Published November 30, 2022

Ontario auditor general finds COVID-19 vaccine wastage, unco-ordinated bookings

The auditor also said the province's COVID-19 vaccine communication strategy was not always effective
Ontario COVID Vaccine Wastage - CP

By Allison Jones in Toronto

Ontario wasted 38 per cent of COVID-19 vaccine doses between February and June because it overestimated demand for boosters, said the province's auditor, who also found the government ran a disorganized booking system and doesn't fully track adult vaccinations.

Auditor general Bonnie Lysyk said in her annual report Wednesday that overall COVID-19 vaccine wastage is nine per cent, or 3.4 million doses. About half of that could have been avoided with better forecasting of demand.

Wastage rates varied quite a bit between public health units, and one private company wasted 57 per cent of its supply between May 2021 and May 2022, but the province hasn't determined the causes, Lysyk said.

Health Minister Sylvia Jones offered a partial explanation at a news conference Wednesday, saying that one of the clinics that company ran was for seasonal agriculture workers arriving at Pearson International Airport, and their arrivals weren't always predictable.

"I am incredibly proud and satisfied that as a result of the work that we did...over 82 per cent of Ontarians over the age of 12 are fully vaccinated in the province of Ontario," Jones said, referring to those who have received two doses.

"Whether it was in pharmacy, whether it was in a mass vaccination clinic, in community or in some cases in businesses, whether it was at your local pharmacy, we got the job done, and we now have a protected community as a result."

Ontario is at about the middle of the pack when compared to COVID-19 vaccination rates in other provinces and territories. 

The auditor said the province's COVID-19 vaccine communication strategy was not always effective.

"It was disorganized, inconsistent and lacking detail about the benefits of COVID-19 vaccines and vaccination, suggesting that Ontarians may not have been as well informed as possible in their decision-making," Lysyk wrote. 

"The Ministry did not always provide clear information on whether to get additional vaccine doses and did not effectively combat misinformation about the vaccine. Health experts informed us that they believed the government’s communication approach sometimes undermined public confidence in vaccination."

She also identified problems with the system for booking vaccination appointments, as the province created its own portal but about half of public health units are using their own, while some hospitals, pharmacies and private companies are using their own methods as well.

"Multiple booking systems also encouraged Ontarians to 'vaccine shop' by registering for multiple appointments to try to get either the quickest appointment or a specific vaccine brand," Lysyk wrote in the report.

"The continued absence of a centralized booking system (as of August 2022) increases the likelihood of unnecessary wastage continuing into the future since such no-show appointments can result in more wasted doses of vaccine."

Multiple bookings led to about 227,000 no-shows in 2021 in the provincial booking system alone, the auditor found, which likely contributed to vaccine wastage.

The lack of a centralized booking system also led to inconsistent controls and checks to ensure that when bookings were opened up to particular groups, such as health-care workers or immunocompromised people, only those eligible were actually making appointments, Lysyk found.

Family doctors were underutilized in the vaccine rollout, Lysyk found, noting that the compensation structure provided a disincentive for them to administer shots in their own offices.

Physicians were paid between $170 and $220 an hour by the government to work at vaccination sites operated by a public health unit or a hospital, while doctors were paid just $13 per dose to vaccinate in their own offices.As well, Lysyk found that physicians at clinics were paid much higher rates to administer shots than nurses, who were paid between $32 and $49 an hour, and pharmacists, who were paid between $30 and $57 per hour.

The Ministry of Health conducted a study of procedures and effectiveness at nine mass immunization clinics between the summer of 2021 and December of that year and finalized the study this July, Lysyk wrote, but did not share results with public health units to help them plan for the rollout of the bivalent vaccines this fall.

As well, the auditor says that despite the Ministry of Health saying in 2014 that it was going to expand a system used for tracking student vaccinations to keep vaccine records for all Ontarians, that has not happened.

Lysyk also recommended the government develop better stockpile planning for personal protective equipment. The province experienced a shortage at the beginning of the pandemic and the government invested heavily in domestic manufacturing. In January 2021 the government entered into a five-year, $99-million contract with 3M Canada for N95 masks.

The government has amassed a stockpile to deal with a viral surge, but if that doesn't occur, the stockpile will exceed 100 million units, worth over $81 million, Lysyk's report said.

As of March 31, Lysyk said the government had $66 million worth of expired, damaged or obsolete PPE inventory.

The auditor also found that contracts for goods and services related to COVID-19 were timely given the urgency of the pandemic, but better co-ordination could have reduced some costs.

About $18.7 million was paid to private companies for underutilized mobile COVID-19 testing, the auditor found.

"Vendors were paid a guaranteed minimum daily payment to cover overhead costs even if a minimum number of COVID-19 tests were not performed," Lysyk wrote in the report.

One vendor charged its guaranteed minimum daily payment of $8,255 whether zero tests or 250 tests were performed in a day, the report said.

The audit identified 105 instances, representing $800,000, in which vendors got their guaranteed minimum daily payment despite testing no one that day.

Lysyk also pinpointed issues with contracts elsewhere, finding the Liquor Control Board of Ontario's IT procurement processes don't always follow the agency's own policies.  

The LCBO awarded $108 million in sole-sourced IT contracts above the dollar value that should trigger a competitive process, she wrote. That represents 42 per cent of all IT contract spending over a three-year period the auditor examined. 

The auditor reviewed a sample of 12 of those contracts and found that while all had business cases attached, none of those documents provided sufficient information to justify a non-competitive process.

"The LCBO explained that non-competitive contracts were more common for IT procurement due to existing legacy systems and because of proprietary rights in software," Lysyk wrote.

This report by The Canadian Press was first published Nov. 30, 2022.

Banner image via The Canadian Press

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