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A patient gets a shot during a flu vaccine program in Calgary on Oct. 26, 2009.Jeff McIntosh/The Canadian Press

A year after vaccine shortages and long lines snarled Alberta's flu-shot program, the province has turned to private wholesalers to help supply pharmacies as it aims to inoculate nearly half of Albertans.

With 12 million vaccines ordered by governments across Canada this year, the delivery of flu shots presents a unique challenge for the country's public-health authorities. After Canada's different governments pool flu vaccine orders into a bulk purchase to secure better prices, the millions of shots need to be distributed to local clinics, and increasingly, pharmacies across the country.

Four years after pharmacists were first allowed to provide vaccines in Alberta, nearly 1,000 outlets in the province have signed up to give flu shots this year. With Alberta's health authorities expecting to deliver 2.1-million vaccines this winter, the province's chief medical officer says the public-health system couldn't handle the logistical challenge of supplying so many different locations.

To face the challenge, Alberta is the first Canadian province to turn to the wholesalers who supply pharmacies with most other drugs to also handle the delivery of flu vaccines purchased by the government.

"So far, we haven't seen any difficulties this year and no complaints from the odd pharmacies that say they didn't get their supplies on time," said James Talbot, Alberta's chief medical officer.

In previous years, pharmacists made individual orders to Alberta Health Services. Deliveries were then made through a system that sometimes involved government employees transporting the vaccines with ice packs in coolers to keep the flu shot between two and eight degrees. A similar system is in place in most provinces.

The means by which flu shots are administered in Canada has changed in recent years. Where children and seniors, along with other people in high-risk groups, were once sent to doctor's offices for a shot, every Canadian province except for Saskatchewan and Quebec has cleared pharmacists to provide flu shots. Most provinces have also moved to a universal vaccine program, moving beyond targeting high-risk groups and appealing to the entire population to consider vaccination.

"You don't need to accept being ill for five or six days this winter, missing a wedding, or work or your holidays," said Dr. Talbot. "We increased the scope of the program last year and people liked it a lot."

The use of highly visible neighbourhood pharmacies has helped the spread of immunization tremendously, according to Susan Bowles, the head of Immunize Canada.

"Using pharmacists catches people who fall through the cracks and creates awareness that sends people to traditional immunization providers as well," she said.

Alberta's pharmacists have a central role in the province's health system, enjoying expanded powers that continue to be debated across the country. Certainly, the rest of the country is catching up. With the exception of Quebec, pharmacists in most provinces can now order tests for patients who come in with complaints and can make substitutions when people report issues with their prescriptions.

Changes to the distribution system in Alberta this year continue the trend of expanding the scope of services provided by the country's pharmacies, according to Barry Power, a pharmacist based in Ottawa who also acts as a spokesman with the Canadian Pharmacists Association.

"Alberta has really streamlined the process for pharmacies by using an established system. It makes sense, it's a well-known, reliable distribution system that can take the burden off public health," said Dr. Power.

Alberta's legislation enlarged the powers given to pharmacists in 2006, a first in Canada. Allowing pharmacists to renew prescriptions, order test results and change drug formulations – all powers jealously guarded by other health professionals to that point.

Across the country there is now talk about expanding the amount of care pharmacists can provide for minor ailments. A report released Thursday by the Canadian Institute for Health Information documented that one in five visits to the emergency room in Canada are for minor problems and could be avoided. The country's pharmacists are considering taking on more of those cases, according to Dr. Power.

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