London Middlesex Primary Care
COVID-19 Vaccination Update
December 30, 2020
Update on COVID-19 Vaccination
(for pdf version click here)
It has been nearly one week since the first Pfizer-BioNtech vaccine dose was administered in our region at the vaccination clinic in the Western Fair District Agriplex. Since that time approximately 750 health care workers have received their initial dose of the vaccine.  A team of staff and physicians continues to ramp up efforts with an expected capacity to administer 500 doses each day next week. This team is committed to administering as many doses to as many eligible workers as soon as possible.

This letter provides an update of the vaccine rollout in the London Middlesex region.

1.     Current state
2.     Primary care participation at the Agriplex clinic
3.     Future phases

Current state

We are in the first of three stages of the province’s vaccination plan.  Guided by the provincial plan, it focuses on congregate care staff (e.g. long-term care, retirement homes co-located with LTC homes or those with memory units). In our region, this represents roughly 10,000 people and given our current supply, this group remains the priority focus for vaccine distribution.

As part of the provincial framework for this initial phase of vaccine rollout, additional eligible groups will include:

  • Residents of long-term care, retirement homes and other congregate living settings
  • Health-care workers
  • First Nations Inuit and Metis populations
  • Adult recipients of chronic home care services

Commissioning the vaccination clinic at the Agriplex began on December 16.  On December 21 vaccine supply was received and in December 23, the first clinic was hosted.  The development of the clinic has been based on the direction and specifications of the government.  For instance, a provincial IT solution has been developed and deployed to track and document the vaccination administration.  You will see that if you work at the clinic.   The OPP inspected the site and certified it for use and all staff have received cyber security training and training on the use of the application. These are but a few examples of the specific work streams that were directed by the province.

Right now, the facility includes a 40,000 sq. ft. space with screening areas, registration areas, waiting areas, 12 vaccination stations (scalable to larger numbers), preparation areas, supply logistics, post vaccination waiting areas, a check out area and a call centre for booking appointments.  Each of these sections and areas is staffed by specific teams currently from LHSC, the MLHU, paramedicine and other support companies who work either with the Western Fair or with LHSC.  At any time during a clinic day 45-55 staff are present on site.  During the commissioning phase IT infrastructure was added including network and hardware, construction of the facility was completed and supplies and logistics put into place. 

Clinic volumes began slowly in the first two days as training was still underway in parallel with the clinic operations. As well, various operational issues were still being addressed and fine tuned.  This week the target is to hit 400 appointments per day.  Over the weekend volume will be reduced based on staff availability but next week the plan is to have capacity for 500 appointment slots.  This will grow as more stock is received and as the first cohort returns for their second dose. Of course, this site can be used in the future as the vaccination program grows.

The explicit focus of this clinic at present is to vaccinate those who work in long term care homes.  This cohort could be as high as 10,000 individuals.  Each home in the three health unit catchments was informed of the vaccination program on December 21.  They provided staff lists and prioritized up to 15% of their staff to call and book appointments.  This percentage was recommended to avoid any staff shortages due to any post-vaccine symptoms that could disqualify staff from working during this holiday time where staffing is limited.

One of our biggest issues is of vaccine availability in these early stages of the program. When the clinic was opened the future supply chain beyond the initial shipment was unknown.  In the last few days, LHSC has received confirmation of more weekly shipments over the next three weeks. The initial supply plus expected deliveries in the coming weeks will be sufficient to completely vaccinate between 9,000 to 10,000 individuals. Now that the supply chain is more sustainable, the clinic is able to administer as many doses as they can and not hold back supplies for second doses. However, the vaccine remains a scarce resource, and unfortunately, prioritization does have to occur. 

Some have questioned why the Vaccination Clinic did not operating on December 25th to 27th.  In the spirit of transparency, we would like to explain some of the background on this issue. The consensus amongst provincial groups was to remain closed these days and open again on December 28.  This was based on the recognition of the health human resources challenges in the hospitals in question; many of whom are also dealing with burgeoning ICU capacity, long term care support and their own outbreaks. 

Health human resource (HHR) constraints are a challenge. While the excellent response from physicians would have filled the vaccinator role there are many more roles that are required at this stage that are completely dependent on hospital and HHR (Pharmacists, Pharmacy Technicians, Nurse Educators, Nurses, Security, ITS, Leaders, call takers / schedulers). This is the same resource pool that is already over worked (like many are). We hope to be able to expand to community-based resources as the program expands.  Currently on any given day about 45-55 people work at the Agriplex and vaccinators are not the rate limiting staffing group.

