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By Dominic Covvey
and David Zitner

A COVID-19 vaccination is available now. However, a momentous challenge is before us: the vaccination of tens of millions of Canadians.

Provincial and federal health departments have considered who should have priority for vaccination and we trust that the final version of this prioritization, informed by the science of risk assessment, will be appropriate.

Dominic Covvey


However, our recent experience with influenza vaccination raises a concern. Recently, the annual influenza vaccination process in one (Dominic Covvey) author’s region was botched when, surprisingly, local health officials established a requirement for registration without reserving capacity. Consequently, weeks in advance, time slots were unavailable in privately- or publicly-funded programs.

We learned afterward that officials had not applied any prioritization criteria to registration; it was first-come, first-served. In addition, the requirement for registration was unusual. Previously, one could merely walk into the vaccination clinic on the scheduled day. The final straw was that, despite the stated requirement for registration, the clinic quietly accepted walk-ins.

It seems inappropriate that, with the concern over two simultaneous epidemics, those at greatest risk – front-line healthcare workers and the elderly, especially those with comorbidities – were not prioritized.

There’s a more significant issue, though. Physicians, clinics and hospitals have invested billions of taxpayer dollars in information systems for patient management. Patients should not need to register at all!


Rather, information systems can select patients by their characteristics, and schedule and assist in contacting them. The Algoma Health Unit in Sault Ste. Marie, Ont. used exactly that approach to manage an H1N1 vaccination program in 2009. The clinic contacted patients and invited them to attend at specific times, vaccinating 1,600 without lineups. Web-based registration can also accomplish this.

Recognizing the acute problems COVID-19 presents, it’s of critical importance that we make use of our e-health technologies to manage vaccination logistics. COVID-19 vaccination must be by priority. First in line must be those with the greatest risk, which we can assess based on pandemic morbidity and mortality statistics. Hotspots may also be high priority to gain control of viral spread.

We hope the Public Health Agency of Canada will have adequate supplies to distribute. Regretfully, this wasn’t the case with the 2020 influenza vaccine in all regions.

Once we have a vaccine, the next and crucial step is staging vaccination based on science. To do this safely, we need to avoid lineups and we must proceed efficiently in a patient-friendly way. We have the technologies in hand to do this.

This is a clarion call to the managers and users and of e-health technologies and to the citizens whose taxes support information technology and immunization. We now need to put our investments to work – thousands of lives may depend on it.

Dominic Covvey, the founding director of the Canadian National Institutes for Health Informatics resides on Mayne Island, B.C. David Zitner, MA, MD, FCFP, is a retired family physician. He was the founding director of the graduate program in Health Informatics Dalhousie University Faculty of Medicine, Halifax, N.S.

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