How closely does Hamilton have to follow Ontario's vaccine rollout?

Despite a provincial framework, Dr. Elizabeth Richardson, Hamilton's medical officer of health, says public health units across the province have been customizing their vaccine rollout according to local need.

But it's unclear just how flexible a public health unit can be.

Brant County, for example, is putting farmers at the front of the line for the vaccine. In Niagara, education workers were prioritized, while in Hamilton, they were not. 

"You can find someone somewhere in the province that is doing something, and you'll find a whole bunch of us that aren't," Richardson said in a board of health meeting Monday.

"And they're doing it because of local reasons, and the rest of us are doing it because we're trying to move through this broader approach to it."

But Richardson also says that flexibility raises questions from people who want to know just how far the city can depart from the main plan. 

"The more that that happens across the province, the more pressure that we get about... the challenges of trying to explain all those different components."

How far can public health units go?

Coun. Maureen Wilson (Ward 1, west end) said on Wednesday that the province was sending "confusing messages" that seemed to hint that local public health units have "a lot more liberties" than she previously thought.

She referenced Peel and Toronto, which issued orders earlier this week closing workplaces with five or more cases of COVID-19. Richardson said she isn't issuing a section 22 order at this time, but was considering additional measures. 

Under section 22 of the Health Protection and Promotion Act, medical officers of health can issue orders in the name of stopping the spread of communicable diseases.

Ontario's Ministry of Health and Long-term Care said that while the province has "one plan" for distributing and administering vaccines, each public health unit is responsible for implementing it and following the priority populations Ontario identifies.

"How that plan is implemented and the specific mix of vaccination sites (hospital clinics, mass vaccination sites, pharmacy, mobile clinics) will look a little different across 34 public health units with unique needs and populations," the ministry said in a statement. 

But the ministry didn't answer if there were limits to how a municipality can change things, or repercussions should it stray too far from the framework.

Hamilton has departed from the provincial framework before. Richardson pointed to the city's decision to vaccinate people in homeless shelters ahead of Ontario moving into phase two because of concern for ongoing outbreaks.

City naming its own hot spots

Just over a week ago, Hamilton also decided to identify three more postal code areas as hot spots, allowing residents aged 50 and older to book vaccine appointments. 

The province only officially designated two areas, and despite Hamilton public health's request, didn't expand to include the others. 

When asked what impacts there were since the city made the call to add those postal code areas — and not the province — Hamilton Public Health Services said "this does increase call volumes and wait times for community members when booking a vaccine appointment."

It referred CBC News to the same response when asked about whether there was a need for more vaccines due to the expansion.

Since the province doesn't recognize those three postal code areas (L8L, L8N and L9K) as priorities, if residents are booking an appointment based on that eligibility, they have to do so through the city COVID-19 hotline.

Everyone using the hotline

People who live in provincially designated postal codes (L8W and L9C) can use that hotline too, but they can also go through the provincial online booking tool.

Premier Doug Ford has also said all adults will be prioritized in its postal code areas, first starting with Toronto and Peel. 

It's yet to be seen whether Hamilton will drop the age in the city-identified neighbourhoods in accordance with the province.  

Richardson said the vaccine prioritization has had a lot of thought put into it "from all sorts of different walks of life" and that the province is updating it along with more transmissible variants of concern. 

"There has been political input into it. There has been scientific input into it. There has been input from the many, many people who are making submissions around it," she said.