Despite the chaos surrounding Ontario’s vaccine rollout, Dr. Homer Tien, the new head of the province’s COVID-19 vaccine task force, is confident Ontario will hit its goal of 40 per cent of eligible adults receiving at least one jab by May 6.
“I think we’ll hit that threshold. Then, if the vaccines ramp up, as promised in May, we should get significantly more so that we’ll be in a very different space by June, July,” said Tien.
Someone with Tien’s lengthy credentials clearly understands the urgency to move quickly. Tien was a military physician for 25 years with the Canadian Forces, trauma surgeon and medical director for Sunnybrook Hospital and currently the CEO of Ornge Air Ambulance, where he continues to oversee the agency full-time.
In an exclusive interview with the Star, Tien — who has been a member of the province’s task force since April 1, leading Operation Remote Immunity for fly-in Indigenous communities — sits down to speak about Ontario’s vaccine rollout for the first time since becoming head of the task force. He agrees that “communication can always be better.”
Tien spoke with the Star about the province’s messaging missteps, supply issues and systemic failures around accessibility among many other things.
This interview has been edited for brevity and clarity.
We’re fighting a new war right now. Between April 1 to 18, Ornge transported 498 people in need of critical care. That’s already double the amount to all transports in March or February. What does this show about our control over COVID-19 right now?
I think the number of patients being transferred is quite substantial. The variants are more infectious. I think people are getting tired of the public-health measures and obviously there’s a disproportionate effect on people who live in crowded socioeconomic circumstances. So I think it’s sort of the combination of all three of these things that are basically hitting us at the same time.
What is happening with Ontario’s supply issue?
I think there’s two aspects. In a place like Toronto, when you think of the amount of health-care personnel and health-care capacity we have a lot of people, my colleagues at Sunnybrook included, who put up their hand and say, “I volunteer, I want to give vaccines, and I want to help out,” with the administration.
We have way more capacity in terms of the ability to give needles than we have actual vaccines. And so if people are booking clinics based on sheer availability of human health resources to give vaccines and do administration, we don’t nearly have enough vaccines. That’s one scenario.
Then if they’re planning based on an allocation. So we’ve got a report that we’re going to get 600,000 vaccines next week. And so then justifiably, they book that amount of human health resources to meet that. And then we have a cut in the vaccine to 400,000. Then there will be a shortage. So then they’ll have to cancel appointments.
What about those who have said that there are vaccines sitting in freezers? How does the allocation for each vaccine work in Ontario?
There are no vaccines in freezers. What happens is when the ministry gets the vaccine, weeks before (we) have allocation meetings with the public health units and then we plan on that. We say here’s how much Pfizer you get, here’s how much Moderna you get, and here’s how much AstraZeneca. What happens is health units plan their clinics based on that.
Pfizer is very regular, it’s reliable. The same amount shows up every week. They plan their clinics based on that allotment of Pfizer. And by the end of the week, right before the next shipment, they are almost run down. No one wants to run to zero because that puts them in a very vulnerable position, but they’re almost to zero. Then they get replenished and they continue on.
Moderna is a little more complicated because as we’ve seen in the news, it gets much more infrequent — the doses get cut back all the time. And so (public health units) tend not to book their clinics on Moderna until they actually see it in their hand and they book it a little more conservatively because Moderna is a little easier to use than Pfizer.
AstraZeneca is a special case because it’s going through the pharmacy chain, but as you know (it has) limitations. For a while it was only good for those 55 and older and it suffered from a major image issue. It’s actually an extremely good vaccine. It’s basically helped the UK sort of get out of their major third wave. (We’ve) worked hard on dropping that age range from 55 and older to 40 and older. So it’s been with the pharmacies and people haven’t been using it, like the uptake has been low in pharmacies. It’s not that it’s sitting in a fridge. It’s just that people haven’t been opting for it as much. Now, the uptake is way better. Our problem now is that we’ll use it up and won’t have anything to refill it.
There’s no provincial fridge where vaccines are sitting because there would be no benefit for us to do that at all. Our plan has always been get it out to people, get it into arms, but particularly the high-risk areas.
Why was there a sudden pivot from age-based priority in vaccinations to postal codes? Is that one of the first things that you implemented when you took over?
If you looked at the original plan that Gen. (Rick) Hillier and the group had decided upon, there’s a Phase 1 and a Phase 2. So Phase 1 actually coincided with his departure and Phase 2 was in April. It was not so much a pivot, but it was that the various high-risk age groups would be finished at that point. One of the first things I did when I started was to talk to the science table around the modelling. We thought there should be a focus now on high-risk areas.
