One of the more perplexing questions about Ontario’s COVID-19 vaccine rollout is why family doctors have been left out.
It’s is a question Dr. Elizabeth Muggah, president of the Ontario College of Family Physicians (OCFP), and her members have been pondering for a while. And they can’t figure it out.
Well into the rollout, with many seniors not vaccinated, and reports of appointment slots not filled, Ontario’s 15,000 family doctors remain mostly sidelined. The only thing happening now is a pilot project in six health units involving primary care providers. Pharmacies are also being mobilized.
“To me, you are in a pandemic; you are going to need all hands on deck. You’d want to be including everybody in this effort, so why haven’t they? I cannot answer that,” Muggah says in an interview. “We have made it clear that we are ready to do this, but we do not have clarity about the plan to get vaccines to us, and what is our role, to this point.”
Muggah says the official line from the beginning was that there weren’t enough vaccines to get family doctors involved. But that’s no reason not to prepare for when vaccine supply increases, so everyone hits the road running. “We have not had an explanation why there is no plan. What they’ve said to us is ‘there is no vaccine,’ ” she says. “But when you are in a pandemic situation, you want the planning to be ahead … you want to be ahead of the next wave. The fact that we don’t have a vaccine is not a reason to not have a plan.”
She says family doctors understood from the start the difficulty of administering the Pfizer-BioNTech and Moderna vaccines, given the lack of the required cold-storage facilities. But there’s now evidence that Moderna can be administered by family doctors. It’s stable when refrigerated at 2 C to 8 C, she says.
Now, the suspension of AstraZeneca use for certain groups has added another wrinkle to a fraught rollout.
Muggah says family doctors know fully well that the vaccination drive must be a multi-pronged effort, with community clinics, pharmacies, mobile clinics and hospitals all fundamental to a successful campaign. Family doctors can play a critical role, not only because they have the knowledge and experience, but a lot of people already get their annual vaccines from them. And time-tested distribution channels used for flu and other vaccines can be adapted for COVID-19. In particular, she says, the most vulnerable people, the seniors who are unwilling, or unable, to go to vaccination clinics, would find it more amenable if vaccines were administered by family doctors.
“When we think about how vaccines normally get to people, what the route is, to get people vaccinated during the flu, annual vaccines, it’s through our offices,” says Muggah, who is also an associate professor at the University of Ottawa’s Department of Family Medicine. “We know them, they trust us.”
She points to a recent survey by the OCFP, which found that one-third of Ontarians remain uncertain about vaccines but would be more likely to get shots if these were administered by family doctors. The survey suggested that getting family doctors involved could increase vaccine intake by as much as 61 per cent among those who are resistant or hesitant – with the potential to raise the provincial uptake by 20 points. This could reduce vaccine hesitancy from 32 per cent to 12 per cent, and result in more than two million Ontarians signing up for a shot.
Clearly, family doctors can make a difference.
Premier Doug Ford has blamed the federal government for inadequate vaccines, saying there’s not enough to go around. Federal procurement has certainly been beset with delays, but there may be more to the problem than supply if some clinics have vaccines but appointments are not being filled.
Part of it may be vaccine hesitancy, and family doctors could help ease doubts and fears. There is a familiarity with them that breeds confidence, and they shouldn’t be sitting on the sidelines at this critical moment.
Mohammed Adam is an Ottawa journalist and commentator. Reach him at: firstname.lastname@example.org