Canada’s slow and painful vaccine roll-out is not surprising to anyone who has been immersed in health care in this country as a patient, caregiver or worker.
The only difference now is that the public have been exposed to the thinly veiled secrets of our beloved Medicare system. The vaccine roll-out has proven that Medicare is not accessible, portable, universal nor comprehensive after all. This isn't only about the numbers of ‘shots in arms’ – it is about how the vaccine programs have been planned, implemented and communicated. It is what the patient experience has been along the way. It is about how this roll-out has encouraged – and discouraged – accessibility to the vaccine. It is about Canada’s glaring gaps in health equity.
I must note that there are many good people inside the system working hard to care for patients and influence positive change. The young nurse who administered my son’s vaccination; the pharmacy assistant who took my husband’s information before his shot; the booking clerk doing her best to answer questions on the phone. As someone told me recently, often these good people feel handcuffed by the system too, just as us patients do. There are many of us who pine for more humanity in health care for all.
It might be tempting to simply throw up one’s hands and blame the “system” on Canada’s failures. The fact remains that the system is made up of people. The vaccine decisions were made by real humans - mostly high level executives who are very far removed from the diverse experiences of Canadian citizens.
There are many ways the vaccine roll-out shows the Canada’s true health care colours. Some of these are specific to my home province of British Columbia, but many of them can be applied nationally. Here's a list of 20 issues:
1. Hesitancy
Vaccine policy setting and planning could have started in May 2020 and completed last year. It didn’t.
2. Slow-Moving
Vaccine policies were stuck in an infinite loop of committee meetings and doled out excruciatingly slowly to an anxious public.
3. Pants on Fire Approach
First there was all this hesitancy (see #1) and then everything was done in a big rush, with no time made to do any consultation with the citizens who ended up being impacted by government’s misguided policies.
4. Out of Touch with the People
High level health executives appear to make decisions only for people like themselves, with no recognition or regard for the ordinary, working class citizen -- people who don’t have the privilege of a graduate degree or high income.
5. Uncoordinated Piecemeal
The vaccine response across provinces has been fragmented and inconsistent, with nothing coordinated federally. And within each province, this is true across health regions and even within communities.
6. Rationing Care
Canada loves to ration care by making people jump through hoops (see #13) to prove their need for health services, including this vaccine (see #15).
7. Focus on Bricks and Mortars
Building new mass vaccination sites instead of maximizing the systems that already work – like pharmacies, outreach programs, community organizations and family physicians’ offices is a big fail.
8. People Unfriendly Physical Environments
These mass vaccination sites are built to be system centred, not patient centred. The clinic my son attended had no chairs for those waiting in the long line-up, no cover in the rain, a need to manually fill out a form on a clipboard (nearly impossible for the elderly gentleman in front of my son who was leaning heavily on his cane) and minimal assistance offered for those who needed it.
9. Sparse Outreach
Similar to #7, once again health care does not know how to go to where the people are. They only know how to build mass central clinics – similar to hospitals – to force the people to come to them. They can't do this because they have few connections in the communities they serve.
10. No Centralized Booking System
Any patient knows the scheduling systems for appointments contribute to the health gong show in pre-pandemic times. Having to sign up on the provincial booking website, then a half-dozen different pharmacy vaccine appointment websites is a symptom of this broken approach.
11. Reliance on Snail Mail Letters (but only for disabled people)
Some people (but only disabled people) had to wait for a letter ‘inviting’ them to book a vaccination appointment. This letter was supposed to come in the mail. I mean, really? Wait... is it 1975? Is this the best you could do?
12. Errors in Booking
Guess what? These special letters (see #11) mailed out to people excluded a bunch of people who were actually eligible for their shots. Due to an error? Picking the wrong criteria? Incompetence? Who knows. These unlucky folks were excluded and tumbled down a big system-created crack in the vaccine roll-out.
