Only 28 per cent of Torontonians received the H1N1 vaccine, far below the 75 per cent targeted by the province.

A report to be presented to the city’s Board of Health next Tuesday states that the estimated vaccination rate of Toronto residents was 28.2 per cent. And it confirms what many have long suspected — that the vaccine arrived too late.

The report, essentially a post-mortem on how the pandemic was managed, outlines lessons learned that can inform pandemic and emergency planning in the future.

While the city’s response was a success in many ways, “things can always be done better,” said Dr. Barbara Yaffe, the report’s lead author and director of communicable disease control for Toronto Public Health.

The public health unit was stymied by changing directives from the provincial health ministry, the report states. For example, the initial plan stated that only public health units administer the vaccine. That was later expanded to include physicians and hospitals.

The report calls on the ministry to review options for efficient vaccine delivery and to clarify criteria for decision-making during an influenza pandemic. It notes that the roles and responsibilities were unclear for the Ontario Agency for Health Protection and Promotion and the province’s 14 local health integration networks, which coordinate local health care services and funding.

Asked about the 28 per cent vaccination rate, Yaffe said: “Obviously I would have liked to have seen it higher, but I think that given all the challenges that we faced, it wasn’t bad.”

The health ministry has said an estimated 38 per cent of Ontarians were vaccinated. Yaffe said she couldn’t explain the discrepancy. Noting the numbers were only “estimates,” she said only about 70 per cent of family physicians who administered the vaccine submitted regular reports on vaccine uptake.

Yaffe said she was disappointed by the low vaccination rate among health care workers. Only 39 per cent of employees in long-term care settings got the shot, 58 per cent in acute care settings such as hospitals, and 59 per cent in complex continuing care facilities, which provide a higher level of care.

Last year, the health board urged the province to make flu shots mandatory for health care workers if coverage rates don’t increase.

The report found that most of the serious illness from the virus occurred before significant immunity from the vaccination was achieved.

“In retrospect, the vaccine came too late,” Yaffe said.

The peak of the infection in the second wave occurred at the end of October, just as vaccine was made available to priority populations. It took up to two weeks for the vaccine to become effective after administered.

Another challenge facing the public health unit was the “lack of robust surveillance systems” that would identify how many people were ill in “real time,” the report said.

H1N1 quick facts

•More than 750,000 doses of the H1N1 vaccine were administered in Toronto.

•28.2 per cent of Torontonians got the H1N1 vaccine. In a normal flu year, 35 per cent of residents get vaccinated.

•Fewer than 50 per cent of physicians surveyed by Toronto Public Health felt the vaccine-ordering process went well. Frequently cited concerns included vaccine delays, excess red tape, wastage due to large shipments of the vaccine.

•There were 30 deaths associated with the H1N1 virus in Toronto and 428 in Canada.

Loading... Loading... Loading... Loading... Loading... Loading...

•Toronto Public Health’s website received 1.4 million hits between October and December 2009, a 200-fold increase over the same period in the previous year.

Source: Toronto Public Health