YORK REGION PUBLIC HEALTH - MASS IMMUNIZATION IMPLEMENTATION PLAN - January 2021
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YORK REGION PUBLIC HEALTH – MASS IMMUNIZATION IMPLEMENTATION PLAN January 2021
TABLE OF CONTENTS
Introduction ....................................................................................................................................... 4
Planning assumption ........................................................................................................................ 4
Incident Management System.......................................................................................................... 4
Partnerships ...................................................................................................................................... 5
Liaison Officer for Congregate Settings .......................................................................................... 5
Internal Partnerships - Mass Immunization Planning Advisory ........................................................ 6
External Partnership – Mass Immunization Task Force .................................................................. 7
Identification of Priority Populations.................................................................................................... 8
Proposed Implementation Strategy – Vaccination approaches ........................................................... 8
Current Site Structure ..................................................................................................................... 9
Phase 1 .......................................................................................................................................... 9
Late Phase 1 and Phase 2............................................................................................................ 10
Phase 3 ........................................................................................................................................ 11
Supply Management ........................................................................................................................ 11
Supply Transportation and Security .............................................................................................. 11
Receiving, Storage, Capacity and Handling .................................................................................. 11
Cold Chain Management .............................................................................................................. 12
Storage and Handling During Transportation and Administration .................................................. 12
Physical Security .......................................................................................................................... 12
Inventory Management/Tracking................................................................................................... 13
Human Resources ........................................................................................................................... 13
Orientation and Training ............................................................................................................... 14
Finances .......................................................................................................................................... 14
Management Oversight and Reporting ......................................................................................... 14
Expenditure Control and Approvals .............................................................................................. 15
External Financial Reporting ......................................................................................................... 15
Documentation and Reporting .......................................................................................................... 15
Surveillance and Monitoring .......................................................................................................... 15
COVAX Solution for Health Units .................................................................................................. 17
Evaluation Approaches .................................................................................................................... 17
Proposed Methodology ................................................................................................................. 18
Communication and Engagement .................................................................................................... 18
Contingency Planning ...................................................................................................................... 20
2
Appendix A – Vaccine Prioritization York Region ............................................................................. 22
Appendix B – Terms of Reference Mass Immunization Advisory ...................................................... 22
Appendix C – Terms of reference External Partner Task Force ........................................................ 22
Appendix D – Vaccine Hesitancy – Communication Best Practices Review ..................................... 22
Appendix E – Structure Mass Immunization Advisory and Working Groups ..................................... 23
Appendix F – Evaluation Methodology ............................................................................................. 24
3
INTRODUCTION
York Region Public Health (YRPH) initiated the planning for COVID-19 mass immunization at early
stages of the response. As a first step, a proposed framework for COVID-19 mass immunization
implementation was created leveraging YRPH’s Emergency Response Plan and outlined several
recommendations for next steps. The proposed framework is based on a flexible hybrid model for
vaccine distribution and administration to meet the various needs of the residents throughout York
Region. Additionally, one of the recommendations to establish a mass immunization advisory with
cross-departmental representation internal to York Region was put in place in October 2020.
Simultaneously, YRPH has worked to implement a staff scheduling software with a component built
specifically to meet the needs of staff scheduling in a mass immunization scenario. Based on learnings
from H1N1, this posed some significant operational challenges. YRPH has also, together with our local
municipalities, collaborated to finalize Memorandum of Understanding (MOU) for pre-determined
municipal facilities to be utilized as large-scale mass immunization sites.
Lastly, to ensure operational readiness to execute an efficient, safe and flexible immunization
campaign, YRPH has utilized several opportunities to pilot various components of the proposed model,
using the flu vaccine.
PLANNING ASSUMPTION
In the initial planning stages, many unknown variables were at play. YRPH sought to outline a flexible
infrastructure and framework able to withstand demand and rapidly changing operational conditions.
Based on this, the planning for mass immunization focused on innovative strategies with a health equity
lens to meet the need of York Regions population to access immunization in a timely safe manner.