13. Eligibility Hoops (but only for disabled people)
Who else has to belong to a certain government program or wait for a special letter to arrive in the mail? That’s right – those deemed ‘clinically extremely vulnerable,’ that’s who.
14. Health Inequity in a Racist, Ageist, Classist and Ableist System
This is how the health system is built, so this is how the vaccine roll-out has happened. See #4, #6, #7, #8, #9, #11, #12, #13, #15, #17, #18, #19.
15. Proving Need (but only for disabled people)
See #13 – who else has to prove they need the vaccine? The burden of proving they are high-risk for COVID is put squarely on the shoulders of disabled people.
16. Pitting One Group Against Another
Somebody compared this vaccine roll-out to the Hunger Games. I’ve watched in dismay as people have turned on each other, accused people of queue jumping, lashed out because of stress, forced one group to fight against another for the scarce vaccine appointments.
17. Passing the Burden to the Citizens AND Patient Blaming
Not everybody has the time to call a dozen pharmacies to hunt down a vaccination. Not everybody has Internet to book a centralized appointment. Vaccine inaccessibility (often mis-labelled as hesitancy) is a real concern -- how much will difficult vaccine appointment bookings contribute to this? (On top of that, the public health press conferences have now pivoted to blaming people for not getting vaccinated. Patient blaming is a real cornerstone of the Canadian health system.)
18. Confusing Official Communications
The public health press conference messaging is confusing at best. You can register for a vaccine, but not book one -- but wait for that invite letter. One website is centralized, the others are not. The vaccinated numbers do not mention that the numbers include those who have only had their first shot, not those who are fully vaccinated. There is a political spin on everything.
19. Dense Written Communications
To share essential health information, our health authority photocopies sheets of paper that are not written in plain language, contain no white space, and feature no graphics. Content is offered in dense university-level English. Patient information like this is written for health administrators, not patients.
20. Being Prematurely Self-Congratulatory
Already we have jumped the gun and are giving our Provincial Officer of Health honorary degrees (two already!) and this pandemic is far from over.
This is not the end. There will be continuing gong shows with the administration of the second dose of the COVID vaccine, when it comes time to vaccinate children, when boosters are needed and with the inevitable next pandemic. We continue to fight hard for vaccine equity for people with Down syndrome and other developmental disabilities over at Ready for My Shot because if we don't, these vulnerable people will be left behind.
Unless health care officials and administrators truly -- and authentically -- make it a priority to understand the experience of patients, their families and health care workers… they are going to continue to miss the mark. These gong shows are going to keep happening over and over again.
In Canada, it takes hope, wishes, privilege, magic and luck to access an essential health service like vaccinations. It should not be that way, but it is. It is time to drop the fairy tale story of how wonderful our health care system is in Canada. It isn’t wonderful. It is deeply troubled.
This is our chance to burn it down and build it up from scratch, starting with honouring patient and families – the very people health care is supposed to be serving. Patients and families have been displaced in the chaos of this pandemic. We are the ‘why’ health care exists and we are treated as a bother and an afterthought. And, as COVID has so clearly exposed, the health care professionals who care for us at the bedside have been mistreated too.
It is easy to identify what is wrong. But how do we fix this mess?
The answer is rooted in bringing care back into health care. Every policy decision and operational roll-out must be anchored in relationship, compassion, and dare I say it, love.
I’m in the middle of writing my second book called Ducks in a Row: Reimagining Health Care. I’m getting weary about talking about all the problems -- although Lord knows the pandemic keeps giving me so much material that I can barely keep up.
We desperately need a big-time power shift. Power needs to be taken from the high-level officials and given back to the people. This can be done with humility and by creating safe spaces for storytelling and constructive feedback.
In the end, the magic sauce to get us out of this mess is compassion and love. There has been so much harm done by the system that we need lots and lots of love to counter the pain caused by this harm, as much as you can spare. We need to stop doling out health care from ivory towers and start caring for each other as human beings.
It is as simple and as complicated as that.
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