Dear Colleagues,

As you are aware, the COVID-19 response is changing rapidly and there is a lack of clarity on many aspects of the vaccine distribution. We are advocating strongly for clarity around our role and transparency about both the timeline and distribution plan – this is essential if we are to safeguard our patients, our communities and ourselves.

The OCFP’s partnership within the Primary Care COVID-19 Vaccination Action Council* is designed to strengthen our position that family physicians and primary care MUST be involved in COVID vaccination efforts.

We appreciate your quick response to the survey we distributed earlier this week to share with Public Health Units. More than 2,000 family physicians and other primary care professionals have already signed up – and this will work to amplify to decision-makers our resolve to work with Public Health to support rapid vaccination and address the calamitous situation in long-term care (LTC) and retirement homes (RH). We also had 20 Indigenous Primary Health Care Council members and associates respond with their readiness to participate with vaccination supports. As new names come in, we will send an updated list to the Public Health Units.

Based on currently available information, here are details on some of the issues around which we are hearing questions: 

• Local Public Health Units will lead local vaccination distribution, with hospitals continuing to lead vaccination of hospital-based physicians and healthcare workers. Public Health Units have acknowledged that their leadership in vaccination needs to happen in partnership with others including primary care. The 34 Public Health Units in the province are identifying primary care vaccination leads in their regions. We recognize the urgency of vaccination in LTC and RH and also know that plans will vary across regions based on local factors and vaccine availability. Our continued, strong focus is to reinforce the need for partnership with family physicians and primary care in these efforts.
• Family physicians and primary care are not expected to have direct access to vaccines until after Phase 1, except for those participating in outreach teams for high-risk individuals in congregate settings. Family physicians and primary care will play a bigger role in Phase 2 and 3 of vaccine distribution. A main role now for primary care is to communicate with patients about the vaccine. There are resources below to support you. We are also pushing for primary care to take a bigger role in future planning phases.
• The Ministry of Health makes decisions about vaccine distribution, with recommendations from the COVID-19 Vaccine Distribution Task Force, led by retired General Rick Hillier. Other tables may feed in but decisions that influence vaccine access are made by the Minister of Health.
• We have raised concern about the apparently inconsistent approach by hospitals regarding vaccination of hospital and community physicians. This issue may be resolved when guidance documents are released to lay out the approach to prioritizing community-based physicians and healthcare workers for vaccination, as expected later today or Monday. 
• Federal and Provincial bodies have committed to working together on vaccination efforts for Indigenous, First Nations, Metis and Inuit communities, as a way to optimize this work. The Indigenous Primary Health Care Council, a member of our group (Primary Care COVID-19 Vaccination Action Council) also sits on the Indigenous Affairs Ontario sub-table.
• The Ministry has confirmed that all primary care clinicians, including physicians, nurses, nurse practitioners and pharmacists, may vaccinate, and that only regulated health providers may administer the vaccine unless it is in their scope of practice (such as EMS and Physician Assistants). 
• The Ministry has just released updated vaccination recommendations for special populations, including those who are pregnant/breastfeeding or have autoimmune conditions or compromised immune systems. In sum – vaccination may be offered based on individual clinical risk assessment and patients’ informed consent. Given the evolving information, be sure to check the Ministry website regularly for updates.

We know these are confusing times and we continue to work for greater transparency and clarity in these critical efforts. Some of our current key areas of focus:

• more clarity around the roles of hospitals, public health and primary care, with emphasis on primary care partnership in Public Health Units’ vaccine planning;
• regular updates and open communication from the Ministry of Health and Public Health Units, including information on vaccine supply and distribution;
• a standardized approach to distribution across the province that addresses local rollout and applies a health equity framework, and transparency about this approach. 

Resources

• As noted above, new Ministry of Health vaccination recommendations for special populations, including vaccine use in pregnancy, those breastfeeding, and individuals with autoimmune conditions/immunocompromised or allergies.
• Answering Patient Questions about COVID-19 Vaccines – updated customizable letter to patients, developed by the OCFP, including information on vaccinations in special populations.
• COVID-19 Community of Practice session on vaccines: OCFP and UofT DFCM – next Friday, Jan. 15, 2021 | 8 to 9 a.m. ET, focused on new information and your questions on vaccine hesitancy and more: REGISTER NOW and also access the recording and resources from today's session (Jan. 8).
• Vaccines Update for Primary Care: CFPC – Tuesday Jan. 12, 2021 | 12 p.m. ET. Panelists include Drs. Caroline Quach-Thanh (NACI Chair), Gerald Evans (ID physician at Queens University) and Mike Kolber (family physician in Alberta who is part of the PEER/Tools for Practice team). JOIN THE WEBINAR
• Centre for Effective Practice (CEP) resources — vaccines information updated regularly
• 19 to Zero – information contains resources for healthcare workers.

Addressing vaccine hesitancy

• Letter to community members and families – update on COVID-19 situation, including vaccines, developed by Ontario Primary Care COVID-19 Vaccination Action Council.

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We know that the volume of information being disseminated currently can be overwhelming. We remain committed to communicating critical developments and will continue to provide timely updates on a weekly basis.

Liz 

*COVID-19 Vaccination Action Council

Ontario College of Family Physicians

Ontario Medical Association Section on General and Family Practice

Ontario’s Academic Chairs of Family Medicine

Alliance for Healthier Communities

Association of Family Health Teams of Ontario

Indigenous Primary Health Care Council

Nurse Practitioners' Association of Ontario

Nurse Practitioner-Led Clinic Association