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Vaccinating Canadians against H1N1 is costing the country nearly twice as much as health officials expected and the tally could easily climb above $2-billion before the pandemic has subsided.

The national inoculation program is only a few weeks in, but $1.51-billion is already being spent, according to a review of estimates from federal, provincial and territorial governments. The actual figure is likely much higher because many provinces are still revising their costs while others have yet to release total estimates.

Even at $1.51-billion, the vaccination effort is proving far more expensive than health officials estimated. In September, provincial and territorial health ministers predicted the cost of buying the vaccine and delivering it at around $16 a dose, or $806-million in total based on the 50.4 million doses ordered. The total cost is currently running at about $30 a shot and climbing.

"I think we said right from the beginning that the on-the-ground part of this was probably always the biggest

"It's always what people underestimate and this is a huge operation. We've seen that play out, the difficulty in running this program."

Dr. Wilson said it won't be known whether the money being spent on this vaccination campaign is justified until after the virus passes. If rolling out the vaccine in October, instead of November as previously planned, helped protect a large segment of the population and did not hinder workplace productivity, then the cost is justified, he said.

"We're sort of in the grey zone, is it worth it or not? We'll have to see how this plays out to determine that. If there is a potential third wave and the vaccine program has helped mitigate that in Canada ... then it still may be worth it," Dr. Wilson said.

But other health experts questioned the cost, saying the public expense far outweighs the seriousness of the illness.

"You really have to ask serious questions about the cost-benefit," said Richard Schabas, Ontario's former chief medical officer of health who is now the medical officer of health for Ontario's Hastings and Prince Edward Counties Health Unit. "I think this is the most overhyped, overblown exercise I've ever been a part of. We continue to lavish resources on a problem that is just not that big."

Public health officials say costs have climbed because of an unexpected surge in demand for the vaccine and interruptions in supply. That forced many regional health authorities to open more clinics and alter distribution plans.

"We really, quite honestly, weren't expecting quite the lineups for vaccines," David Butler-Jones, Canada's Chief Public Health Officer, said in a recent interview. He added that it's important to keep in mind that this is the largest immunization program in Canadian history.

"This is just so unprecedented in terms of what the provinces and territories have actually been able to accomplish, in getting [the number of people vaccinated] in the space of one week, normally what wouldn't be done for a month or two," he said.

The costs of the H1N1 program start with the vaccine itself, which is made by GlaxoSmithKline. The federal government ordered 50.4 million doses for $403.2-million in total. The federal government is covering 60 per cent of that amount, with the provinces and territories picking up the remainder.

But the cost of getting that vaccine into millions of arms has jumped far higher, and faster, than health officials expected.

Take Manitoba, for example. In September, the province announced a detailed H1N1 preparedness plan and set aside $47-million for the program. That was supposed to be enough to buy the vaccine and pay for distribution, extra health-care staff, masks, gloves and gowns. But less than two months later, Premier Greg Selinger said the program's cost could double.

Last week, Quebec's Health Minister said the province will spend at least $200-million on H1N1 vaccinations and Alberta has put its figure at $100-million. By contrast, Alberta spends about $3.2-million on free seasonal flu shots annually.

Some provinces are sticking to their original forecasts. British Columbia, for example, set aside $80-million for all H1N1 efforts in September. That included $13.7-million to cover its share of the cost of the vaccine doses. "I believe we are still well within the envelope," Perry Kendall, B.C.'s provincial health officer, said in an e-mail yesterday.

Ontario has budgeted $650-million for its H1N1 program, far more than any other jurisdiction, including the federal government. And yet, provincial officials acknowledge that figure could change depending on the severity of the pandemic.

"This is only a rough estimate at this point and the costs could go higher when the extraordinary costs to the public health system are factored in," David Jensen, a spokesman for the Health Ministry, said in an e-mail yesterday.

As a comparison, the health-care costs from the SARS outbreak in 2003 were about $845-million in Ontario, but that amount included compensation to health-care workers.

The various provincial estimates likely don't include a host of additional H1N1-related costs being incurred by municipalities and others. For example, the chair of the Vancouver Board of Education has estimated it will spend an extra $300,000 this year for H1N1 related items in schools, such as additional hand sanitizers, wipes, facial tissues, spray bottles and soaps.

Experts are a long way from determining the effectiveness of mass inoculation campaigns. One study published last year by the Public Health Agency of Canada examined Ontario's seasonal flu-shot program. The province was the first in Canada to adopt a universal program in 2000 covering all residents (most provinces offer seasonal flu shots only to at-risk populations).

While critics have questioned the cost-effectiveness of the Ontario program, the study found the province had fewer influenza-associated deaths, hospitalizations and emergency-room and doctors-office visits than provinces with targeted programs.


  • $16: The predicted cost per dose of buying and delivering the flu shot
  • $30: The current cost of each flu shot
  • 50.4 million: The number of doses ordered by the federal government
  • $200-million: What Quebec expects to spend on H1N1 vaccinations
  • $650-million: What Ontario has budgeted for its H1N1 program