Future pandemic responses need to ensure the maximum number of people at greater risk are immunized as a top priority, says a new report by the Health Quality Council of Alberta (HQCA) released last week.
Earlier this year, Health Minister Gene Zwozdesky asked the HQCA to conduct a review of Alberta’s response to the H1N1 pandemic, which claimed 71 lives in the province.
The review examined the adequacy and effectiveness of the preparation for and implementation and deactivation of the co-ordinated provincial response to the H1N1 pandemic by Alberta Health and Wellness, Alberta Health Services (AHS), the Alberta Emergency Management Agency (AEMA) and their stakeholders.
The report identified many key problems with the way AHS rolled out its vaccination program.
Prior to the first wave of the pandemic from April 19 to July 25, 2009, the province was plagued with lingering challenges as a result of the amalgamation of the regional health authority boards. The report noted the development of a pandemic plan was not a priority given the other challenges AHS was facing at the time.
The report also found policies for pandemic immunization and the use of antiviral drugs during the pandemic were not in place until after the second wave of the pandemic, Oct. 11 to Dec. 5, 2009, had already begun.
While AHS was required to establish contractual agreements with external providers such as pharmacists and family practitioners to aid in the delivery of the immunization campaign, it took several weeks — far longer than anticipated — for AHS to obtain legal counsel on the policies before it could move forward.
And while both AHS and Alberta Health and Wellness agreed high-risk groups, including young children, pregnant women and those over the age of 65, should be the first to receive the vaccine, immunizations were originally open to all Albertans starting Oct. 26, 2009 when clinics started up. Within the first week, 55 per cent of those immunized were not part of the high-risk group.
In total 31 per cent of people under age 65 at high risk were immunized, as were 51 per cent of children six months to four years, 52 per cent of health care workers, 35 per cent of pregnant women and 66 per cent of aboriginals on reserve.
The report strongly stated that future pandemic responses must implement plans to ensure the maximum number of people at greatest risk are immunized as a priority.
There were several silver linings in the report, most notably with strong collaborative leadership shown by the medical officers of health in providing clear direction of public health issues in order to mitigate the risk of infection from the H1N1 influenza virus.
The report said the medical officers of health also gave the public regular updates on the evolution of the pandemic through joint press conferences and it commended the Alberta branch of First Nations and Inuit Health for showing significant leadership in achieving an immunization rate of 66 per cent of the 65,000 aboriginals living on reserves.
Furthermore at the end of the immunization campaign, more than one million doses of the vaccine remained unused.
Speaking on behalf of staff at the Grandin Medical Clinic, manager Louise Harrison said she would like AHS to provide more support for family medical clinics and to acknowledge the role they play in situations such as a pandemic.
“From our perspective, hopefully in the future, [AHS] would provide a little more support for the family medicine clinics such as ourselves in keeping us abreast of the situation and allowing us to sense that we are sort of the first call for families who find themselves in difficulties,” Harrison said.
“For us to have a little bit more of an involvement in the actions that are being determined might be more helpful,” she said.
St. Albert MLA Ken Allred said it’s expected there would be some problems with the province’s H1N1 immunization campaign.
“We’ve known that there were some problems in the H1N1 implementation and I guess those aren’t unexpected, that there would be some problems in the system,” said Allred.
“It came on so fast and supposedly was a pandemic but it didn’t really end up being that big a problem but nevertheless it was an attempt to roll things out as fast as possible,” he said.
Initially, Allred said there was a lot of concern the majority of Albertans didn’t think the H1N1 pandemic was as serious as it was and weren’t going to get the vaccine.
“I guess one thing that they probably have learned is maybe they should treat the people who are the most gullible first, I think that’s probably the big thing and I’m sure they can learn from the small incidents as well,” Allred said.
The HQCA report listed 18 recommendations, including developing quantifiable triggers to activate an appropriate response to a pandemic or public health emergency and developing integrated pandemic preparedness exercises.
The report also recommends the province develop a prioritization matrix to help ensure the maximum number of people who are at the greatest risk of getting sick are immunized early on.
Of the 18, this was the only recommendation AHS took under advisement, stating it wasn’t sure if a prioritization matrix is the best method to accomplish this goal.
