Why won’t Toronto vaccinate residents around the clock starting next week? We ask the man with the plan

Yorkregion.com
March 10, 2021
David Rider

Last week Mayor John Tory raised the prospect of round-the-clock vaccine clinics when the first three open next week. This week fire Chief Matthew Pegg, head of Toronto’s COVID-19 emergency response, said maybe later. With calls growing, and COVID-19 variants spreading, we asked Pegg to explain.

What changed from last week to this week?

Nothing has changed. The ability to expand clinic operations has always been a key component of the clinic operations. As soon as vaccine supply allows the city to open more clinics, and we begin vaccinating more residents, we will then be in a position to operationalize 24/7 clinics.

Until we have all nine city-operated immunization clinics operating seven days a week, which is dependent upon the available supply of vaccine from the province, expanding hours of clinic operation is not planned. We can’t have clinic operational plans that exceed our vaccine supply.

Are there logistical issues around 24-hour operations -- security, or keeping non-city sites like Scarborough Town Centre open all night?

Absolutely. Staffing our network of city-operated clinics is complex and challenging, to say the least. To operate our nine clinics from 11 a.m. to 8 p.m. seven days a week requires about 1,400 staff.

Transitioning to 24-hour operations would require us to on-board additional staff or redeploy existing staff from the current operational schedule into an expanded schedule. That would result in reduced clinic hours in one or more locations to expanded hours at another location.

We may well have to hire additional staff moving forward but not until vaccine exceeds what we can deliver through the current clinics with the current staff.

Also, opening the first three clinics more than two weeks ahead of schedule has put additional challenges on existing staff, many of whom are still being trained.

You talk about clinics being “scaled and paced” to get the most shots done in the shortest time. What does that mean?

Every aspect of clinic operations is calculated on the basis of time. We calculate the number of doses to be administered by each vaccinator on an hourly basis.

We start with the total quantity of vaccine available on a daily basis. Then we determine how many clinics we can open and how many staff in each to get the maximum doses per day while ensuring the safety of clients and staff.

“Pacing” is the time it takes clients to move through the clinic, from registration and screening to vaccine administration and aftercare. We plan it knowing some elderly clients, for example, take longer to move through.

“Scaling” is how many clinics we can open at any given time, given vaccine doses available. Our priority is to get all nine clinics open, across the city, as very soon as vaccine availability permits. We start with the first three clinics March 17, knowing we can scale up operations in those clinics and later open the others.

If you open the clinics longer, can’t you vaccinate people more quickly, which is urgent given the threat from COVID-19 variants?

In theory, yes we might be able to, but as long as we are vaccine-limited it would lead to highly irregular and unreliable clinic schedules. It could also result in being able to open only one clinic as opposed to three locations across the city.

Also, when someone books their appointment for their first dose of vaccine, they also book their second dose. For us to have vaccine and clinic availability for the second dose, we need to ensure we have reliable and consistent clinic operations. We don’t want to have to cancel an appointment for lack of vaccine.

You said you’d consider expanding clinic hours, including 24-7, when Toronto is getting 500,000 doses per month. Why that number?

That is the total number of doses we can administer in our nine city-operated clinics at the normal pace of operations. Once we get more vaccine, acceleration options emerge including increasing clinic pacing and hours to match vaccine supply. This may well include the transition to 24-hour operation.

We have plans in place to increase our vaccinations to 975,000 doses per month on the current schedule, when we get vaccine. But at the 500,000 mark the city’s immunization task force will review and decide if we should accelerate operations up to and including 24-hour operations.

5. Bottom line: why, given the race between vaccines and variants, aren’t we opening any of the clinics 24-7 right away?

There is simply not enough vaccine available to open clinics, in a reliable or sustainable basis, on a 24-hour basis at present. We are still bringing additional clinics online and we are still in the process of scaling up clinic throughput -- daily doses -- in direct response to increased vaccine availability.

In accordance with the provincial framework, our priority is to vaccinate people born in 1941 or earlier, get all nine city-operated clinics running to maximize access across the city, and then increase throughput so each of the nine clinics are operating at maximum capacity.