As Canada prepares for a massive increase in vaccine doses from abroad, some provinces and territories are using outdated technology to record their vaccination data and not fully participating in a system Ottawa created to manage infectious disease outbreaks.
The results of a Globe and Mail survey sent to every province and territory found a patchwork of systems for recording vaccine information that will be crucial in monitoring supply, adverse reactions and population immunity across the country, and for booking appointments. Some provinces reported that they had not enabled core pieces of the technology, called Panorama, that the federal government designed for campaigns like this one.
The SARS epidemic of 2003 highlighted the fact that Canada lacked a modern public-health database to manage all the information related to outbreaks of infectious diseases. Ottawa funded the creation of Panorama for all provinces and territories to use. The platform is actually a suite of technologies and databases for vaccine and infectious disease tracking. But more than a decade of delays and the increasing cost of participation led some provinces to opt out of some parts, revert to their previous systems, or adopt other technology platforms.
The end result is 13 different vaccine-tracking systems, many of which do not communicate with each other or Ottawa.
Shannon MacDonald, an adjunct professor at the University of Alberta faculty of nursing and a researcher with the Canadian Immunization Research Network, said the situation gives the federal government an incomplete picture of the national vaccine program.
“We can’t look at immunization coverage nationally,” Prof. MacDonald said. Some provinces and territories, she added, will struggle even to track their own programs.
Panorama has been in use for several years to track immunizations. The federal government obtained new technology in January to address some of the gaps, and that platform came online on Feb. 2.
Every province that responded to The Globe confirmed it has yet to plug in to the new system.
Representatives of some provinces said health officials still use paper or basic Excel spreadsheets to track vaccines and vaccinations.
The Globe survey found that Quebec, British Columbia, Yukon and Saskatchewan use Panorama, or some version of it, for various aspects of the COVID-19 vaccination campaign. Alberta, the Northwest Territories, Ontario and Manitoba have their own systems. Other provinces did not respond or did not indicate what technology they use.
In light of COVID-19, Ontario hired the accounting company Deloitte Canada to develop a new system. COVaxON, once it comes online, will manage “scheduling, client management, recording administered doses, site inventory management, receipt of vaccination” in a platform that is easy to use, Ministry of Health spokesman David Jensen wrote in response to the Globe survey.
Since December, Canada has received just over a million doses of two types of COVID-19 vaccines. In the next six weeks, four million are scheduled to arrive, and tens of millions more before the end of summer.
The shelf life and storage requirements of each vaccine must be closely monitored. Dale Hunter, a spokesperson for Saskatchewan’s Health Ministry, said the state of the province’s vaccine cold storage is “reported and tracked manually,” meaning the data are sent to the ministry via e-mail or fax. Panorama can be used to manage inventory, but several provinces and territories, including Saskatchewan, said they had not enabled that feature.
The Northwest Territories is using Excel spreadsheets and “specially trained logisticians” to ensure that “no dose is wasted,” Health Ministry spokesperson Andrea Nilson said.
Panorama includes a feature that allows health authorities to scan the barcodes on pallets and doses to keep track of the vaccines and who needs a second dose of which one. None of the provinces or territories that responded to the survey said they had enabled that feature, meaning health authorities enter the data manually.
In Ontario, government employees enter lot numbers into COVaxON when vaccine shipments arrive. Nurses and doctors who administer the vaccines can select the identifying serial numbers on their computers from a drop-down list. This helps clinics track doses both used and unused. Quebec does something similar, Health Ministry spokesperson Robert Maranda wrote.
Mr. Jensen wrote that Ontario’s system could be more efficient if the federal government provided lot numbers in advance.
Many provincial and territorial health systems are accessible on only a limited number of hospital and clinic computers, raising the question of whether they could be used more widely, such as in pop-up clinics or pharmacies.
The Globe asked provinces how they would deal with data entry for vaccinations in makeshift clinics or pharmacies. Manitoba, Alberta, Ontario and Quebec said their systems are designed to be accessible in all clinics and pharmacies. Saskatchewan reported that only public health facilities and some First Nations communities have access to Panorama. Data from pharmacies will be entered manually.
Prof. MacDonald said most provinces and territories have “good enough” systems to manage the vaccination programs. But she said that if any continue recording data with pen and paper, “we’re in a lot of trouble.”
There’s also the question of how provinces and territories will book vaccination appointments.
Alberta, British Columbia, and Saskatchewan are finalizing their booking systems. The Northwest Territories is leaving that issue to health authorities and hospitals. Booking systems for Quebec and Ontario are online.
Health authorities will need to monitor for adverse reactions and the possibility that some people who received the vaccine still contract COVID-19 – which could indicate a defective batch, a more potent variant, or that the patient is among the few for whom the vaccine is not effective.
Quebec’s system is designed to identify defective batches based on reports of adverse reactions and to notify those who received doses. Ontario is tracking adverse reactions with a system that has not been integrated into COVaxON. Saskatchewan and the Northwest Territories have not activated Panorama’s adverse-reaction module, and submit their reports manually.
The Public Health Agency of Canada is the main body responsible for monitoring adverse reactions. However, some provinces told The Globe they report to Ottawa on that manually or infrequently.
As the vaccinations continue, provinces will want to know what proportion of their population is immune at any given time. A 2016 study found the majority of provinces and territories lacked the ability to do a complete analysis of a mass vaccination campaign.
New Brunswick spokesman Shawn Berry said the province’s technology can “obtain near real-time immunization data for COVID-19 vaccinations.” Quebec said its system allows good population surveillance for infectious disease outbreaks, which includes vaccination data. While many provinces and territories that responded did not provide much detail, most told The Globe that, even if they can analyze their data, they do not automatically share the results with the federal government.
Most provinces and territories provided complete answers to the Globe survey, but British Columbia spokesman Devon Smith wrote that “confidentiality and safety” issues prevented the province from answering. Manitoba spokesman Brian Smiley said the province was unable to respond to most questions. Newfoundland and Labrador spokesperson Erin Shea indicated the province was still struggling with a recent outbreak of COVID-19 cases and could not fulfill the request. Nunavut, Nova Scotia and Prince Edward Island did not send responses.
Prof. MacDonald said the COVID-19 crisis should inspire provinces to modernize their health infrastructure. “God forbid it takes a pandemic for us to get moving on this,” she said. “But let’s make hay.”
Multicultural Meanderings 