New Brunswick

What's the cure for vaccine-rollout hiccups? N.B. pharmacist has some thoughts

Why flu clinics run so much more smoothly than COVID clinics, and how we could get both on the same page.

The day could come when COVID clinics are a smoothly run, yearly affair. Here's how we could get there

Sussex pharmacist Kevin Duplisea says the logistical challenges of getting vaccine doses to pharmacies are the biggest challenge of the rollout. (N.B. Pharmacists' Association/Stephen MacGillivray Photography)

It may seem like a dream right now. A mirage even.

But the day could soon come that COVID-19 vaccine clinics are an unflustered rite of autumn passage not unlike a flu clinic, unfolding once a year with no confusion, no incorrectly booked appointments and absolutely no mention of blood clots.

Remember flu clinics? It all seemed so easy: you'd go to the pharmacy, or your doctor, or your workplace, you'd get your shot and that'd be that.

Within weeks, everyone in the country who wanted a shot would have one.  

Meanwhile, Canada's COVID-19 vaccine effort has been a twisting, turning, arduous, military-led ordeal.

Why is it so different from any other mass-vaccination effort, and will it ever be a simple one-and-done affair?

New Brunswick pharmacist Kevin Duplisea has some thoughts about that.

Why things are different this time around

Duplisea, who worked in the ICU trenches during the SARs outbreak in Ontario and writes a column for the New Brunswick Pharmacists' Association, now administers COVID-19 vaccines at Sharp's Corner Drug Store in Sussex. Some 60 to 90 of them a day, in fact. 

He has administered his fair share of flu shots and knows better than many how different things are this time around, and why.

First of all, Duplisea said, this entire pandemic has been a learning curve that keeps throwing the experts new curves.

"With the flu shot, we can plan for it, we know it's coming up every year, we have time to prepare, we have a vaccine in place for it, " he said. "That's not the case with the pandemic. This is the first time we've seen this."

From the beginning of the pandemic, the race has been on to get vaccines developed and tested.

Then came the next Herculean task: developing a vaccine rollout.

Unlike the flu vaccine, the new and approved COVID-19 vaccines have temperature-control and time-sensitive storage requirements.

Unlike the flu vaccine, there are three — soon to be four — approved vaccines for the coronavirus, each with slightly different storage requirements or recommendations around what age group should receive it.

And unlike the flu vaccine, there are lots of questions and constantly evolving data and answers.

"There are many differences," Duplisea said, "but the main difference from the pharmacists' end of it has been the logistics of getting it to the store."

Pharmacist Kevin Duplisea vaccinates a customer at Sharp's Corner Drugs in Sussex. Duplisea said he and a second vaccinator at the store are administering 60 to 90 COVID-19 vaccines a day. (Sharp's Corner Drug Store/Facebook)

Take the Moderna vaccine as just one example. 

It can't be tipped over during transport, has to be kept upright, it can only go to one site, once it has arrived it has to be thawed, once the vial is punctured it has to be used within six hours, so patients have to be there and ready to receive it, no walk-ins allowed. 

"And of course, two doses are required," Duplisea said. "So you're doing that twice."

In comparison, he said, the flu shot is a one-shot deal and is stable in normal refrigeration temperatures for many months, "so we don't have to worry about any of the supply-chain issues."

Then there are the requirements to socially distance, have a limited number of patients in the store and to wear a mask, which makes it difficult to speak and to be understood.

For some of these people, this trip to the pharmacy was their first time out of the house since February 2020. Just think of that.- Kevin Duplisea, pharmacist

That, combined with the urgency of keeping to a schedule so as not to jeopardize the temperature-sensitive dose, poses another, unexpected challenge: making time to spend time with someone who badly needs it.

"The thing I've noticed the most this week, compared to the flu shot, is that lives have been on hold," Duplisea said.

"We're working with people who are 85 and older, and for some of these people this trip to the pharmacy was their first time out of the house in public since February 2020. Just think of that."

Duplisea said he's been deeply moved by the realization that, for a lot of New Brunswickers, this has been cripplingly isolating. The last thing he wants to do, he said, is rush them out the door.

"A lot of people have blessed me after getting the vaccine, they've brought in shot glasses to do a shot with me. They're very, very happy to be out in public again."

An unprecedented volume of phone calls

A second key issue that sets this rollout dramatically apart from flu vaccine clinics has been the volume of phone calls from people in different age groups and demographics, including rotational workers, truckers and complex care workers.

"All those people are trying to get the vaccine as soon as they can," he said, "but we are limited by the number of vaccines that are distributed by the province, which in turn is trying to prioritize based on shipments coming in from different manufacturers and adjust as the outbreak circumstances change."

Duplisea stressed that pharmacists are happy to take the calls, "we're not faulting anyone for that."  

But answering questions about the vaccination process, about vaccine safety, about eligibility, it all takes time.

Duplisea says customers have been 'very, very happy' to get their shot. (Sharp's Corner Drug Store/Facebook)

"Although we are being very well supported, there's no extra staffing for any of this," Duplisea said.

"This is volunteer, the pharmacy profession has volunteered to take this on because we believe in what we're doing, we care about the public, we want life to get back to normal." 

As for when, or if, yearly COVID-19 vaccination clinics will become a thing, Duplisea said it's too soon to say.

But if they do, he anticipates they would unfold with much less fuss.

Over time, he said, the need to break the rollout down by age or priority group would probably fade, as would uncertainty around the vaccines themselves.

That would dramatically bring down the volume of calls and questions.

As vaccine production, delivery and supply levels even out, the planning and administering hiccups would even out as well.

Vaccines requiring less rigid transportation and storage rules might evolve, which would smooth out logistics and allow for such things as walk-in COVID-19 clinics as opposed to by-appointment-only bookings.

"I envision that once we get the population vaccinated the first time that it will begin to head toward [yearly clinics], but it will very much depend on the variants that come and the vaccines' capability," Duplisea said.

"In a perfect world it would be something that would be rolled out around the same time as the flu shot, but I don't think we have the data to say that one way or another yet." 

ABOUT THE AUTHOR

Marie Sutherland is a web writer with CBC New Brunswick based in Saint John. You can reach her at marie.sutherland@cbc.ca.

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