Jordan Heath-Rawlings: According to government numbers, there were 282,371 doses of COVID 19 vaccines administered in Canada this Wednesday. That’s a lot. Canada is very lucky, but it’s worth noting that Wednesday’s number was actually the lowest total number of vaccines administered in one day since May 25th, when our vaccination effort was still ramping up. One day’s numbers are just one day, but the overall pattern clearly now shows a plateau and even a slow decline in daily vaccinations. Some of that decline was bound to happen, but not all of it. With more than 75% of eligible Canadians having one dose and more than 50% having two, we’ve picked the lowhanging fruit when it comes to vaccinations. The last mile of this vaccine rollout is going to be tougher. It’s going to be about making shots easily accessible, about targeting individuals who, for whatever reason, simply haven’t bothered yet. And it’s going to be about convincing vaccine hesitant people in person, one on one to get their shots. None of those things are easily done at mass vaccination clinics or in big lineups at hospitals and community centers. Fortunately, that’s not the only way that we administer vaccines in this country. There is another way, and I don’t want to spoil it, but it’s, well, it’s the way we administer almost every other vaccine in this country. So maybe we could try that next.
I’m Jordan Heath-Rawlings. This is The Big Story. Dr. Liz Muggah is the President of the Ontario College of Family Physicians. Hello, Dr. Muggah.
Dr. Elizabeth Muggah: Hi. Thanks for having me.
Jordan Heath-Rawlings: You’re very welcome. This is something that a lot of people we’ve talked to about vaccines said is a conversation that we should have at some point. So I’m really glad we’re having it.
Dr. Elizabeth Muggah: Yeah, me too. I think that we’re excited as family doctors to be participating in the vaccination rollout for COVID 19, but I think there’s lots to dig into there. So I look forward to our conversation about this.
Jordan Heath-Rawlings: So first, maybe in general, pre COVID, or just leaving COVID aside how much of vaccinating in Canada is done by family physicians typically?
Dr. Elizabeth Muggah: So the great majority of vaccination is done by family doctors in their offices. So we start vaccinating, really, when we see patients who are infants. So right from the very beginning through childhood and then all the way through to those who are quite elderly. The reality right across the country is that we’re doing that. There are some vaccinations that we share the responsibility with other parts of the health sector. So school age vaccines that happen often around grades seven and eight. That’s something that Public Health takes the lead on in many provinces, including in Ontario. So the school based vaccine would be an exception. And the flu shot is one where we share with pharmacies. So in the most recent year, pre COVID, family docs gave about 55% of all flu shots in Ontario, and then the rest were given through pharmacy and some public health units. But overall, family docs really are the ones leading vaccination for patients from cradle to grave.
Jordan Heath-Rawlings: So if we had been having this conversation, let’s say back last November or December, just as we were starting to get approvals on these vaccines and it was becoming a reality, what role would you have envisioned that family doctors might play on the rollout?
Dr. Elizabeth Muggah: Well, given what I just told you, that this really is our core business, I just anticipated we would be heavily involved in this vaccination rollout. It was clear, of course, that this is not a typical vaccination effort. I mean, this is a massive one that was going to require a different approach. So I also assumed that we would have some mass vaccine clinics and public health would be leaning in, and pharmacies would be leaning in really an all hands on deck. But I absolutely thought we would be part of the real on the main team, so to speak. And I looked a bit to what was happening in other jurisdictions, I think many of us did is family doctors. So if you think about, say, the United Kingdom or Israel who were ahead of us in terms of their vaccine rollout, and we looked at what was happening there, we saw that family doctors were playing a bigger role in those countries. Family doctors have been engaged really early. They had been on boarded so that they were ready. It was really kind of a system where everyone was asked, do you want to participate or not as a family doc? And if you did, you were given those vaccines and off you went. So based on all of that, I think we really had a particular impression, and were looking forward to really participating as partners and as leaders in that vaccine effort.
Jordan Heath-Rawlings: And so when did you start to realize that you would, not to say not involved, because I know that family doctors are doing some things. But when did you kind of realize you would be more, I guess, more on the bench than in the starting lineup as the team came together to put out vaccines?
Dr. Elizabeth Muggah: Yeah. It became clear to us in December-ish that we were not being called upon early on to participate in the planning for the vaccination rollout. And that was our first indicator, I guess.
Jordan Heath-Rawlings: Right.
