Dear Colleagues,

Following my message from last week and our information posted this past weekend, we promised to update you on any new developments.

We met Tuesday with General Hillier, together with our partners in primary care. We communicated that clarity on roles, responsibilities and timing for the vaccination rollout are urgently needed; further, that we want to support our Public Health Units and at the same time we need to be kept informed and be part of the planning. 

Dr. Kieran Moore, CMOH in Kingston, Frontenac, Lennox and Addington, and a family doctor, describes our critical role. Thank you Dr. Moore for expressing our needed collaboration so eloquently.

We know and understand the frustrations, given details on the rollout have been either absent or often unclear. As family doctors, we continue to do what we always do – look out for the best interests of our patients.

If we are to protect and care for our patients and remain on the frontlines of care, we must stay healthy. Now that vaccine supply has increased and based on the Ministry of Health’s own healthcare worker prioritization (page 10), we are continuing to advocate that family doctors and staff must be vaccinated as soon as possible. It’s crucial that available vaccines are used immediately and according to priority needs.

New information released yesterday by General Hillier

• Online/phone booking system should be operational March 15 and open ONLY to 80+ for now (or those calling on their behalf). Pilots happening this week to test the system.
• Vaccinations mostly to begin the third week of March. Some regions may begin 80+ vaccination earlier depending on their supply and progress with the highest priority populations. Based on anticipated supply of Pfizer and Moderna vaccines, those 75+ to start April 15 – more timing details here, which may be faster once AstraZeneca (AZ) and Johnson & Johnson (J&J) vaccines arrive.
• Vaccination will be led by Public Health Units (PHU) and provided through a combination of mass vaccination sites, mobile teams, and pharmacies. General Hillier mentioned “mini-mass vaccination clinics in primary care” where clinics get together to offer vaccination. 
• No specifics on how homebound seniors will be vaccinated. We understand PHUs are aware of and planning for this – we will continue to advocate for solutions for our most vulnerable and to support them in these efforts.
•  We will not be vaccinating in our practices until potentially later in the rollout (when we have AZ and J&J vaccines).
• Notifying those 80+ about how/where to book and get vaccinated will likely include widespread public communications (leaflets, media, PSAs, etc.) from the government and PHUs. 
•  General Hillier mentioned a role for family doctors in notifying 80+ patients. We do not yet have any formal direction or further information about what our role is in this regard.

What we can do now

• Educate: Continue to educate your patients about vaccination. We have compiled answers to some common questions from patients 80+; and for you, here are modules on COVID-19 vaccination recently launched by OCFP and UofT Department of Family and Community Medicine.
  • Contraindications/precautions: acutely unwell/fever; severe allergy/anaphylaxis to prior COVID vaccination or one of its components. Use eConsult, as needed, for additional support on allergies/special populations.
  • Verbal attestation of discussion with provider required for: pregnancy, and those on specific immunosuppressants (e.g. Car-T therapy, chemotherapy, stem cell therapy, monoclonal antibodies, and other targeted agents) for whom it is advisable that they receive counselling by their treating specialist. See the OCFP’s document on vaccinating special populations.
  • At this point, family doctors are NOT required to provide letters or documentation of consent. Patients will be consented at the vaccination site – FYI, this is the consent form that will be filled out at the vaccine site.
  • Per NACI guidance, there should be a minimum 14-day waiting period to get the COVID-19 vaccine after any previous vaccine (e.g., shingrix/pneumovax) and additional vaccines should not be given for 28 days after the COVID-19 vaccine. 
• Communicate: we can support public health efforts by reaching out to our patients over 80+ to encourage them to get vaccinated. Here is an updated template for a website/email message you can use. 
•  Vaccinate: you can connect with your local PHU or local OHT to ask about participating in vaccination efforts at the mass and mobile vaccination sites. 

*****

Thank you as always for your care of your patients, many of whom are struggling as the pandemic carries on. 

As I read in this recent report about COVID-19 and primary care in OECD countries, we are “the cornerstone of the global response and recovery from current and future public health emergencies". 

Take care,

Liz