As Canada's largest-ever immunization campaign enters its second week, lower-risk Canadians are being asked to step aside so the most vulnerable to swine flu can continue to get their shot first.
This had been the day that most provinces had planned to start offering the vaccine to everyone, not just those at high risk of complications from the flu, such as those who are pregnant, have asthma, diabetes or another chronic illness.
But with demand much higher than expected among those groups, and shortages expected, officials in most provinces have decided to keep the focus on high-risk groups before turning to the general population.
Many clinics are screening patients looking for the vaccine, to ensure they really are high-risk, and asking parents who bring along young children to not get the vaccine themselves if they are otherwise healthy.
Pregnant women are also included in the high risk group, and the Public Health Agency of Canada announced Monday that it would roll out the first doses of a special vaccine for them.
Officials expect to give out 225,000 doses of the vaccine for pregnant women by the end of the week.
Until now, most provinces agreed not to turn anyone away, especially since many were waiting hours in line with others at high risk. But with shortages expected, that approach is changing.
While Alberta first chose to vaccinate anyone who showed up at flu shot clinics, that led to the temporary closures of some clinics, because of shortages. So now, health officials say they will concentrate on immunizing only high-risk groups.
Ontario is imposing similar restrictions. But Ontario's chief medical officer, Dr. Arlene King, acknowledges that people won't have to prove they're at high risk and clinics will essentially operate on the honour system.
Restrictions will be stiffer in Nova Scotia. That province has ruled that people under age 65 with chronic health conditions are no longer considered in the high-risk category. Only pregnant women, children under five years old, First Nations communities and health-care workers will be eligible for the vaccine. Everyone will be turned away for now, until the vaccine shortage eases.
In P.E.I., only half of the expected vaccine doses for this week have arrived. With the province running dry, four clinics will be given the remaining vaccine to children six months to school-entry age, as well as to household contacts of children less than six months.
Production slowdown to last a week
The restrictions are being implemented because vaccine maker GlaxoSmithKline has announced it will only be able to produce about 400,000 doses of the vaccine this week instead of the million or so doses expected.
Adjuvant is an additive in a vaccine to boost the immune system. The World Health Organization had earlier told pregnant women to avoid the adjuvant because it had not been widely tested in pregnant women. On Friday, it told pregnant women to get whichever vaccine is soonest available.
Canada ordered 1.8 million doses of the vaccine from the vaccine manufacturer. This caused the shortage of the regular vaccine.
Health Minister Leona Aglukkaq explained to Canada AM that GSK had underestimated how much the changeover from manufacturing the regular vaccine to the unadjuvanted one would choke supply.
"GlaxoSmithKline overestimated their ability to produce the adjuvanted vaccine while they focus on unadjuvanted vaccine," she said Monday.
"That vaccine will be distributed. The following week we expect to be back to the normal production and that vaccine will continue to flow to the provinces and territories."
The minister added that while it was federal health officials who devised the guidelines that selected those who should get the vaccine first, how the vaccine gets into the arms of Canadians is up to the provinces.
"Ultimately, at the end of the day, the provinces and territories decide who they will distribute their vaccine to, for their rollout plans," she said.
Aglukkaq made similar comments to CTV's Question Period on Sunday, adding she was still confident that every Canadian who wants the vaccine will be able to get it by December.
"We have to have this government take responsibility and help the provinces and territories and not blame them and say 'it's not my department'" Liberal MP Dr. Carolyn Bennett said in an interview on CTV News Channel.
Some infectious disease experts worry December may be too late, since this fall's "second wave" of H1N1 is expected to last only a few weeks.
Others, such as Dr. Michael Gardam, Director of Infection, Prevention & Control at the Ontario Agency for Health Protection and Promotion disagree. He notes that while there has been a lot of flu activity in B.C. and case numbers are ramping up in parts of Ontario, "other parts of the country are just beginning to see an increase in cases.
"So it's still going to be spread out over many months. I think if people can still get their shots in a few weeks from now, depending on where they live, it's certainly doing it," he told Canada AM Monday.
Even if flu activity peaks, the virus will still be out there for a while yet. And, notably, he said, it isn't mutating, despite Internet rumours to the contrary.
"This strain has been remarkably stable throughout the world. We're still dealing with the same virus we were dealing with back in April," Gardam said.
Emergency debate on Parliament Hill
In an emergency debate in Ottawa requested by opposition MPs, critics blasted the federal government on the long lineups and the shortage.
Liberal Leader Michael Ignatieff called the government incompetent, saying the government has released confusing information about the H1N1 vaccine which is "a source of enormous anxiety among Canadian families."
Aglukkaq responded by saying there will still be vaccines for those who want it.
Earlier in the day opposition MPs peppered the Conservatives with questions in the Commons, asking why there has been such confusion given that the government said months ago that it was prepared.
"Six million doses were produced ahead of schedule. As soon as they were available and authorized, they were transferred to the provinces and territories for their rollout. We will see thousands more this week and a million more next week," said Aglukkaq.
"They need a clear communications strategy from the government in terms of clear and unambiguous messages," Bennett told CTV News Channel.
Referring to Aglukkaq's statement in parliament that public health officials have done hundreds of media interviews on the issue, Bennet said they were not enough in the wake of the public's confusion.
"That cannot substitute for a public awareness campaign that should've happened all summer," she said.
CTV News Channel invited members from the Conservative party to participate in the discussion but they declined.