The current planning assumption for YRPH are:
• To vaccinate at least 75% of the 1,213,602 YR residents (910,202)
• Public Health’s role: planning, coordination, support, distribution and administration
• Timing of vaccine distribution – starting late 2020 and rolled-out in stages during 2021
• Initial roll out to priority populations
• Double dose, 21 and 28 days apart (at least for two initial vaccines)
• Other providers to support immunization (e.g., physicians, pharmacies and hospitals) – at a
capacity of immunizing ~ 50% of the Regional population
• Drive-through immunization clinics can be operationalized over the months of April – October
• Support community run drive-through clinics led by local practitioners & mobile clinics led by
EMS
• The type of clinic (e.g., drive-through, mobile, static) will determine the speed of immunization
INCIDENT MANAGEMENT SYSTEM
YRPH activated its Health Emergency Operation Centre (HEOC) in response to COVID-19 on January
23, 2020. The Incident Management System (IMS) was the foundation of the operational set-up from
the time of the HEOC activation.
4As the response has grown and shifted overtime, the IMS structure has shifted accordingly to meet the
everchanging demands of the response. Figure 1. outlines the IMS structure current as of January 19,
2021. This structure represents a simplified version of the current IMS and does not reflect the
breakdown of the extensive branches within planning, operations and logistics.
Figure 1. YRPH IMS structure Jan 19, 2021
PARTNERSHIPS
To ensure adequate operational capacity and a comprehensive planning approach, an early focus was
set to build and leverage existing and new partnerships with both internal and external partners, local
organizations, practitioners and other stakeholders for the development of streamlined processes. In
addition, these relationships will enable access to and communication with vulnerable residents as well
as increased capacity to reduce potential vaccine hesitancy throughout the community.
Liaison Officer for Congregate Settings
Within the HEOC IMS structure the Liaison Officer has collaborated with hospital and provincial
partners to coordinate the response to support Long-Term Care Homes, retirement homes and
congregate settings with respect to vaccine distribution. The focus areas within these collaborations
have been:
5• Coordinating and liaising with Ontario Health (OH) on vaccine distribution for Long Term Care
Homes (LTCH) and Retirement Homes (RH)
• Providing internal support to the Vaccine Operations team on data related to numbers of staff,
residents, essential caregivers and agency workers
• Liaising and coordinating between the operations team and Ministry of Children, Community
and Social Services, York Region Social Services and Ministry of Health (MOH) on congregate
setting (CS) prioritization and planning
• Attending weekly LHIN meetings and communicating to LTCH/RH administrators (congregate
settings in the future) on vaccine plans
• Supporting as the main point of contact for LHIN leads and facilities within York Region
• Collaboration with hospital and provincial partners to coordinate the response to support LTCH,
RH and CS with respect to vaccine distribution
• Coordinating and liaising with OH on vaccine distribution overall
In addition, our HEOC Liaison CS, together with the COVID-19 vaccine operations chief have attended:
• 2 vaccine education sessions provided to LTCH administrators
• 2 vaccine education sessions provided to RH administrators
• 1 education vaccine education session provided to Mackenzie Health IPAC Hub
HOEC Liaison Officer work with primary care providers
During phase 1 of vaccine distribution, YRPH engaged local primary care providers to support
vaccination in LTCH and RH. YRPH was informed that practitioners throughout the Province had
indicated their interest in supporting vaccination efforts through a survey done by the Ontario College of
Family Physicians and a virtual meeting was hosted with local primary care providers on January 7th to
leverage their interest. To date, 55 physicians and 7 nurse practitioners have vaccinated alongside
YRPH immunizers and hospital partners.
Areas addressed by the HEOC Liaison officer within the collaboration include:
• Physician billing practices for immunization in LTCH and RH settings
• Remuneration for nurse practitioners, registered nurses, pharmacists and pharmacy technicians
• Continued engagement as YRPH plans for the second doses of COVID-19 vaccine for LTCH
and RH as well as the first doses for other congregate care settings
• Support the work to ensure that primary care providers will continue to be engaged to support
vaccination efforts going forward
Internal Partnerships - Mass Immunization Planning Advisory
YR mass immunization advisory held its first meeting in October 2020 (see appendix B for Terms of
Reference). The advisory has cross departmental representation in addition to partners such as York
Regional Police (YRP) and local Physicians. The COVID-19 Mass Immunization Advisory Group aims
to:
• Provide leadership and direction to mass immunization working groups in all operational areas
for the development and execution of work plans for the various clinic options (and reach
vulnerable populations) including staffing and resource needs and estimates
6• Develop and advance strategic recommendations for review and approval by the HEOC and the
Regional Emergency Operations Centre (REOC) where there are Corporate implications
• Provide oversight and direction to working groups in the implementation and evaluation of the
mass immunization implementation framework
• Track and report on the status of activities in collaboration with other key stakeholders
Eight working groups, divided based on areas of focus, were created and are reporting into the mass
immunization advisory. Subsequently, as the planning efforts covert into operations, the work is
transferred to the vaccine operations section or other functions within the HEOC IMS structure where
applicable. The advisory is lead by the vaccine operations chiefs (see appendix D for advisory and
working group structure) to ensure continuity and alignment between current operations and proactive
planning.