Additionally, there was concern about staffing availability for long term care homes given that some staff vaccinate could experience symptoms which could have disqualified them from work during the holidays. Given many homes tenuous staffing status over the Christmas break, no one wanted to cause any further staffing challenges at that time.  

However, with more experience of the vaccine and building capacity to administer the vaccine we plan to be open on over the New Years weekend. We also are moving to a 7-day a week clinic. 

Primary care participation at the Agriplex clinic

The response and interest shown by the entire primary care sector has been enthusiastic and we are grateful for your commitment to help. Marshaling a large team of 45-55 staff per day to run the operation at the Agriplex is a significant draw on resources so the participation of primary care physicians will be critical in our success.  Primary care physicians who are credentialed at LHSC have been contacted or will be in the coming days to schedule their participation at the Agriplex.   Physicians who are not credentialled may be contact in the near future once the ongoing needs of the clinic are better known. LHSC’s teams will provide training around clinic operations and the provincial electronic documentation system as well as information on how to bill OHIP for your clinical services. 

The plan for physicians is to book into 3.5-hour time slots (930-1300, 1300-1630) up to a maximum of four on the first round of shift offerings. Physicians will need to arrive about 15-30 minutes before the start of their first shift so we can ensure that they can log into CovaxON (the provincial IT system) and so that staff can review the process with the physician.  The process is driven by the software and includes confirming consent, reviewing any contraindications to vaccination and a two-client identification. The vaccination process is taking about 5-6 minutes per client.  Clinical Informatics support will be available until the physician is confident with the process.

Future phases

Within the provincial framework, planning for future vaccine rollout continues in a collaborative manner with the Middlesex-London Health Unit (MLHU), Huron-Perth Public Health (HPPH), Southwestern Public Health (SWPH) and London Health Sciences Centre (LHSC). Primary care representatives have also been invited to participate in the planning process, and Dr. Gordon Schacter has recently joined the initial planning meeting. We are now working to ensure that the planning work is integrated into structures such as the sub-regional triads which partner public health, acute care hospitals and primary care in each sub-region.

As more vaccine becomes available, other health care workers will be prioritized.  The health units are developing an inventory of various health care provider groups and organizations.  Efforts will start shortly to prioritize other community-based health care workers. LHSC is leading the work to prioritize hospital health care workers and will be engaging hospitals in that work next week. All of this will be used to schedule vaccinations in a staged and priority driven manner.  A provincial prioritization guideline is being used that assesses:

  • Risk of exposure to COVID-19 within a health-care setting based on health-care worker role or responsibility;
  • Risk of severe disease or outcomes from COVID-19 among patient population served; and
  • Criticality to health system capacity (of the individual’s role)

Last week, Health Canada provided regulatory approval for Moderna’s COVID-19 vaccine, which we anticipate will be added to the regional vaccination program shortly.  We are in the very early stages of what will become a mass vaccination program; much like we see each year with the flu vaccine. In the coming weeks and months more vaccines will be approved by Health Canada and a more robust supply of all vaccines will be available for the entire population. This larger vaccination program will be directed by public health and will include a wider variety of vaccination providers and operations.

This is an exciting time and one of significant optimism.  We are committed to communicating more as more information becomes available.   Rest assured that we all want the vaccination program to expand as quickly as possible and to meet the diverse needs in our communities.

If you have any questions please reach out to us and we can route your inquiry to the appropriate contacts.

Neil Johnson
Chief Operating Officer, LHSC

Dr. Gordon Schacter,
London Middlesex Pandemic Clinical Lead

Dr. Alex Summers
Associate Medical Officer of Health, MLHU
If there are non-hospital COVID-19 related issues/solutions in your region, please escalate them to your
Regional Pandemic Clinical Lead
(tasked by Ontario Health West to facilitate, coordinate, and engage with stakeholders for the pandemic response within the SW LHIN area RE: primary care/vulnerable populations)...structure HERE.
Dr. Gordon Schacter
Co-Chair, SW Prim Care/Vulnerable Pop'n Response
London. Middlesex Pandemic Clinical Lead