TORONTO — Anticipating increased demand for the flu shot this season, pharmacist Sean Simpson has invested in a few unorthodox supplies that go well beyond extra face masks: street signage, traffic cones, a pop-up tent and hard hats.
He'll need them for the drive-through vaccination clinic he's setting up in the parking lot of his Virgil, Ont., Pharmasave, a scheme he hopes will address COVID-19 fears while offering customers a quick way to get their shot.
"We've worked it out in our heads a number of times and we seem to think it'll work," says Simpson, who was still waiting Tuesday for his vaccine shipment to arrive.
"We'll have a setup where we're able to vaccinate people in the car and monitor them for the recommended period of time and let them go on their way so that we can reduce the interaction with others."
While residents in Prince Edward Island and New Brunswick have been among the first in Canada to receive doses in recent weeks, pharmacies and doctor's clinics in much of the rest of the country are still waiting and preparing to deliver their shots. Many start their programs in October or early November.
Canadian Medical Association president Dr. Ann Collins says varied start times depend on when the vaccine supply is delivered to the province, when it is dispersed to depots, when it's picked up by the provider, and ultimately when providers have their provision plan in place.
This season, the Fredericton-based physician says pharmacists and doctors are eager to try novel ways to offer large-scale flu clinics that can maintain pandemic safety precautions, noting her own family physician hosted a flu clinic in a parking lot last weekend.
At Simpson's Pharmacy in Virgil, drive-thru visits will be by appointment only, with waivers and related paperwork to be filled out online.
Simpson expects the outdoor clinic will limit face-to-face interaction between strangers, avoid any need for a waiting room and reduce crowding in the actual store.
Ottawa family physician Dr. Aly Abdulla says COVID-19 precautions rule out traditional mass-vaccination tactics, such as renting out the nearby legion.
At the same time, getting the shot to as many people as possible is more crucial than ever to avoid a feared "twindemic," in which simultaneous flu and COVID outbreaks overwhelm the health-care system.
Abdulla expects to offer the flu shot when patients come in for routine appointments. But he's also in talks with local public health about a joint effort that might see several doctors share the cost of renting a large space for a flu clinic, which would also allow them to pool their doses if needed.
"Our plan is to have public health screening areas — maybe arenas, maybe clinics that are not using their space on evenings and weekends — to have these flu clinics," says Abdulla, adding he's also heard of doctors in Guelph, Ont., and Georgian Bay considering drive-thru clinics.
"(They) will essentially be ad hoc in the community, based on what the needs are."
This year, the Public Health Agency of Canada says more than 13 million doses have been ordered, a jump from last season's 11.2 million doses. Ten per cent of that is the high-dose influenza vaccine — itself a 25 per cent increase from last season as public health focuses on inoculating more adults 65 years and older, who account for most hospitalizations and deaths from flu and COVID-19.
Shoppers Drug Mart says its stores in Prince Edward Island began delivering the flu shot Sept. 28, while those in New Brunswick began Oct. 5.
The chain, including its Loblaw pharmacies, continues a staggered rollout in Ontario on Wednesday; Manitoba and Nova Scotia next week; British Columbia, Alberta and Saskatchewan on Oct. 19; the Yukon on Oct. 26 and in Quebec's Pharmaprix outlets on Nov. 1.
A spokeswoman says availability in Newfoundland and Labrador was still to be determined, and that customers should contact their local pharmacy to confirm details.
Theresa Firestone, senior vice-president of health and wellness, touted a contactless digital consent form that includes screening for COVID-19 symptoms, drop-in appointments and dedicated senior's clinics — when stores will be opened exclusively for older shoppers — with meeting increased demand.
"Physician offices often close at the end of the workday. We have many stores open until midnight ... and we have a number of stores that are 24-hours," added Firestone.
Victor Wong, an associate owner and pharmacist at a Shoppers Drug Mart in east-end Toronto, says requests for the flu shot "have been off the charts," with some customers asking about its arrival since the summer.
He expects demand will be high at his store after hearing some doctors are skipping the season entirely.
"We have local doctors, even within our close proximity, who have already phoned us to let us know that they will not be opening up their clinics this year for flu shots or will be diverting their flu shot patients to our store," says Wong, whose store delivered more than 600 flu shots last year.
Dr. Samantha Hill, president of the Ontario Medical Association, says many community physicians have struggled to stay afloat during the pandemic and simply cannot afford to host a vaccination clinic this year.
She points to the added costs of personal protective equipment and cleaning supplies, and sometimes staff, to sanitize exam rooms — all while the provincial fee schedule has not kept pace with increased overhead.
"They're really in trouble. They carried the health-care system on their backs for the last few months," says Hill.
Still, Hill says physicians are determined to serve their patients and find creative ways to address demand. .
In Ontario, the OMA says 55 per cent of flu shots are delivered by physicians, 40 per cent by pharmacies, and 5 per cent by corporate employers who provide them to their workforce. Data was insufficient on the remaining 5 per cent.
Simpson expects to be allotted nearly 1,000 doses this season for his two stores, including another Pharmasave — Simpson's Apothecary in nearby Niagara-On-the-Lake, Ont. — with the first batch of 400 doses arriving this week.
But it likely won't be enough.
"Based on the volume of calls we received to date, we're pretty confident we're going to go through our first allotment very quickly," says Simpson, noting last year's stock ran out in December.
"I fully expect there will be times when when we will run out."
Many of Canada's doctors feel the same way, with a recent survey by the Canadian Medical Association finding half of 598 respondents expected they won't have enough doses this season. A broader survey of 1,459 doctors found half had trouble accessing personal protective equipment and many feared they'll have trouble safeguarding patients and staff while delivering the flu shot.
Hill worried about the long-term effects of relying on pharmacies and private business to address patient care while the public system buckles under multiple pressures.
Hill acknowledges "a multipronged approach" in "unprecedented times" as reasonable, but also urged the province to invest further in the public system, with funds and supplies for additional staff, sanitizing and overheard costs.
"If the health-care system as we know it collapses — and that's a fairly strong word to use but I'm going to use it — because we lose 10 or 20 percent of our outpatient and family clinics, those are patients who don't have access to health care," she says.
"And we started this year, before COVID came, with waitlists and emergency hallway medicine and a government who acknowledged that there was a need to fix health-care in Ontario."
A statement from the health ministry touted nearly $70 million invested in this season's vaccination program and defended the role pharmacies play in increasing access.
"Increasing the locations where Ontarians can receive a flu shot increases access for patients and spreads out the demand for the product across our health-care providers, particularly as some providers are focusing on virtual care in response to COVID-19," the government stated in an email.
Ontario's first shipments of flu vaccines started being delivered in late September to public health units, long-term care homes and hospitals to prioritize vulnerable populations.
The health ministry said broader community distribution "is currently being rolled out and will continue in the coming weeks."
This report by The Canadian Press was first published Oct. 6, 2020.
Cassandra Szklarski, The Canadian Press