The eight working groups are:
1. Clinic Planning & Set Up
2. Logistics HR Staffing
3. Onsite Logistics
4. Software Implementation Task Force
5. Communication
6. Practice, Protocols and Training
7. Data Management, Surveillance, Evaluation and Reporting
8. Health Equity
External Partnership – Mass Immunization Task Force
To ensure consideration and input from relevant external partners, in the planning for mass
immunization, an external mass immunization task force has been created (see appendix C for terms of
reference). As directed by the MOH, the purpose of this Task Force is to provide overall direction and
coordination in the preparation, launch and operations of the COVID immunization campaign in York
Region. The Task Force will collectively plan and implement a system level approach for mass
immunization.
The Ethical Framework for COVID-19 Vaccination Distribution will be used to guide recommendations
on how vaccine will be offered to priority populations and sub-groups including recommendations on
promoting uptake of groups that have been sequenced ahead of others, but are not reaching
anticipated rates of vaccination due to access barriers.
The York Region COVID-19 Vaccine Task Force will work towards developing a timely, coordinated
plan to:
• Provide feedback to public health in the identification of its regional priority population profile for
each of the phases in the immunization plan
• Effectively distribute vaccination in the community including to those at high risk, vulnerable
populations, the general population in the community as well as in congregate and other
settings in the community
• Collaborate to develop innovative and equitable solutions to deliver vaccinations to patients and
residents
7• Provide education and outreach support to ensure primary care, healthcare providers and the
community have factual vaccine information to make informed decision
• Be the conduit of information back to their respective groups
• Work in alignment with the COVID-19 Mass Immunization Advisory Group
• Participate in separate working groups if need be
IDENTIFICATION OF PRIORITY POPULATIONS
Social determinants of health (SDOH), such as gender, socioeconomic position, race/ethnicity,
occupation, Indigeneity, and homelessness are factors that potentially increase risk and severity of
COVID-19 infection. Incorporating SDOH into risk considerations and assessments is crucial for
supporting an equitable COVID-19 response.
Immunization planning and support will be prioritized for high-risk populations, such as the elderly,
residents and staff of congregate living arrangements such as long-term care facilities, front-line health
care workers, and those in living or working conditions with elevated risk for infection or
disproportionate consequences, including Indigenous communities.
The purpose of this document (Appendix A) is to support the mass immunization prioritization process
of York Region residents by identifying:
• York Region’s priority populations as outlined by the Ontario government’s proposed
prioritization categories
• Sub-setting prioritization based on factors such as communities with a high-prevalence of
COVID-19, health inequities or local staffing criticality
• Identify sectors, settings or population groups that are missing from the categories
• Identify evidence-based approaches to sub prioritization, using provincial and local data
• Any additional criteria that should be considered for prioritization at the local level
• Provide a population profile for each priority population (e.g., the number of individuals in each
priority population)
PROPOSED IMPLEMENTATION STRATEGY – VACCINATION APPROACHES
Based on the need to immunize York Region residents in a timely, efficient and safe manner, YRPH will
implement a flexible hybrid model for vaccine distribution and administration. This includes multiple
fixed clinics sites in various sizes, drive-through and mobile clinics in combination with an “outreach
immunization program” for CS. Staffing models, equipment needs, cold chain requirements, client/staff
scheduling, and financial implications have been carefully considered to optimize a cost-effective and
efficient mass immunization plan. This operational solution includes:
• Four to five static, large scale, mass immunization clinics in four municipalities (option of two -
three clinic sites in Newmarket)
• One small or medium size, fixed or mobile, clinic in the remaining five municipalities
o One of the core mass immunization planning assumptions prior to COVID-19 was the
utilization of 17 pre-identified school sites (MOUs are in place with both school boards).
