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A young girl watches apprehensively as a nurse prepares her flu shot.

Patients at private medical clinics in at least two provinces have jumped the queue for H1N1 vaccine during a nationwide shortage of the flu shot, rekindling a debate about the perils of two-tier health care in Canada.

Copeman Healthcare, a private clinic in Vancouver that charges patients annual membership fees of $3,900 in the first year, has already received its first shipment of H1N1 vaccine and is hoping for more soon, said chief operating officer Chris Nedelmann.

Medcan, a clinic in downtown Toronto that charges just under $2,000 for a head-to-toe checkup, received 3,000 doses last Friday, enough for 8 per cent of its patients.

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Ontario Health Minister Deb Matthews is vowing to launch a review of Toronto Public Health's decision to give Medcan access to a vaccine in short supply at a time when officials across the country are scrambling to rein in a pandemic that is taking a growing toll on Canadians. "When all of this is behind us, I think it is a question we are going to want to take a pretty good look at," Ms. Matthews said at a news conference yesterday.

The private-clinic controversy, the latest to dog Canada's largest-ever inoculation campaign, raises concerns about the patchwork of practices for distributing the vaccine.

In many provinces, including Alberta, Saskatchewan and Quebec, the vaccine is available only through public clinics. Other provinces, including Ontario and British Columbia, are doling out the vaccine to physicians and family health-care practices as well as to public clinics.

Copeman and Medcan were among a group of doctors' offices and clinics that applied to local health officials to distribute the vaccine.

David McKeown, Toronto's medical officer of health, said his office encouraged as many doctors as possible to get the vaccine. The doctors had to agree to store it properly and give it only to patients at risk of developing complications from the virus, such as pregnant women and young children, he said.

"I don't have any basis to withhold vaccine from patients of a clinic like this," he said, referring to Medcan.

Provinces have been forced to suspend the rollout of the vaccine to the general public because the number of doses they will receive for at least the next two weeks will be far less than they initially expected. The shortage comes just as demand for the vaccine is surging.

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In Ontario, the government plans to launch measures to ensure that no doctors' offices and clinics hoard the vaccine, but instead make every effort to give the flu shot to their high-risk patients.

"If there's vaccine being held back and not being used for priority groups and we need it, we will get it back," Ms. Matthews said in an interview. "We're saying, use it or lose it."

Because the distribution chain in Toronto alone includes 302 doctors' offices as well as 43 health centres, including Medcan, Ontario will not receive information until later this week on the number of residents who have been vaccinated.

Controversy over the private clinics comes as the provinces make last-minute changes to their pandemic plans by restricting the vaccine to those at risk of developing complications from the disease, including pregnant women and young children. In many cities, Canadians began lining up as early as 4 a.m. over the weekend for their H1N1 flu shot, only to be told that all but the most vulnerable should go home.

Medcan at first intended to offer the vaccine only to its 40,000 patients. But the clinic announced on the weekend that it will open its doors to the general public and work with public health officials to vaccinate non-members who are at risk of developing complications. A Medcan spokeswoman said it was the right thing to do, given the vaccine shortage.

Mr. Nedelmann said Copeman has been following guidelines from the province and Vancouver Coastal Health, and their patients are receiving limited doses of the vaccine the same way thousands of other British Columbians are: from their family doctors.

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"My understanding is there are a number of clinics, including ours, that do have a limited supply of vaccine and we're operating just like any other clinic in our respective cities," he said.

Public health officials were criticized yesterday for giving vaccine to Medcan and Copeman.

"It seems kind of funny that they would have a special supply of vaccine available only to people who pay a membership fee," said Robert Bell, chief executive officer of University Health Network, one of Canada's largest hospitals.

The debate over public versus private health care has long been a heated one. Although Canada ostensibly adheres to a single-payer system in which citizens' basic health needs are covered by their provinces, private clinics have sprung up, leading to concerns about a "two-tier" system that allows the rich to jump queues.

Liberal health critic Carolyn Bennett called on federal Health Minister Leona Aglukkaq to enforce the Canada Health Act and launch an investigation into whether any patients of the private clinics not among the high-risk groups received the vaccination.

"If people are paying to queue barge in the middle of a public health emergency, that could be in violation of the act," Ms. Bennett said.

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Ms. Aglukkaq said it is up to the provinces to determine how they distribute the vaccine.

In Alberta, H1N1 vaccination clinics that abruptly closed over the weekend may reopen tomorrow in the midst of what public health officials called a temporary vaccine shortage and unexpectedly strong public demand.

The province is now trying to "refocus" its efforts to target only those in high-risk groups, and will turn away all others, officials announced yesterday.

Until now, Alberta merely suggested that those most at risk for developing complications for the virus get their shots first, but officials didn't discriminate against healthy individuals who showed up at immunization clinics.

"We will have stringent policies in place," Alberta Health Minister Ron Liepert said. "The voluntary compliance obviously did not work."

With a report from Shawn McCarthy in Ottawa

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Private clinics

Medcan Clinic

  • What: A preventive health clinic providing care, diagnostics, personal training and services. Sixty-five per cent of their clients are companies who send their employees for medical care, while the other 35 per cent are individuals who pay their own way.
  • Where: Toronto
  • When: Started 1987
  • Services: The most popular item is a five-hour head-to-toe medical exam, including an ultrasound, chest X-ray, blood testing, nutritional analysis and fitness assessment. But the clinic also offers ongoing personal training, nutritional advice and a "genomic risk assessment," which tests for potential genetic diseases.
  • Fees: The comprehensive health exam, also known as the "executive medical," costs close to $1,900. Bundle it with a membership, which includes discounts on other services, and the whole package costs just under $2,700.
  • H1N1 Vaccine: Medcan received 3,000 doses of H1N1 vaccine on Friday and demand from its 40,000-person database is through the roof, says the clinic's medical director. The clinic announced late Saturday it will also make vaccination appointments for non-members that Toronto Public Health puts on a priority list.

Copeman Healthcare Centre

  • What: Provider of "unhurried health care" specializing in preventive medicine, started by a Canadian medical student-turned-businessman disillusioned with shortcomings in the public health-care system. Their website boasts "medically supervised programs of therapeutic lifestyle change."
  • Where: Vancouver and Calgary
  • When: Started 2004
  • Services: The comprehensive health assessment consists of a battery of 55 tests, including blood work, extensive medical imaging and consultations with nutritionists and kinesiologists. Members of the "Elite Plan" get a risk assessment, screenings, health plan and ongoing medical support. Copeman also offers physiotherapy and extensive mental-health services.
  • Fees: Initial consultations are free, but a full-body checkup costs $1,400. Annual membership is $3,900 the first year and $2,900 every subsequent year. Children under 22 are free if both their parents are already members.
  • H1N1 Vaccine: Copeman's Vancouver clinic has already received its first shipment of H1N1 vaccine, says chief operating officer Chris Nedelmann. They're hoping for more soon, and its Calgary clinic is still waiting - along with the rest of Alberta's physicians - for its first batch to arrive.

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