TORONTO — The images of 89-year-old Gisèle Lévesque rolling up the sleeve of her black cardigan to become the first person in Canada to receive a coronavirus vaccine transfixed the nation.
Health aides applauded. Canada’s health minister wept. Lévesque had spent eight months confined to her room in a Quebec City nursing home. The shot into her right deltoid brought hope to a country where the virus has infected more than 680,000 people and killed about 17,400 of them.
But one month into the largest mass immunization campaign in Canadian history, joy and relief have given way to exasperation and a smidgen of partisan finger-pointing amid a rollout that critics say has been uneven, bumpy and sluggish.
For much of 2020, a strong and largely unified response to the pandemic helped Canadian hospitals avoid becoming completely overwhelmed like those in many of its peer countries. But despite securing more vaccine doses per capita than any other country in the world, it has lagged the United States, Britain, Israel and others in getting shots into arms.
Canada has given at least one dose of a vaccine to 1.11 percent of its population, according to the University of Oxford’s Our World in Data site. The United States has administered three times as many doses per capita.
“The vaccine rollout across our country has lacked speed,” said Nathan Stall, a geriatrician at the Sinai Health System in Toronto. “It has lacked urgency. It has lacked transparency. And it has started to deviate from some of the priority populations … who need it most.”
Vaccinating a country as vast as Canada, and where some people live in very remote areas, was always going to be “an extraordinary logistical challenge,” former Canadian health minister Jane Philpott said.
Philpott, dean of the faculty of health sciences at Queen’s University in Kingston, Ontario, noted that the speed has picked up in recent weeks. But there is “still a significant need to accelerate,” she said, “and a lot of anxiety around the pace with which vaccines are getting into the country and getting delivered out to provinces and being administered.”
Many of the issues dogging Canada’s rollout — inadequate planning and coordination, a slower than desirable speed and logistical complications posed by the ultracold storage required by some of the vaccines — mirror those of other countries.
In some parts of Canada, responsibility for administering vaccines has been downloaded onto already strained hospitals. Some areas paused vaccinations over the holidays, prompting an outcry. Ontario took weeks to figure out how to get the Pfizer vaccine into long-term care homes long after other provinces had found solutions.
The federal government is responsible for procuring vaccines and distributing them to the 13 provinces and territories. Provincial and territorial officials decide which groups to prioritize and handle the logistics of delivering doses.
Some jurisdictions are running out of doses before new shipments arrive. In others, thousands of doses are sitting in freezers.
Anita Anand, Canada’s procurement minister, has likened the vaccine strategy to “betting on multiple horses” and hoping one pays off. The government struck deals with seven pharmaceutical firms for up to 414 million doses and boasts that its vaccine portfolio is the world’s largest per capita — enough to vaccinate the country’s 33 million teenagers and adults several times over.
But that’s contingent on regulators approving those vaccines. Canada placed one of its largest bets — for up to 72 million doses — on a vaccine being developed by Sanofi and GlaxoSmithKline that’s unlikely to be available before the end of 2021 after data showed an insufficient response in the elderly.
So far, Canada has guaranteed a supply of 80 million doses, half from Pfizer and BioNTech and the rest from Moderna. Both require two doses. The government is aiming to vaccinate all Canadians who want one by the end of September.
Six million doses are expected before the end of March. Maj. Gen. Dany Fortin, the military commander in charge of Canada’s coronavirus vaccine logistics, acknowledged this week that there would be a “scarcity” of resources in the first quarter of the year, but said supplies would then “ramp up.”
Judith Sayers, president of the Nuu-chah-nulth Tribal Council, which represents 10,000 members of 14 First Nations on the Pacific Coast of Vancouver Island, wants the pace to increase. Fewer than 1,000 people have received at least one dose.
She said vaccine hesitancy, rooted in part in a distrust of a health-care system that has discriminated against Indigenous people, is a concern. Doctors and nurses are hosting Zoom calls to answer questions and combat misinformation.
“We want to make sure our elders, our speakers, our historians and our knowledge-keepers are protected as much as possible,” Sayers said.
Some analysts question whether the vaccination of priority groups is moving fast enough.
Stall said Ontario had enough doses to vaccinate all of its long-term care residents before the end of 2020 but did not. Now only those in four provincial coronavirus hot spots will be vaccinated by Jan. 21. Models show deaths in long-term care homes are on pace to exceed those of the deadly first wave.
Meanwhile, low-risk employees of acute-care hospitals with little or no patient contact have received vaccines — doses critics say should have gone to long-term care homes. Supply is not an issue, they say: About 20 percent of Ontario’s doses are in freezers.
“I think that there is a real tragedy in how we’re prioritizing,” said Allison McGeer, the director of infection control at Toronto’s Mount Sinai Hospital. “I’m finding it very difficult to watch.”
Prime Minister Justin Trudeau said this month that he was “frustrated” to see vaccines in freezers.
But some premiers blamed Ottawa for the hiccups. Alberta Premier Jason Kenney has said his province is running out of doses before new deliveries from the federal government arrive. He has floated procuring doses himself.
Manitoba Premier Brian Pallister said his province needed more than “a squirt gun” of doses. It has administered 35 percent of doses distributed to it, outpacing Nova Scotia, which has administered 28 percent.
Some provinces, including Quebec and British Columbia, are lengthening the intervals between first and second doses of the vaccine to stretch their limited supplies.
The vaccinations come at a critical time in Canada’s epidemic. The country recorded a seven-day average of 7,727 cases on Thursday, up 18 percent from the previous month. The daily number of new cases is more than triple that of the peak of the spring wave, according to the Public Health Agency of Canada.
Surging hospitalizations in many provinces are straining the health-care system. Quebec implemented Canada’s first curfew this month, while Ontario delayed the reopening of schools after the holidays in hard-hit areas.
“A lot of people are portraying this as a race between the vaccine and the virus,” said Jeff Kwong, an epidemiologist at the University of Toronto. “But really the vaccine has had a massive head-start on us.”
David Naylor, the co-chair of the federal government’s covid-19 immunity task force, said the initial rollout was “somewhat slow and chaotic,” but it has improved. The federal government’s next step, he said, should be to clarify the supply chains so provinces and territories “can plan more effectively.”
Future phases of the rollout, he said, are likely to feature more complex questions, including whether doses should be prioritized for regions with higher caseloads or distributed on a per capita basis.
McGeer, the Mount Sinai infection control director, is not optimistic the country can finish vaccinations by the end of September.
“It is very clear to me that we could meet that target if we choose to,” she said. “It’s not so clear to me that we’re going to choose to.”