Were there plans from the beginning to move to these postal code hot spots after age-based priority?
I don’t know if it was in the plans by postal codes, but the way that their modelling is presented is by postal code, by the first three, the first letters and digits of the postal code. So all of their socioeconomic data on what’s high risk is defined by that. And so to use their model to its fullest effect, it sort of makes sense to use how they sorted out their data.
Let’s talk about Ontario’s communication problems with the public about the vaccines.
When we communicate something and people are confused with what our intent is, I mean, we should always be apologetic about that because communication can always be better. There is a bit of an operational and time essence. I would point out that if you looked at Dr. Brown’s data from April 12, although the modelling was quite dire there’s this plot of green and red by neighbourhoods. If you look at the age groups from 50 to 70 for in the highest risk neighbourhoods, that imbalance is now corrected somewhat. The whole premise of his analysis was that the lowest risk neighbourhoods were actually getting way more vaccinations. And so in that switch and in the confusion of how that came out and again, communication could always be better. I think there’s always a trade off between operational efficiencies.
But whether it’s about logging on to a singular website to book a vaccine or navigating walk-up mobile clinics, people are wondering ‘where do I go?’
I think you’re right. I mean, I think some of this is historic in the sense that when it was first set up, there’s limitations to the provincial booking system and then there were different, I guess, ways of booking. So for these mass vaccination and hospital vaccination systems, I think from a planning point in December when people were conceiving this, if you’re thinking that you’re about to launch a booking system, there’s some benefits of having some redundancy in your system so that if for whatever reason, if the larger system has some issues, at least you have a redundant system that’s based at the hospital level or at the public health unit.
The trend has been that we’re slowly migrating towards a provincial system, but that is a bit of a process and (public health units) continue to migrate over. But there is a sense that, well, if there is an issue, the redundancy does give them a bit of flexibility. So that’s on the provincial system versus some of the public health units. There’s a separate channel, obviously, through pharmacy and pharmacy represents a separate challenge and a separate channel for getting vaccines. And so that’s a little more difficult for us to have that on a provincial system. So, again, it’s sort of the trade off.
How about immigrant and low-income families? Is there a literacy issue in the way we communicate vaccines? I think back to my family, we’re Chinese-Canadian. I don’t know how they’re going to get information like that.
Absolutely. Your experience here resonates with me as well in terms of, you know, my parents who don’t speak English so well and they’re not as savvy with technology. How do they get this information? I think one of the things that we’re doing now is we’re partnering with community groups in the high-risk neighbourhoods. So places of worship, community centres, and we’re sending mobile teams out. And so that level of communication is more at the community level. So community leaders would call up someone’s parents or someone’s aunts and uncles to say, “Hey, there’s a pop-up clinic that’s going to happen at this location.” These are much more community-led initiatives at the public health unit. We’re focusing on those in the high-risk areas as one strategy to reach out to people who might be lost otherwise. Plus, we’re obviously still doing the mass vaccination clinics because those are the fastest way to immunize. But they miss out. They lose out a bit in equity. And so from the equity point of view, we need to be active in reaching out to people.
Let’s talk about Operation Remote Immunity. More than 200,000 people have received jabs (first and/or second). What are the major points behind the success of this rollout?
There’s two major ones. One is community involvement. This is the model that we’re trying to bring to the pop-up clinics (in Ontario) which is the idea that when you get the community excited, then you reach the most people and then there truly is a sense of community engagement. For Operation Remote Immunity, we actually identified a community leader who was responsible for setting up the clinic for that community. We arrange for funding to get full-time work for that person, plus their helpers and so forth. So that person was arranging this liaison with our team. We had multiple conference calls with the Chiefs and the band leaders and their health-care staff. So I think it’s that level of engagement of the community that makes it successful.
The other major reason why I was successful is (because) in the midst of the vaccine shortage (the Ontario government) guaranteed my supply. We basically had a very tight schedule. If there was a supply issue, that would have been catastrophic for us because the community had already been mobilized and ready to go. We only used Moderna because of its ease for use. We were always sort of nervous that we booked all these aircraft to go to these First Nations communities, are we going to be able to do it? So you had to be more conservative in your booking.
Is this something that can be brought to all hot spots in Ontario? How could that happen? Can we give the same guarantee of supply?
We have a gross imbalance of demand for supply. There’s no easy way around that. I think in the May, June time frame, there’s been some promise of larger shipments of Pfizer with the same regularity as they have now, and maybe significantly more. Where we’ve been having trouble has been with Moderna and AstraZeneca. Those are the ones that are the easiest to use in the mobile setting because they don’t have the stringent logistical challenges for cooling and so forth.
