Spreading Manitoba's vaccine beyond supersites could get doses into arms faster, experts say

The province of Saskatchewan currently has vaccines spread out across 10 different zones, with doses heading to more than 50 different communities. As of Tuesday, that province had used up more than 100 per cent of the doses allotted to it by the federal government.

British Columbia health officials plan to establish vaccination clinics in 172 communities by March. That province has administered more than 80 per cent of its doses.

In Manitoba, which currently has two large vaccination sites in urban centres, and plans for a third site in Thompson and two smaller northern clinics, 56 per cent of the province's doses have made it into arms.

Vaccine and logistics experts say there are advantages and disadvantages to both centralized and decentralized distribution systems, and vaccine volumes are still too low to really judge how efficient different provinces are. 

Given the relatively slow pace of its vaccine rollout so far, however, Manitoba might consider taking lessons from other provinces that have chosen to distribute their doses more widely.

"I think that would be the way to go," said Mahesh Nagarajan, an expert in vaccine supply chains and a professor of operations at the Sauder School of Business at the University of British Columbia. 

Manitoba's plans for distributing vaccines include pop-up sites in remote communities, which would stay until the entire adult population is vaccinated. No details have been released on when those sites might start to appear, or where they might go first.

Members of the province's vaccine implementation task force had planned to release more of those details last week, before shipment delays of the Pfizer-BioNTech vaccine forced them to rethink their strategy. 

Nagarajan says B.C. has been very adaptable, responding to changes in the science, as well as the distribution of vaccines, and has been successful at getting vaccines to vulnerable populations.

"What would really be interesting to see … once this phase is done, is how they're going to do the high-volume vaccinations with appointments, scheduling and some of the big urban centres," he said. 

"That's what is going to be the key of telling whether B.C. is doing well."

Advantages and disadvantages 

When populations are concentrated in a single geographic area, it makes sense to have a centralized system, Nagarajan said. 

Decentralized systems have the advantage of speed, he said, particularly in places where there are many remote communities with small populations. A regional hub can be established where deliveries can be co-ordinated.

Another province that has taken a regional approach in its early vaccine rollout is Ontario, which had used 72 per cent of its doses as of Tuesday. 

"The pandemic is taking different shapes in different specific, smaller regions," said Maria Sundaram, an infectious disease epidemiologist with the Institute for Clinical Evaluative Sciences and the University of Toronto.

"[So] we want to make sure that those regions in Ontario have the most wiggle room possible to make those plans that are specific and make sense for those regions."

Local expertise

While local health regions don't control the number of doses they receive, they have the ability to make decisions about the location of clinics, staffing, and public outreach.

"Those local public health units have a better understanding of the infrastructure that's available and the support that they have that's available as well," she said in an interview with CBC's Information Radio.

"That sort of local knowledge of how these systems are working together, and where there might be the greatest need on today versus tomorrow — those are really important pieces of information to consider when we're designing these rollout plans."

University of Manitoba community health professor James Blanchard also says there are advantages to both centralized and decentralized vaccine distribution systems. The key is how they are managed.

Blanchard recommends the province pull in experts from outside the public health system to help.

"It takes a particular type of expertise to manage those kinds of operations," he said.

"This kind of a thing, at this pace, is a bit unprecedented. So it does take detailed planning, it is complex, and it needs to be accorded that level of attention and expertise to do it."

Manitoba's vaccine task force is expected to release more details about its rollout plans, including its priority list, on Wednesday.