Some Toronto hospitals have started vaccinating staff who don’t deal directly with patients — and, at Michael Garron Hospital, offering doses to executives — raising questions over the ethics of immunizing these employees ahead of community health workers and the thousands of long-term-care residents and staff still waiting for shots.
As Ontario’s case counts continue to explode, and fears mount over more easily transmissible new variants of the coronavirus, there is growing urgency to vaccinate as quickly as possible, especially in long-term-care facilities, where mortality rates have been highest.
Hospitals are distributing scarce vaccine doses according to provincial guidelines that prioritize the highest-risk individuals and face intense pressure to vaccinate as quickly as possible. But in some cases where frontline staff have already been vaccinated, or surplus doses are at risk of being thrown away, some hospitals have started offering vaccines to executives or low-risk employees who don’t interact with patients — even as other hospitals, community health workers or long-term-care homes await first doses.
On Sunday night, a leaked email from University Health Network revealed the hospital system had secured a “limited” number of vaccines from Newmarket’s Southlake Regional Health Centre and was offering them to all staff, including researchers. Health workers on social media reacted with outrage, questioning why Southlake’s extra doses were being redirected to low-risk employees downtown when so many high-risk health workers — including in Newmarket — were still waiting to get vaccinated.
UHN spokesperson Gillian Howard said Southlake’s offer was made to five hospitals: UHN, Sick Kids, Mount Sinai, Women’s College and Toronto Grace. The Star, which obtained the UHN email, also surveyed 19 other hospitals that have received vaccines about whether they were offering doses to executives or staff with no patient contact.
Most of the hospitals who responded said they have so far been only vaccinating frontline staff that work with patients. Only Michael Garron Hospital said it is now offering doses to all employees, which includes its executives.
Dr. Isaac Bogoch, an infectious disease physician with UHN and member of the province’s vaccine task force, said Ontario’s clear priority right now is long-term-care residents, staff and frontline workers who come into contact with COVID-19 patients. “We shouldn’t veer from that,” he said.
Kerry Bowman, a bioethicist at the University of Toronto, believes offering the vaccine to non-frontline staff is “fundamentally wrong” and a “clear ethical violation” that should be investigated.
“There needs to be accountability and it erodes trust in the system.”
Officials at Southlake Regional Health Centre realized Sunday morning that the hospital had excess appointment slots, spokesperson Kathryn Perrier said in an email. She did not explain what caused the surplus, but said Southlake offered its extra doses to UHN because “we were aware that they had run out of vaccine.”
Last week, UHN’s CEO and president Dr. Kevin Smith tweeted that the hospital would be out of vaccine by Friday, and had 3,000 people booked to receive doses over the following three days.
“Our objective, while keeping with the provincial prioritization framework, was to ensure that no vaccine supply was wasted,” Perrier said. “The Pfizer doses planned for Sunday’s clinic were already onsite yesterday morning and could not be transported, which is why staff from UHN came to Southlake.”
Once vials of Pfizer and Moderna vaccine are thawed they can’t be refrozen, according to Health Canada.
Perrier did not respond to questions about whether the hospital first tried offering its additional doses to long-term-care workers or community doctors, and directed the Star to York Regional Public Health.
The agency redirected the Star back to Southlake to answer questions about “specific decisions made” by the hospital. But spokesperson Patrick Casey said all staff and residents at long-term-care homes in York Region were expected to receive their first dose of vaccine by end of day Monday.
As for redirecting hospital doses to community doctors, at Michael Garron, spokesperson Shelley Darling explained that hospitals are “not permitted” under the provincial distribution plan “to administer the COVID-19 vaccine outside of health-care workers and physicians working in long-term-care homes (LTC), priority retirement homes and hospitals.”
Howard said that when UHN received Southlake’s offer on Sunday, the downtown hospital network had already vaccinated all of the long-term-care and retirement homes that it’s responsible for.
She said no UHN executives have been vaccinated and the hospital’s process is to first offer vaccines to those directly caring for COVID patients. She added that UHN also has 300 researchers working directly on COVID “and therefore at risk for both disease and transmission.”
She said it was up to individual employees “not to step forward if they are not patient-facing.”
“We have to rely on the honour principle of staff and others as we roll out a mass vaccine campaign,” she said. “We certainly are discussing what disciplinary actions should be considered for those who are jumping the queue.”
She said further complicating things was the fact that the Pfizer vaccine originally couldn’t be moved from the site (because it needs to be kept at super-deep-freeze temperatures).
“Later, UHN demonstrated how Pfizer could safely be moved so we now have the capacity to use Pfizer and Moderna in long-term care, which we are doing,” Howard said, adding the task force is not recommending moving vaccines out of red zones to communities with less COVID.
But Bowman said the email sent by UHN did not make clear that staff who don’t interact with patients should avoid raising their hands for Southlake’s extra doses, and does not blame individual employees who might have signed up.
“The hospitals were completely wrong to do this,” he said.
At east Toronto’s Michael Garron Hospital, all employees are now being offered the vaccine, including communications staff, employees who work from home, and executives, though the president and CEO, Sarah Downey, has not received the vaccine, spokesperson Shelley Darling said in an email.
This is “to ensure there are large volumes of eligible people in our clinic each day to meet the 500 doses a day goal,” Darling said.
She added that the hospital is following the province’s guidelines for how to prioritize vaccinations among its employees, and has already vaccinated all the long-term-care residents in homes it supports.
Bogoch said the province’s senior task force leadership is aware that non-frontline workers are currently getting vaccinated, and it’s being addressed.
He stressed the importance of sticking with the province’s ethical framework — but also that every effort should be made not to waste vaccines. “We should have better systems in place,” he said, to make sure they “go into the most high-yield arms possible given that there’s such a shortage of vaccinations.
“There’s no finger pointing, it’s a team sport. There’s going to be mistakes and we’ve got to get it right, and if there’s mistakes along the way, OK, let’s correct them and move on.”
Dr. Samir Sinha, director of geriatrics at Mount Sinai Hospital and University Health Network, said UHN was clear in previous emails, one of which was seen by the Star, that the vaccines should only be for researchers who interact with patients.
But what troubles him is that there are still so many long-term-care staff and residents waiting — and they’re the ones at highest risk of getting sick and dying of COVID.
“These are the folks that need to be absolutely at the front of the line, before I would argue even other frontline health-care workers or patient-facing research staff,” he said.
Bowman said there needs to be a “clear protocol” that’s aligned with the prioritization framework about how leftover doses at the end of the day are distributed.
Phase 1 of the vaccine rollout should clearly be targeting “significantly vulnerable people and the people that care for them,” he said.
“There’s no point in having guidelines if we’re not going to stick to them.”