What is happening with the mobile clinics and what is the plan moving forward? There has also been confusion, and long line ups, etc.
As much as I’d like to take credit for all of the mobile clinics, because I think they’re doing wonderful work, mobile clinics tend to be the work of the public health units and the local health officials who recognize that there’s an area of need. We want to encourage this, and so we’ve had lots of discussion about the importance of doing pop-up clinics. We’ve created some resources that certain public health units might access, for example, we put some nurses on contract so that we can send them to these clinics. We have some planners that can help.
Experts are pointing to paid sick leave legislation as a way to ensure essential workers have the comfort and ability to take time off, knowing that Canada Recovery Sickness Benefit is different. Wouldn’t it help, let’s say, if an essential worker who got vaccinated had a sore arm and could take the next two days off to rest before carrying heavy objects?
Accessibility for vaccines is an issue. That’s the whole idea when you’re in a lower socioeconomic area, that those are extra barriers (you face) than if you’re living in the Lawrence Park area of Rosedale. You can just take time off. I think what we need to do is make it as accessible as possible for people, regardless of socioeconomic class. So that can be pop-ups at work, vaccinations at work, vaccinations in their community, places of worship. In Toronto (we’re working with) a Hindu temple called BAPS Temple sort of at the border of the Rexdale area. We’re in the midst of running a pop-up clinic there for the congregation there, but also for the surrounding neighbourhood. Within days, I think about 98 per cent were booked and so very, very successful booking, but what we noticed is that we’ve gone through the bands already. Theoretically, there should be fewer 80 year olds or 70 year olds booking because they’ve already had their opportunity to book. But we are noticing that there are 80 year olds and 70 year olds that are looking at the temple for the pop-up and that suggests that it’s reaching a group that haven’t otherwise been either reached or convinced to get through vaccination.
But why do you think there is this much resistance for Ontario to implement something like a legislated paid sick leave?
I really can’t tell you, whether or not there is resistance or not. I can’t really tell you because I’m not privy to those conversations.
What are the biggest challenges ahead of you?
I think it’s, we’re in the middle of a third wave. So everything that we’re doing and planning is in that context of the third wave and the sort of diminishing ICU capacity. So there’s a sense of urgency to everything. Then that’s in the context of at least this month of very questionable supply, so that just sort of increases the pressure on everybody in the sense that we have this burning need to get these vaccines out, particularly the high speed to the high-risk areas. But in the context of vaccine allocation that you’ve been planning on and all the parties have been planning on has just been cut. Those are the major challenges that we face, the pressure to get stuff out. Hopefully we’ll be seeing larger numbers, but then there will be some issues about planning for second doses for people and how we’re going to do that, or even what happens with children and so forth.
What would you say to the average Ontarian struggling to find a vaccine appointment and battling between the ethics of getting it?
I think when it’s your turn, I think you should absolutely go get it and not wait for someone else. For example, if your parents who are over 80 are still thinking about which vaccine to get (and) you’re over 60 and they’ve determined you are in a high-risk area, I don’t think you should wait. I mean, that’s a great Canadian trait to be so polite and say “you first,” but when you’re called, I think you should go get your vaccine.
I think probably start with the Ontario site for booking vaccinations and then you could look at the public health units as well. The pharmacies advertise where people can get vaccines. Again, I realize, “wouldn’t it be great if there were one site, just, you hit that one site,” and unfortunately, this is where we’re at right now. But I think for that amount of effort and maybe even asking for some help, I think it’s well worth that amount of effort to get your vaccination both for you personally, but also for us as a society.
How are you feeling personally?
It weighs quite heavily. There’s a slightly different perspective when you’re overseas versus when you’re at home in your own backyard. As a surgeon or as a clinician, there’s always a slight depersonalization in the work that you do. When someone comes in and we have to do more surgery on them, you can’t really continue doing that if you personalize every case. Same thing with trauma surgery. I think, though, that every day when we look at the province, this is our community we see in crisis. These are my colleagues that I hear on the TV, on the phone, saying that they’re stressed, that they’re impacted by some of the tough decisions that they have to make. There is a sense that we’re now almost a year and a bit, a year and a half into it. And so there really is a sense that you have to turn your mindset into: this is just, it’s a marathon. We just got to keep going. One more kilometre, one more step or that much closer, but it’s a bit of a mind trick because you don’t quite see the end. So you keep running with the idea that we’re closer, but we don’t know where the end is yet.