Under current circumstances these sites will have limited accessibility beyond the
summer months or during other school closure
8o In the absence of school sites, YRPH has connected with other external partners to
explore options to utilize their settings as small or medium static or drive-through sites
• Create an outreach immunization program that consists of a dedicated public health team(s)
with relevant experience to:
o Vaccinate vulnerable individuals (e.g., those living in the Region’s ~250 congregate
settings and shelters and other non-traditional clinic sites) through on-site immunization
services in settings that have no medical staff associated with the facility
o Provide vaccine support to medical staff associated with the remaining congregate
settings (e.g., LTCH/RH) to facilitate administration of vaccine to their specific residents
o Offer a minimum of one mobile clinic in collaboration with Paramedic Services potentially
by utilizing their command center bus, or other suitable regional vehicles to provide
immunization services to areas without a fixed clinic site and to specific segments of the
population (e.g., elderly and migrant workers)
o Assess the option to utilize home care providers to immunize in home care settings
• Offer a drive through COVID vaccine clinic in collaboration with Paramedic Services
incorporating the lessons learned from piloting a drive through flu clinic in Fall 2020
• Explore opportunities to bundle COVID-19 vaccination with other existing health services (e.g.,
sexual health, dental - and school clinics). These opportunities will depend on the amount and
type of required documentation for COVID vaccinations by the province
Current Site Structure
The five static sites that have been secured throughout YR and are located in Georgina, Newmarket,
Richmond Hill, Vaughan and Markham with MOUs in place. These sites were chosen based on
accessibility criteria, population distribution and neighbourhoods of vulnerability. The sites can
accommodate greater number of immunization tables 10 – 24 and as more vaccine becomes available
and clinic hours can be expanded.
Agreements are underway for three large drive through sites located in Newmarket, Vaughan and
Markham. These drive-through sites will operate in sequence throughout 2021. Several physician and
Nurse Practitioner sites are being assessed related to accessibility and vaccine storage capabilities. In
addition, mobile clinic options are being confirmed with one option being utilization of retrofitted YR
Transit busses. These mobile clinics aim to target populations with potential limited access to
transportation including temporary foreign workers and groups with lacking access to vehicles and
public transportation. As vaccine becomes more available additional “pop-up” sites will be operational
and site visits are currently being conducted.
All current sites identified have the capacity to scale up or down. This includes increasing/decreasing
immunizer stations, increasing/decreasing drive through lanes and hours of operation.
Phase 1
Within phase 1, YRPH has worked together with numerous partners to provide immunization services
in LTCH and RH. As of Jan 18, all clinic operations in the 28 LTCHs and 37 RHs had been completed
for dose one. Figure 2. outlines the structure of strike teams that entered into the facilities to immunize
residents, staff and essential caregivers. Additionally, some LTCHs utilized their own staff to administer
vaccine to their residents. Many staff and essential caregivers also received the vaccine at the Regional
hospital clinic sites. As outlined in figure 2 the strike teams consisted of YRPH RNs, YR Paramedic
9Services, local practitioners and hospital staff. The same method will be utilized for dose two in these
settings.
Figure 2. Strike team set-up phase 1 immunization distribution
Late Phase 1 and Phase 2
As more vaccine becomes available YRPH will move into priority groups beyond LTCH and RH. As
identified in figure 3 the plan is to set-up the first large clinic sites in preparation for when vaccine
becomes available to high risk populations with an occupational focus. As vaccine accessibility
increases, more sites will be made available. YRPH works in collaboration with first responders such as
Police and Fire Departments to ensure alignment in plans and operational readiness to vaccinate these
groups effectively.
Figure 3. Planned clinic set-up during late phase 1 and phase 2
10Phase 3
In phase 3 a
comprehensive mass
immunization campaign
will be up and running.
