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Even failures can have a silver lining: Ontario had the lowest H1N1 vaccination rate in the country, but the millions of dollars poured into its program averted nearly one million cases of pandemic influenza.

A new analysis, believed to be the first to look at the cost-effectiveness of the immunization program, found that despite the controversy surrounding Ontario's $180-million mass immunization program and the low uptake, the dollars proved to be worth it. The rollout of the vaccine last fall saved 50 lives and prevented 420 hospital admissions, 28,000 visits to emergency departments and 100,000 visits to doctors' offices.

Lead author Beate Sander, who undertook the analysis as a doctoral student at the University of Toronto's faculty of medicine, said the study is proof that Ontario residents got enough bang for their buck. "Things can be costly, and still be cost-effective," she said. "It [the vaccine rollout]was early enough to provide value for money."

The study, published in this month's issue of the journal Vaccine, runs counter to the criticism levelled against Ontario, and much of Canada, that its campaign to protect Canadians against an influenza pandemic failed dramatically, because of low vaccination rates in many parts of the country. Even Ontario's chief medical officer of health, Arlene King, acknowledged last month that public-health officials neglected to properly organize a mass immunization program.

Only about a third of residents in the country's most populous province got the shot, the lowest vaccination rate, according to a Statistics Canada survey released Monday. And less than half - 41 per cent - of Canadians lined up to receive the vaccine.

Public-health officials and medical experts, taking stock of the country's response to the pandemic, point to three reasons for the low vaccination rates: a failure to communicate the risks of the pandemic and the safety of the adjuvant; sequencing guidelines that gave priority to high-risk groups and were not followed by some provinces, confusing the public; and Ottawa's inability to inform provinces fully of the weekly vaccine supply, which stalled planning.

But Ms. Sander and her colleagues found that coverage of the mass vaccination program focused too much on the costs, and not the overall health benefits.

"We wanted to look at it in a formal and objective way," said Ms. Sander, now a health economist at the Ontario Agency for Health Protection and Promotion. "One always has to put costs into context. Most vaccination programs are cost-effective."

Using mathematical modelling, the researchers predicted what would have happened if no intervention had been used to prevent the spread of H1N1 and the impact it would have had on the health-care system. Those figures were compared with the actual number of deaths, hospital admissions and emergency-room visits in Ontario. The H1N1 vaccination program not only prevented about a million people from catching the virus, but also resulted in the province saving $20-million in health-care costs, the study found.

Ms. Sander noted that if the vaccine was rolled out a few weeks later, the program's cost-effectiveness would have eroded considerably. "If you start earlier, it would be more effective and more cost-effective. If you start even later, it would be less effective and less cost-effective," she said "It seems that in Ontario we were just right in time to make it cost-effective."

Ontario, like much of the country, began vaccinating its population just before the peak of the second wave of H1N1. While many lined up to be vaccinated, a segment of the population was diagnosed with it early on and, as a result, was immune.

The research paper did not study the cost-effectiveness of the immunization program in other parts of the country. Ms. Sander said it would be difficult to say if the benefits elsewhere would be similar to that in Ontario, because much depends on how the program was rolled out and how the pandemic unfolded in each province.