opinion: hunting for vaccines is insanity. we need to do better

by: dr. nili kaplan-myrthhave you ever had someone tell you a story and you wished that you could record every word the person said, to share it with the world? that used to happen every now and then in family medicine. we hear stories that are painful, or funny, or give us pause, and we file them away in our charts and in our hearts.with the pandemic, it feels as if there is a moral imperative, a greater urgency, to share what is said. patients sit across from me every day now, on the red sofa that is the hallmark of my little office, and they tell me about their lives during the pandemic, and i think, “the world needs to know this.” not the specifics of people’s lives, not the personal or medical details, but their messages need to be heard, the voices of the community need to be broadcast on loudspeakers so that someone in leadership, someone with the power to effect change, will hear them.three weeks ago, at our first “jabapalooza” — an immunization event that i organized with the help of medical students and community volunteers to immunize 220 people in the community — the city set up barricades on the street in front of my family medicine office, and we set up chairs and tables to get to work. then i got into my car to drive to the home of a person whose wife had reached out to me. i arrived with a photographer and reporter from maclean’s, and we were all invited into his home to stand at his bedside and hear his story.he had polio as a child. he recently fell out of his wheelchair, broke his legs, and was furious because he could not convince public health to arrange a mobile team to come and immunize him. although he was old enough to meet the criteria to register for his vaccine, he did not fit the category of “home care.” the day before i saw him, he was at the ottawa hospital for a medical appointment and yet nobody would walk down the hall with a needle to jab into his arm (the covid-19 vaccine clinic was just a few paces away).after he told us his story and we gave him his needle, i returned to jabapalooza to hear the stories of long-distance truck drivers, teachers, cleaners and postal workers. i ended the day with a second home visit, a gentleman with advanced amyotrophic lateral sclerosis (als) whose family had similarly given up, in great frustration, on the monumental task of accessing the vaccine through the province or public health.

the day was book-ended by these men with disabilities whose families knew their way around the health-care system and had the ability to reach out to me. they were aware that they enjoyed privileges that other people with disabilities lacked. i was filling a gap in the bureaucracy for them, but that was a chasm that others were unable to cross.last weekend, i stepped out of the rain to stand under a tent on the footy sevens soccer field, to speak with another 330 people who came for our second jabapalooza. this time, a local pediatrician, an expanded team of medical students and community volunteers listened as person after person told us their stories. oc transpo bus drivers, construction workers, grocers, early childhood educators, pilots, mechanics. they explained that they were on multiple pharmacy wait lists. they hadn’t been able to line up at 5 a.m. for pop-up clinics run by the city. there were outbreaks in their workplaces.at the end of the day, we had given 328 doses and we reached out to find people for our last two doses. within a matter of minutes, four people arrived on site. one woman had registered. i don’t remember her story. the other two women and a middle-aged man had not registered, but they understood that it was a vaccine clinic and had come to ask to be immunized. although the family did not speak a word of english, we communicated through gestures that we only had one dose left. the woman, whom i assume was the mother. pushed her son with down syndrome forward, asking us to immunize him. one of the volunteers phoned a friend who could translate for us, he filled in his consent form, and we gave him his jab. i did not post a photograph of him on social media, but i yearned to scream out to the world that we needed to do better, that all the “hunting” for vaccines is insanity, that we need to do a much better job in our province of taking care of the community.every day, i receive messages from people who aren’t my patients, who are asking me to help them because the provincial and public health system has no way to book their second doses if they weren’t booked when they got their first doses. i receive requests for vaccine from people who can’t rely on pharmacy wait-lists because their work requires them to travel distances, they aren’t in the vicinity of the pharmacy if their name is ever at the top of the list. i phoned every patient in my family practice to tell them that i want to plan jabapalooza 3 and give them their vaccine the moment it is available.i’m stuck, though, because our public health unit says they don’t know if/when there will be any more vaccine for primary care (although other health units have provided family doctors with mrna vaccines, ours has not yet done so). someone suggested that i refer my patients to vaccine hunters canada, instead, as if “hunting” for a vaccine is a reasonable alternative to being offered an appointment by a family doctor.i ask each person who comes into my office how they are coping with the pandemic. this week, a special education teacher sat down in my office examining room, leaned forward, and started to talk to me about how anxious he has been throughout the pandemic. “three parents of kids in our class were hospitalized. two other parents were admitted to the icu. the kids in our classrooms don’t keep their masks on. they bring the virus into the school, and then kids bring it home to their parents who are vulnerable. our school has to stay open, for these kids, but it feels like it is only a matter of time until further disaster strikes.”we talked about the murmurings of other schools reopening before the end of the school year. “it can’t happen. parents must be vaccinated,” he asserted. we sat and talked for a half an hour about the mental health of children with prolonged lock-downs, all the complex reasons that in-class learning is vital for so many students and parents, but then with furrowed brow and fists clenched, he groaned, “where were our leaders when they could have been proactive? when they could have done everything to avoid the need for another lockdown? paid sick days, smaller classrooms, testing, tracing, vaccine rollout.” with his permission, i am sharing his fears and anger with you.what we are dealing with, locally, pales in comparison to what the human population is up against, globally. one of my patients shook his head when i asked how he was doing. he told me that his family is in india and already 50 per cent of his relatives have been infected with covid-19.there’s been lots of talk in the media about people’s loss of trust in leadership, fatigue over jurisdictional squabbles, the confusion and consequences of poor communication about covid-19 vaccines. there is no question that vaccine rollout has been chaotic, uneven, inequitable, and bogged down in endless bureaucracy. we need to do better as ottawans, as ontarians, as canadians, and as global citizens.i don’t want to leave the impression that all of our stories are sad or angry. there are examples of innovation, of stepping outside the box, of people helping each other. we need to keep advocating for “all hands on deck,” to support initiatives in primary care, in pharmacies, in public health and hospitals settings, mobile units, outreach to vulnerable populations.we can do this with excellent outcomes. we need to step back and marvel at the existence of the covid-19 vaccines, the ingenuity of the scientists, the incredible work of everyone who has helped to get vaccines into arms, and we need to ask, “whose story aren’t we hearing, and how can we reach out to help?”hopefully, one day soon we can sit down together to share happier stories about reuniting with family and friends. first we have a lot of work to do, and we have to do it together.dr. nili kaplan-myrth is a family physician, anthropologist, writer, and co-host of rxadvocacy podcast. follow @nilikm