Dr. Elizabeth Muggah: And then the vaccine started to roll out, and we saw that government was handing the vaccines to mass vaccination clinics and to pharmacies, and we weren’t going to be engaged. So actually, in Ontario, what we did at that early juncture as things were just starting is we came together as family physician leaders and leaders in the primary care sector, generally across Ontario, came together to talk about this and to think about what’s our strategy going to be. How do we get our message out that we really want to participate, that we’re feeling like we’re on the bench, so to speak? So that was an early effort that was a grassroots, in some ways, effort and then included many associations and organizations that support or represent family doctors, including our Ontario College.
And then what happened was there was a bit of a trickle that came to primary care, to family docs. So the province said, we’ll have some portion of vaccines that will now go to family physicians. And in six public health units, there are 34 public health units across the province. In six public health units, we will give those public health units a small amount of vaccine. At that stage, it was only the AstraZeneca, and we’ll see how it goes. We’ll pilot this. So we were given in those areas, family docs it up and said, sure, we’ll take some. And public health units handed the vaccines to those clinics, and the vaccines were all allocated and jabs got into arms, so to speak. And then that pilot was expanded. And so then all 34 public health units again were given small amounts, again AstraZeneca, to give to a portion of the family docs who had their hands up in each of the 34 public health units. So where we are now is, you know, in that same model, essentially, there are somewhere around 6-700 family practices or primary care sites, so to speak, where vaccines are being given by family doctors and in office.
Jordan Heath-Rawlings: Can you give me a little context around that? Maybe how many family doctors are in Ontario in general? Like, what percentage are we talking about that’s actually putting shots into arms?
Dr. Elizabeth Muggah: Yeah. That’s a great question. So there are 15,000 family doctors in Ontario, and of those somewhere around 10,000 are practicing what I would call comprehensive family medicine. So that’s the cradle grave where this would be absolutely part of your core business. So when I think 700 sites, there could be a number of family docs working in each of those sites. So we don’t actually have those numbers. That would be information that the government would have, because when you’re giving vaccinations, you record yourself as the vaccinator. But we don’t have those numbers on how many family docs are giving vaccines. We just have how many sites, locations, clinics, so to speak, is it being given.
Jordan Heath-Rawlings: Right.
Dr. Elizabeth Muggah: Now, I can tell you we know from our family doc members of our College that there are many who have their hand up and have been wanting vaccines and haven’t been able to give them.
Jordan Heath-Rawlings: Was there ever a conversation with the province about that, when you kind of realize that it wasn’t going to happen? And you said Hey, we have our hands up here like, we can help. Were you ever given a dialogue to explain why you weren’t more heavily involved?
Dr. Elizabeth Muggah: We definitely made that message clear to the Ministry in every way that we could. In March, we did release the results of a survey that we had done of the public, which showed that there was a good portion who were still uncertain about getting vaccinated. And that particularly for that group, to move the dial for them from feeling unsure towards feeling certain about and ready to be vaccinated more than any other healthcare provider, it was their family doctor who would help them do that. And I would say it was a disappointment to us that we had to continue to advocate to participate in something that was really our core business.
And I guess I would be remiss to not talk about all the other ways family docs were participating in vaccinations. So there were lots of family doctors who were and are still working in those mass vaccine clinics giving vaccines. There were family docs who also partnered again with Public Health to support vaccination in long term care and retirement homes. So where those efforts were happening. So I think we really stepped up in any way that we could to be able to participate in this really important effort to get everybody vaccine. But the piece that was missing was that opportunity for us to do it in office.
Jordan Heath-Rawlings: Did you ever get a reason like, was it logistics? Was it that they just thought mass vaccine clinics would be faster and more effective? Or was it just like, wait your turn. You’ll get some.
Dr. Elizabeth Muggah: I think you’d have to ask them exactly what their reasons were.
Jordan Heath-Rawlings: Fair.
Dr. Elizabeth Muggah: It was never laid out for us explicitly. I think at the front end, you know, it was a vaccination effort that I think they said, like, how do we get this done the quickest, right. That was the sort of main imperative. And I guess they saw the mass vaccine clinics as an efficient way. And I think that’s true. And I would commend Public Health for their incredible work in terms of running those mass vaccine clinics. But what we’re seeing now with the plateauing is that now this absolutely was about an efficient, speedy vaccination process being important. But the other outcome when it starts to plateau is you need to reach the full population, and you will get to a point where there are people who can’t or don’t want to stand in the long line in a mass vaccine clinic or don’t feel that the pharmacy is where they want to go. And now they’ve turned to us and I would say, well, Yes, this is what we’ve been telling you. If you’d involve this from the beginning, we could have helped in the front end. So that we did this really as all hands on deck. And we also would have really been working on that population that maybe has questions and wasn’t prepared to go somewhere else to get vaccinated.
