Some Toronto hospitals have started vaccinating staff who do not deal directly with patients – and, at Michael Garron Hospital, offering doses to executives – raising questions about the ethics of vaccinating these staff before they are community health workers and the thousands of long-term workers. residents and care staff are still waiting for vaccines.
As the number of cases in Ontario continues to explode and fears mount about new, more easily transmitted variants of the coronavirus, there is a growing urgency to vaccinate as quickly as possible, especially in healthcare settings. long term, where death rates were highest.
Hospitals are distributing rare doses of vaccine according to provincial guidelines that prioritize those most at risk and face intense pressure to vaccinate as quickly as possible. But in some cases where front-line staff have already been vaccinated or excess doses are at risk of being thrown away, some hospitals have started offering vaccines to low-risk managers or employees who don’t interact with patients – even like other hospitals, community health workers or long-term care homes await the first doses.
On Sunday evening, an email leak from the University Health Network revealed that the hospital system had obtained a “limited” number of vaccines from Southlake Regional Health Center in Newmarket and was offering them to all staff, including researchers. Health workers on social media reacted with outrage, wondering why extra doses of Southlake were being redirected to low-risk downtown workers when so many high-risk health workers – including in Newmarket – were still waiting to be vaccinated.
UHN spokeswoman Gillian Howard said Southlake’s offer was made to five hospitals: UHN, Sick Kids, Mount Sinai, Women’s College and Toronto Grace. The Star, which got the email from UHN, also polled 19 other hospitals that received vaccines to see if they offered doses to executives or staff without contact with patients.
Most of the hospitals that responded said they had so far vaccinated only frontline staff who work with patients. Only the Michael Garron hospital said it now offers doses to all employees, including its executives.
Dr Isaac Bogoch, infectious disease specialist at UHN and a member of the province’s vaccine working group, said Ontario’s clear priority right now is residents, staff and workers front-line long-term care workers who come into contact with patients with COVID-19. “We shouldn’t be straying from it,” he said.
Kerry Bowman, a bioethicist at the University of Toronto, says offering the vaccine to non-frontline staff is “fundamentally wrong” and a “clear ethical violation” that should be investigated.
“There has to be accountability and that erodes trust in the system.”
Southlake Regional Health Center officials realized on Sunday morning that the hospital had excessive appointment slots, spokeswoman Kathryn Perrier said in an email. She did not explain what caused the excess, but said Southlake offered her extra doses to UHN because “we knew they were out of the vaccine.”
Last week UHN CEO and President Dr Kevin Smith tweeted that the hospital would run out of vaccines by Friday and 3,000 people had been booked to receive doses over the next three days. .
“Our goal, while respecting the provincial prioritization framework, was to make sure that no vaccine supply was wasted,” said Perrier. “The Pfizer doses scheduled for Sunday’s clinic were already there yesterday morning and could not be transported, which is why UHN staff came to Southlake.”
Once the Pfizer and Moderna vaccine vials are thawed, they cannot be refrozen, according to Health Canada.
Perrier did not respond to questions about whether the hospital first tried to offer its extra doses to long-term care workers or community doctors, and referred the Star to York Regional Public Health .
The agency redirected the Star to Southlake to answer questions about “specific decisions made” by the hospital. But spokesman Patrick Casey said all staff and residents of York Region long-term care homes are expected to receive their first dose of the vaccine by the end of the day on Monday.
Regarding the redirection of hospital doses to community doctors, to Michael Garron, spokeswoman Shelley Darling explained that hospitals are “not allowed” under the provincial distribution plan “to administer the COVID-19 vaccine apart from health workers and long-term physicians. – retirement homes (LTC), priority retirement homes and hospitals.
Howard said when UHN received Southlake’s offer on Sunday, the downtown hospital network had already vaccinated all long-term care and retirement homes for which he was responsible.
She said no UHN executive has been vaccinated and that the hospital’s process first involves offering vaccines to those who directly care for COVID patients. She added that UHN also has 300 researchers working directly on COVID “and therefore at risk of disease and transmission.”
She said it was up to individual employees “not to move forward if they are not in front of the patients.”
“We must rely on the principle of honoring staff and others when we deploy a mass vaccination campaign,” she said. “We are certainly discussing what disciplinary measures to consider for those who skip the line.”
She said the fact that the Pfizer vaccine could not originally be moved from the site further complicates matters (as it must be stored at extremely high temperatures).
“Later, UHN demonstrated how Pfizer could be moved safely so that we now have the ability to use Pfizer and Moderna in long-term care, which we are doing,” Howard said, adding that the group of work did not recommend moving vaccines out of red areas. to communities with less COVID.
But Bowman said the email UHN sent didn’t make it clear that staff who don’t interact with patients should avoid raising their hands for the extra doses of Southlake, and blame employees who allegedly could register.
“The hospitals were completely wrong to do this,” he said.
At the Michael Garron Hospital in East Toronto, all employees are now offered the vaccine, including communications staff, home-based employees, and executives, although President and CEO Sarah Downey , did not receive the vaccine, spokeswoman Shelley Darling said in an email.
This is to “ensure that there are high volumes of eligible people in our clinic every day to meet the goal of 500 doses per day,” Darling said.
She added that the hospital follows the province’s guidelines on how to prioritize vaccinations among its employees and has already vaccinated all long-term care residents in the homes it supports.
Bogoch said senior management of the province’s task force is aware that workers who are not on the front lines are currently being vaccinated and this is being addressed.
He stressed the importance of sticking to the province’s ethical framework – but also that every effort should be made not to waste vaccines. “We should have better systems in place,” he said, to make sure they “go into the best performing arms possible given that there is such a shortage of vaccines.
“There’s no pointing fingers, it’s a team sport. There are going to be mistakes and we have to get it right, and if there are any mistakes along the way, OK, let’s fix them and move on.
Dr Samir Sinha, director of geriatrics at Mount Sinai Hospital and the University Health Network, said UHN made it clear in previous emails, one of which was seen by The Star, that vaccines do not should be intended only for researchers who interact with patients.
But what troubles him is that there are still so many long-term care staff and residents waiting – and they are the ones who are most at risk of getting sick and dying from COVID.
“These are the people who absolutely have to be on the front line, before I even say other frontline healthcare workers or research staff in contact with patients,” he said.
Bowman said there was a need for a “clear protocol” aligned with the prioritization framework on how the remaining doses at the end of the day are distributed.
Phase 1 of the vaccine rollout should clearly target “very vulnerable people and the people who care for them,” he said.
“There’s no point in having guidelines if we don’t stick to them.”