Based on demographic,
socio-economic and
epidemiological data
several scenarios have
been planned for to
ensure that a mass
immunization campaign
can run effectively
during any time of the
year. Various options
for clinic types and
locations have been
outlined and determined
as most suitable under
various conditions such
as the time of the year
(limited options for
drive-through clinics
during the winter
months).
SUPPLY MANAGEMENT
YRPH utilizes Operative IQ (OPIQ) as the inventory system for tracking Personal Protective Equipment
(PPE), IT and other immunization supplies (with the exception of vaccine). OPIQ provides
comprehensive support for all supply and logistical operational components within the PH COVID-19
response. During mass immunization each clinic site will be represented with a supply room in the
system to ensure effective tracking and management of PPE and other supplies.
Supply Transportation and Security
Most supplies transported within YR on behalf of PH is either transported by PH and occasionally with
support from Paramedic Services and courier companies. For transportation of vaccines, YRP/OPP
escort vaccine transportation with doses greater than 10,000. For lesser amounts, arrangements are
made as available or by paid duty. Security will be on duty 24/7 when vaccine is on the clinic premises.
Receiving, Storage, Capacity and Handling
YRPH’s primary vaccine depot is located at 17150 Yonge Street, Newmarket. In addition, YRPH is
currently in the process of allocating an alternate “secondary” vaccine depot within proximity to the
11primary vaccine depot as well as highway 404. The secondary location will allow for increased storage
and handling capacity as well as quick access to the highway allowing for increased efficiency in
distribution across all of York Region. Based on this, YRPH could scale up storage capacity given
access to both walk-in refrigeration and freezer units. At this time, YRPH also has one ultra-low
temperature (ULT) freezer that can store Pfizer COVID-19 vaccine. Additional equipment has also been
purchased including vaccine fridges, vaccine freezers, and portable electric transport coolers; all with
temperature monitoring ability. YRPH is currently in the process of hiring additional staff to
accommodate the anticipated increase in workforce requirements as vaccine supply increases further
expanding our capacity.
Cold Chain Management
YRPH has a vaccine inventory team comprised of skilled Registered Pharmacy Technicians and Public
Health Pharmacists to ensure that storage, handling, and transport of vaccines meets the Ministry’s
Vaccine Storage and Handling Protocol. Vaccine stability data is compiled by our pharmacist utilizing
the manufacturer product monograph and in consultation with the manufacturer’s drug information
pharmacist. Furthermore, all vaccine fridges and freezers are temperature monitored with the ability to
alert designated staff 24/7 should the temperature reach the set threshold values. As a redundancy,
YRPH has built-in a third-party monitoring service for all vaccine storage units that will contact
designated staff 24/7 as an added layer should there be issues that can affect temperature (e.g., power
outage).
Storage and Handling During Transportation and Administration
YRPH utilizes a refrigerated (two built in lithium battery generators) vaccine van to transport vaccines to
five regional facilities as centralized ‘hubs’ for ease of access across the Region. Amongst the five hubs
is 17150 Yonge Street where the depot is located (also has back up power) as well as the following four
distribution locations:
1) 4261 Highway 7 East, Markham
2) 50 High tech Road, Richmond Hill
3) 9060 Jane Street, Vaughan
4) 24262 Woodbine Avenue, Keswick
Currently, YRPH is exploring the acquisition of additional Regional vehicles to support increased
transportation demands for vaccines. Similar considerations for the existing refrigerated van (e.g.,
temperatures) will be required for any additional acquisition of transport vehicles.
Physical Security
The vaccine depot is located in a secured area at 17150 Yonge Street, Newmarket, in an area unseen
by the public with very strict access in place. Access is restricted via security card access and security
access is provided only staff that require to perform vaccine inventory and distribution functions. There
are multiple checks in place during the distribution process to ensure that more than one person is
involved in processing an order. At this time, additional security measures such as video surveillance is
being explored as an added layer of security. During vaccine delivery, only dedicated staff in vaccine
operations are aware of the transit route and anticipated delivery time fame related to both receipt of
shipments and local deliveries.
12Inventory Management/Tracking
YRPH has implemented the use of COVAX for inventory management and tracking as it relates to the
COVID-19 Vaccine. Service Delivery Locations (SDL) are updated daily (where applicable) to ensure
timely and proper documentation of vaccine movement. In addition, cycle counts are conducted weekly
to ensure quantities within COVAX align with the physical quantity on hand. Any variance in the cycle
count is immediately investigated to determine cause and quickly implement strategies to prevent
variances from reoccurring.