So at the start, there was certainly a question about transportation of the vaccines. So the AstraZeneca vaccine was one where it was much easier to transport and store. And then we just learned, well, that’s not a problem, actually. We can have Moderna and Pfizer, both of those can be stored safely and perfectly well in a family doctor’s office with absolutely no questions. But that may have been an early piece. I have to say, when we look across the country, I think we can see there was a similar pattern right across Canada in terms of the potential of family doctors really not being realized.
Jordan Heath-Rawlings: Let’s talk maybe about why that can change now. You mentioned we’ve hit the plateau, that’s one reason. Maybe let’s start with how you guys can maybe, I can’t speak for every instance, but can maybe try to succeed where other vaccine pushes have failed?
Dr. Elizabeth Muggah: You know, I think I would start with what family medicine is all about, which is this relationship with a patient over time. So I know my patients from, many of them from the time they were little babies all the way through. And so now that trust that builds between the family doctor and their patient is such a powerful part of supporting vaccination. I mean, I think when something’s new, like a new vaccine, you want to go to somebody who you trust to talk about that, and they’ve given you good advice before they’ve seen you through thick and thin. They’ve given you all your other vaccines. So that’s who you want to talk to. And from my end, I would say I feel so well equipped to have these conversations with my patients. I mean, I know everything about their health history. I know all the medications they’re on. As a doctor, I’m absolutely up to date on all of these vaccines, what their side effects could be when you need to take them, how they work and what they might mean for you as an individual. I don’t have to speak in generalities. I can say I know you and what’s going on with you and you’re on this medicine or have that illness. And so I combine that, that trust and then our knowledge, our scientific knowledge, and then our very individualized understanding of that person’s health conditions, all of that together is the reason why family doctors are really just so uniquely positioned to provide vaccines and at any stage of a vaccination rollout. But right now, as we’re talking about this sort of last mile, some people are calling in the last kilometer at this juncture when we really have people who haven’t even, there’s a portion who haven’t even had their first shot. And we see patients over time. And I will say from personal experience that these conversations about the vaccine can take more than one go.
Jordan Heath-Rawlings: Right.
Dr. Elizabeth Muggah: So I’m having multiple conversations over time with someone, and I take every opportunity. Every visit that I have with somebody right now includes a conversation about the vaccine.
Jordan Heath-Rawlings: Can you give me an example of what those conversations might be like?
Dr. Elizabeth Muggah: Yeah. I mean, I’m really honest to goodness, I have it with every single patient encounter. And if it’s a mom who’s come in or a dad who’s come in with their child and maybe their child isn’t of an age where they’re getting vaccinated, then I still take that opportunity to talk to the parents. Have you been vaccinated like, Yeah. Let’s talk about your little one. And then let me just finish by asking you this. So I ask the question, it’s really important that this is approached with empathy, this conversation, and with curiosity, I would say, because there’s not one reason why somebody may not be ready to be vaccinated. And so it’s actually quite interesting to have those conversations, you know, and you prod a bit. Well, you tell me what’s on your mind. What are you worried about? And sometimes, you know, I had a patient recently who I talked to, and I was really surprised that she hadn’t been vaccinated. She’s got multiple health issues, and she lives on her own. And so she’s frail and would be really at risk for COVID complications. And then she hadn’t been vaccinated. What’s that about? And in my head maybe had some assumptions. Well, maybe it’s about the medicines she’s on or her illnesses or whatever. No, her worry was she pretty much hadn’t left the house during the pandemic because she was so worried about catching COVID. So the thought of going to a mass vaccine clinic or even into a pharmacy was one that she was very fearful of. So I have to say we were lucky our clinic in Ottawa, we are vaccinating our patients. We were lucky to get vaccines. And so then I could work her through that and say, Let’s book you here. Let’s book you in here. And so for her that that was what it was about. It was about a place where she felt safe and an environment that was familiar to her.
