Even as it continues to struggle with pandemic communications, testing capacity and contract tracing, Manitoba's government is staring down the barrel of yet another new and daunting challenge.
Last week, an exasperated Health Minister Cameron Friesen told reporters he couldn't say much about COVID-19 vaccine distribution because he cannot get clarity from Ottawa on how many doses the province will initially get, protocols for storage, and recommendations on who should be getting it first.
However, Friesen claimed, even in the absence of this information, Manitoba would be okay — because it is relying on its existing system of flu vaccine distribution.
That comment raised a red flag to health professionals across the province.
Manitoba's current system for distributing influenza vaccine is outdated, vague and random. As the province acquires various shipments of flu vaccine, it first ensures hospital patients, residents of long-term care facilities, and First Nations get it first.
After that, it quickly degenerates into a first-come, first-serve melee.
Officially, a spokesperson for Manitoba Health said anyone and everyone who wants a flu shot can get one at a multitude of locations: doctors offices, ACCESS health centres, immunization clinics, and pharmacies. However, that statement is somewhat misleading because, like other provinces, Manitoba does not receive all of its flu vaccine doses at the same time.
To distribute the vaccine to the rest of the population, the province randomly organizes pharmacies, clinics and other providers into three cohorts. When the first shipment arrives, it is distributed to cohort 1. As more vaccine is made available, it is provided to cohort 2. Only after the first two have been supplied does the third cohort get its share.
Manitoba's current system for distributing influenza vaccine is outdated, vague and random.
The following year, there is a shuffling of the order: the second cohort is promoted to the first spot, third to second, and the former first drops down to the bottom of the list.
It doesn't take a health-care logistician to see that this approach inevitably results in unequal access, creating shortages in some areas and surpluses in others.
Why, you might ask, doesn't the province distribute the vaccine more evenly, and then ask everyone to focus on immunizing the elderly and ill, along with doctors, nurses, other health-care workers, teachers, front-line emergency services personnel?
Nobody knows for sure.
A Manitoba Health spokeswoman confirmed, under current policy, "Once a clinic or pharmacy gets their doses, they take appointments and/or distribute as it makes sense to them." Given the importance of getting vulnerable populations vaccinated, some doctors have built a workaround.
Doctors Manitoba confirmed about 75 clinics have agreed this year to share supplies of flu vaccine so a greater number of doctors can immunize a greater number of high-priority patients. Doctors Manitoba proposed this strategy last year to Manitoba Health, but found there was no interest.
Doctors Manitoba confirmed about 75 clinics have agreed this year to share supplies of flu vaccine so a greater number of doctors can immunize a greater number of high–priority patients.
The greater concern now is, as Friesen suggested, this system will be used for COVID-19 vaccine distribution.
Ottawa has already raised concerns about potentially disorganized efforts.
The National Advisory Committee on Immunization is drafting recommendations to provinces on who should receive a COVID-19 vaccine first.
According to preliminary NACI guidelines, it will be impossible to use a strategy similar to that of the H1N1 pandemic in 2009, when people were encouraged to attend mass immunization clinics and many had to line up for hours in close quarters. NACI officials have admitted they don't yet know how the provinces will deal with the mechanics of distribution.
It's all theoretical right now, but if updates on about a half-dozen COVID-19 initiatives are to be believed, it will all quickly move into the realm of the practical.
The United States Centers for Disease Control and Prevention and the U.S. Food and Drug Administration have set Dec. 10 as the day they would consider emergency approval of COVID-19 vaccines. The vaccine makers believe they could start shipping doses right away, with some people getting the first shots as early as Dec. 12.
That timetable assumes there will be no additional clinical or safety concerns with the vaccines, which could still happen.
Nobody is quite sure when Canada will receive its first shipment. The federal government has, to date, secured contracts with five pharmaceutical companies to acquire an estimated 358 million doses of a variety of vaccines. When they will arrive and how they will be divided up among the provinces remains a bit of a mystery.
It's no secret Manitoba has stumbled profoundly on other logistical challenges (such as testing and contact tracing capacity). That kind of track record does not bode well for an orderly vaccine distribution that could mean the difference between life and death.
The existing system for flu shots is simply not going to get the job done. COVID-19 represents a challenge that will require a more thoughtful, innovative approach.
Unfortunately, those two commodities have been in short supply in Manitoba's pandemic response.
Born and raised in and around Toronto, Dan Lett came to Winnipeg in 1986, less than a year out of journalism school with a lifelong dream to be a newspaper reporter.