Ontario pharmacies facing an 'administrative nightmare' when booking 2nd vaccine doses

For Kyro Maseh, the approximately 1,100 people vaccinated against COVID-19 at his Toronto pharmacy represent both a badge of honour and a fast-approaching burden.

In one respect, Maseh is celebrating the figure as a sign of his pharmacy's contribution to ending the pandemic.

But Maseh also knows a bill is coming due soon, since he and his staff will have to contact each of his vaccinated patients, probably one-by-one, to make sure they come back for their second doses.

"This is an administrative nightmare," said Maseh, the owner of Lawlor Pharmasave, an independent pharmacy on a busy stretch of Kingston Road in Toronto's east end.

"I have to go into each patient's profile separately, click four or five times to find their email, send out an email and then have them book their second dose that way," he added.

Ontario pharmacies, which can administer the AstraZeneca COVID-19 vaccine to people 40 and older, are forced to navigate that complicated process largely because they are not allowed to schedule appointments through the provincial booking portal.

Instead, each of them have been operating under a mishmash of up to three separate scheduling, tracking and invoicing programs, which are said to be more complicated and harder to manage than a centralized system.

That approach is the cause of growing concerns that some patients could miss out on their second vaccine dose, either by falling through cracks between the various systems or because individual pharmacies may struggle to keep up with their growing patient lists.

Maseh plans to hire a new employee tasked exclusively with managing follow-up appointments. Ultimately, he said changes that make it easier for pharmacies to schedule appointments will be required.

"If that does not occur, you will get a significant number of patients that do not get their second dose," he said.

You can search for a pharmacy offering COVID-19 vaccines here.

Pharmacies expected to notify recipients

Ontario residents who schedule their COVID-19 vaccine appointments through the provincial booking portal are required to book both first and second dose appointments at the same time.

However, services that do not use that system, such as pharmacies and pop-up clinics, "may give you instructions on scheduling your second appointment when you get your first dose."

Ontario's largest pharmacy operators, Loblaw and Rexall, have both said they will send notifications to recipients when they become eligible for a second dose, which is currently set at up to 16 weeks after the initial dose.

Lisa Christensen, a Toronto resident who was vaccinated at a Shoppers Drug Mart on March 12, said she was initially told that the provincial government would follow up with her to book a second appointment.

"This process seems to have been fuzzy wuzzy," she said.

"I'm a university and college educated person, whose first language is English, who is middle class, I read newspapers, try to keep up with information and I still find the process, at least in Toronto, the whole thing a little confusing."

Flexibility, at the expense of consistency

Justin Bates, CEO of the Ontario Pharmacists Association, acknowledged the complexities and burden of the existing system on individual pharmacies, but said the decision did come with some advantages.

"What that meant early on is that we gained a little bit of flexibility," he said, since pharmacies could book appointments without being forced to use the provincial booking portal. 

"One of the disadvantages is that it's not a central system and that can create some inconsistencies," Bates added.

Further changes to complicate the second dose booking process could also be coming, including the possibility that patients who received the AstraZeneca vaccine for their first dose could be given a Moderna or Pfizer vaccine for their second dose. 

Ontario has asked the National Advisory Committee on Immunization to update its recommendation on that practice by mid-May.

The Pfizer and Moderna vaccines are more difficult to administer at pharmacies since they need to be stored at much lower temperatures than the AstraZeneca vaccine. 

However, Ontario is operating a pilot project now in which the Pfizer vaccine is being offered at select pharmacies in hot- spot neighbourhoods.