With someone else, it could be a totally different conversation. You know, people have, sometimes have a sense about what their personal risk may or may not be. So I have had patients where they actually have very sort of public facing work, I have somebody who was a mechanic, for example, and is working in a garage, so pretty closed-in space with lots of other people and has to talk to clients when they come in with their cars. But his sense was, well, I’m not a risk. Like, I just go from my house and then I’m in the garage. And then I was like, well, actually, you’re essentially like an essential worker and you are exposed to people. So let’s talk about that, your perception of your personal risk, right. And now there’s lots of questions. Now we’re dealing with youth.
Jordan Heath-Rawlings: Right.
Dr. Elizabeth Muggah: So I think for anyone listening to this podcast, I would say that group, getting that group vaccinated, the 12 to 17 year olds is just such a critical priority for us over the summer so that we make sure as many people, as many of these kids are vaccinated when they head into school as possible, just how important that is. And that, again, with a different kind of conversation that you have with the parents and with the child, right.
Jordan Heath-Rawlings: Sure, yeah.
Dr. Elizabeth Muggah: About maybe some of them are really afraid of needles. That’s actually a super common thing. Yeah. So those would be just a few examples. But I think sometimes if we make some assumptions about why somebody may be hesitant, we really miss the mark.
Jordan Heath-Rawlings: That’s really interesting, because I think when we talk about vaccine hesitancy, we all get this image in our head of those people online or on Facebook who I think it’s going to give you a 5G chip and think it’s going to alter your DNA and all of that kind of stuff when that’s actually a really small percentage of eVen the people who aren’t getting vaccinated.
Dr. Elizabeth Muggah: Yeah. You’re absolutely right, Jordan, is really a spectrum. And I also think what somebody might say online or with how they they react to a certain bit of news on social media and everything that may be very different than the conversation that they feel comfortable having a safe place with their family doctor where they can really put on the table. This is actually what I’m really worried about, right. I have a real fear here, and you can safely talk about it and help them move towards hopefully being more ready.
Jordan Heath-Rawlings: So Let’s talk about the last mile then.
Dr. Elizabeth Muggah: Yeah.
Jordan Heath-Rawlings: The first question I have is have you guys had an internal conversation about putting a plan together, being ready, having your hands in the air and being ready to go? And second of all, I have you been given any indication that the time is coming for you guys to get in the game?
Dr. Elizabeth Muggah: So to your first question. Absolutely. We’ve been talking about that as a College. We’ve been doing that in partnership with other organizations that support or represent family doctors in primary care. So we’ve worked really hard to keep all of our family doc members informed, engaged, ready for when those vaccines arrive. And in terms of what we’ve heard, we heard the announcement from Minister Elliot, I guess it was last week now, saying that family doctors were going to play a bigger role. We welcomed that, as I said, it was something that we’ve been telling them for a long time. So we welcomed that messaging from her. We don’t know what that’s going to look like yet. We have not been told, does playing a bigger role mean that we’re going to get more vaccines. And if we’re going to get more vaccines, how many vaccines are we going to get, and when? So the details of that are not clear to us.
We’ve certainly understood that the government has seen that things have plateaued and they need to do things differently, and that doing things differently, you and I have just talked to most of the time about how that what that means for family doctors being more involved. I think doing things differently is also going to be more sort of just generally kind of smaller, community based efforts where the vaccines are going to the people in more pop ups, maybe school based. So I think there are a number of strategies that we understand that they’re looking at. But no, we have not seen the plan, and we look forward to receiving that information from, from government, and we hope to hear more and continue to give that messaging back to government and other partners.
Jordan Heath-Rawlings: Dr Muggah, thank you so much for this. I feel like I got some real insight into what you guys can bring off the bench, I guess.
Dr. Elizabeth Muggah: Yes. So that’s the point. Yeah. Don’t bench us. We’re a core part of the team, and we’re absolutely here ready to support the efforts to make sure that all Ontarians are vaccinated and we can get back to normal again.
Jordan Heath-Rawlings: Dr. Liz Muggah is the President of the Ontario College of Family Physicians. That was The Big Story. For more from us, including lots and lots and lots about vaccines, head to thebigstorypodcast.ca. Talk to us anytime on Twitter at @TheBigStoryFPN. Email us with your thoughts and opinions and criticism and, most importantly, praise, at thebigstorypodcast, all one word, all lowercase, @rci.rogers.com [click here!]. And find us in your favourite podcast player, whichever one it is will be there.
Stefanie Phillips is the lead producer of The Big Story, Ryan Clarke and Joseph Fish are associate producers. I’m Jordan Heath-Rawlings. Be safe this weekend. Enjoy it. Thanks for listening. We’ll talk Monday.
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