Ontario's fractured vaccine booking system is complex, but gets job done

Ontario's vaccine booking system has been described as complex, fractured, and frustrating, but as first-dose uptake tops 75%, experts say it's getting the job done.

The government's vaccine booking portal isn't accessible in all regions, pharmacies manage their own appointments outside that system, and pop-up clinics can generate long lines.

Many have complained about the system but observers say that despite its faults, it is generating results.

Dr. Peter Juni, scientific director of Ontario's COVID-19 Science Advisory Table, said he's "extremely grateful'' to residents for persevering.

"It may be frustrating, sometimes it may be less than ideal, that you have to queue, that you have to wait, but I think we have to look at this from the perspective of the glass being half full,'' said Dr. Juni.

"We're at such a critical crossroads because of the Delta variant, we just need to help each other, leverage our sense of community and sense of service.''

Timothy Sly, an epidemiologist and professor emeritus at Ryerson University's School of Occupational and Public Health, said he was initially skeptical of Ontario's capacity to quickly get its population vaccinated. The rollout, he said, exceeded his expectations even as the experience for many has been arduous.

"It's good that we did manage those numbers but at the cost of a lot of people being confused and frustrated en route,'' he said. "It could have been done much more effectively.''

Shiran Isaacksz, a co-lead on Toronto's mobile vaccine rollout, said the province's multiple avenues to booking a shot offer flexibility.

"Just using a portal, or just using a pop-up doesn't satisfy all the various challenges people have in accessing the vaccine. So we do need multiple options and variety,'' he said.

An issue with having all those options, he, said, is that the urgency of the vaccination campaign generates anxiety among people who worry that they're not getting their shot at the very earliest opportunity.

Without a central place to look at all the various options, it can be hard to know whether you're waiting longer than necessary to get jabbed.

It's taken a grassroots effort to attempt to fill that void. Vaccine Hunters, a volunteer-run website and Twitter account that aggregates appointment availability, has been embraced by politicians local, provincial and federal alike.

But not all problems caused by the disjointed system are so easily solved.

Some residents who are moving up their appointment for a second dose have reported having a hard time cancelling their original slots. The process isn't automatic for new bookings made outside the provincial portal, such as at pharmacies.

Last week, residents who became eligible for faster second doses also expressed frustration at only finding available appointments outside their home communities amid immense demand.

Some of the failings have also been to do with communication, said Emily Musing, vice-president clinical and chief patient safety officer at the University Health Network.

"There are a lot of balls in the air, a lot of factors that have led to the concerns and confusion,'' she said.

Priorities in vaccination have shifted over the months, from residents of long-term care homes to those who live in hot spots.

All of that happens quickly, at the same time that supply levels fluctuate and guidance about dosing intervals changes. For Oxford-AstraZeneca recipients, for instance, the province recently allowed a second shot to be booked after eight weeks rather than 12 after public pressure.

"All of those things lead to difficulty and complications and trying to communicate a clear story to the public,'' Musing said.

Paired with valid complaints early in the rollout—mostly to do with low supply—it can be easy to malign the process, she said.

The province was slower than others to launch its booking system, though it's since picked up the pace.

And it was criticized by its own scientific advisers for distributing vaccines per capita, instead of diverting them to hot spots during most of the pandemic's deadly third wave. The government ended up sending half its supply to hot spots for two weeks in early May, before returning to the per capita model.

Even earlier in the pandemic, some doctors in rural or remote areas complained that they weren't able to get the jab as quickly as their urban counterparts.

Data from Public Health Ontario now shows that as of June 12, there were no significant differences among public health units when it comes to vaccine coverage.

Musing said that ultimately, Ontario's vaccine rollout is a success story.

Ontario is ahead of or on par with the other provinces in terms of vaccination rates. Just over 24% of the population had been fully vaccinated as of Monday, while more than 76% had received an initial dose.

And unlike Manitoba and Alberta, Ontario hasn't implemented lottery-style incentives.

The United States, meanwhile, has only seen 53% of people receive at least one dose, though 45% of the population is fully vaccinated, per the Centers for Disease Control.

"At this point, we do have access to supply, we also have information out there, which I think has helped with vaccine hesitancy,'' Musing said. "Those are all helpful things to get us to continue to move forward.''