become available. That is expected to happen later in May, depending on supply. “It should be a level playing field,” he said.

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This pilot phase will be different from the earlier trial for pharmacies to distribute AstraZeneca vaccines. In that phase, Ontario chose locations in Toronto, Windsor and Kingston – which has some of the lowest COVID rates in the province – before widening distribution to more pharmacies.

“This is much more targeted to hot spots,” Mr. Bates said of the Pfizer trial. “It’s a smaller number of pharmacies, and fewer doses.”

The OPA has developed a playbook with lessons learned from other jurisdictions, such as Alberta, where Pfizer doses are already being administered in pharmacies. Once Pfizer’s vaccine is removed from ultra-cold storage, it remains good for five days as it thaws, so pharmacies must manage appointments to ensure there is no wastage, Mr. Bates said. There are also different procedures for drawing the Pfizer vaccine from its vial, he noted.

Pharmacies in Ontario have been coping with a surge in demand for vaccine appointments, after eligibility to receive the AstraZeneca shot was broadened to include people as young as 40. Many pharmacies have already depleted the AstraZeneca doses that were allocated to them so far, Mr. Bates said, and the remainder could be out of doses by the end of the week, pending further shipments.

In order to be considered for the Pfizer pilot, pharmacies had to be in a COVID-19 hot spot, have no remaining doses of AstraZeneca and must have demonstrated high performance in administering the AstraZeneca shots, Mr. Bates said.

Other key considerations for participating in the pilot were meeting “complex vaccine storage and handling requirements of the mRNA vaccines” such as Pfizer’s, Ontario Ministry of Health spokesperson Christian Hasse wrote in an e-mailed statement. Mr. Hasse did not respond to questions about why the balance of corporate-owned and independent pharmacies differed from the recommendation from OPA, and how the distribution will be balanced as the rollout expands.

Nine of the pharmacies in the pilot are owned by Loblaw Companies Ltd. – seven Shoppers Drug Mart locations, one Loblaw Pharmacy and one DrugStore Pharmacy. Two Rexall locations are also included, and one is a Walmart pharmacy.

Pharmacist Mina Maseh, owner of the Friendly Care West King Pharmacy in northwest Toronto, said he received word last weekend that his location was being considered for the pilot. His pharmacy has already hired extra staff in order to administer the AstraZeneca vaccines and has been managing appointments to avoid crowding and move a high number of doses, he said. When a corporate-owned store nearby was chosen instead, he was frustrated.

“The store that was chosen does not represent this hot zone,” he said. “It borders on a more posh area of the city. It’s not seeing people that are really struggling with COVID. … If I have to wait another two or three weeks, how many more people in this neighbourhood are at risk?”

Mr. Maseh said he has been having multiple conversations with patients who are hesitant about the vaccines, and has been attempting to address distrust in public-health systems. He said two people he “was begging” to take the AstraZeneca shot later ended up in intensive care with COVID-19, while there were others he was able to convince.

“It scares me,” Mr. Maseh said. “If they’re going to someone that’s not their pharmacist, that they haven’t known for years, they’re not going to be convinced.”

While the OPA had hoped to see an even distribution, the locations chosen for the pilot are “good pharmacies,” Mr. Bates said.

“I think it will balance itself out,” Mr. Bates said. “This will happen really quickly … as we look at the second phase of this implementation.”

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