HUMAN RESOURCES
York Region Public Health took an informed approach to identify the human resource requirements
leveraging our experience and knowledge from our Vaccine Preventable Disease program and H1N1
clinics. Using this approach, we looked at the following:
• Review of clinic site scales to understand the capacity of each site identified
• Number of doses feasible per immunizer per hour
• Roles and responsibilities required to support the flow of each type of clinic (e.g., drive
through vs. static sites)
Based on this approach, the following roles were identified as required:
• Clinical leadership
o Site manager
o Clinic coordinator and co-coordinator
• Clinical staff
o Immunizer
o Vaccine supply nurse
o Vaccine inventory and cold chain management
• Non-clinical staff
o Greeter/Screener
o Line Management
o Supplies clerks
o Runners
o Check out
o Security and police
In addition to the identification of roles required, YRPH has identified the numbers of staff required for
each category of staff, broken down by role and facility type (numbers may change slightly over time
but not substantially):
Table 1. Clinic staff roles
Category Role Small Medium Large Medium Drive Mobile
Static Static Clinic Static Through Clinic Bus
Clinic Clinic Outreach
Clinical Site Manager - 1 1 1 -
Leadership Clinic 1 2 2 2 1
Coordinator/Co-
coordinator
13Clinical Staff Immunizer 4 10 20 12 4
Vaccine Supply 1 3 6 3 2
Nurse
Greeter/Screener 1 2 4 3 1
Line - 1 2 2 1
Management
Non-Clinical
Supplies Clerk 1 1 1 1 0.25
Staff
Runner 1 2 4 3 1
Check Out 1 2 4 3 1
Security/Police 2 4 5 4 2
TOTAL 12 28 49 34 13.25
Based on these requirements, the following staffing strategies are underway:
• Strategies for obtaining clinical roles include:
o Internal redeployment
o Collaboration with paramedic services, primary care and hospitals
o External recruitment
o Contracts with staffing agencies
• Strategies for obtaining non-clinical roles include:
o Internal redeployment
o Exploration with local Municipalities
o Exploration with non-for-profit agencies (e.g., Red Cross, St. John’s ambulance)
o Exploration with private staffing agencies
o External recruitment
o Working with Regional partners (e.g., York Regional Police)
Orientation and Training
Training and orientation are in the process of being developed for the various clinical and non-clinical
roles. A mass immunization practice framework has been developed which includes:
• Baseline orientation (e.g., IPAC, AODA, privacy, customer experience and de-escalation, HEIA)
• Role specific knowledge and skill development
o Clinical leadership (e.g., management skills, leadership, communication, clinic flow and
oversight)
o Clinical staff (e.g., CPR, medical directives, immunization skills)
o Non-clinical staff (e.g., role specific processes and materials)
• Documentation practices (e.g., systems training, clinical documentation)
• Quality assurance processes (e.g., audits, evaluation, timely knowledge refresh)
FINANCES
Management Oversight and Reporting
All expenditures incurred for the COVID-19 Vaccine program are recorded separately in our financial
system. A budget has been established for this program, and monthly financial reports (Budget
Variance Reports) are produced for management review. Our financial team supports the review of
14financial reports with variance analysis and forecasting on a quarterly basis. Detailed queries of
transactions are also available and reviewed regularly to ensure all expenses have been properly
coded and captured. Potential errors and omissions may be identified by Program Managers, or
Financial staff and are investigated with follow up action taken as indicated. Ongoing forecasting
discussions between the Program management and Finance are held to ensure expected expenditures
are aligned with actual results. Budget estimates for 2021 were prepared in the fall of 2020, when few
details of the program were known; thus, variances to budget are explained and should be expected.
Expenditure Control and Approvals
Purchase orders are issued by the Region’s Procurement Office for properly authorized purchase
requests, with a streamlined process implemented for COVID-19 related procurement. Vendor Invoices
are reviewed against receiving documents or other appropriate supporting documents and authorized
by management with appropriate signing authority. Employee time is recorded on bi-weekly attendance
reports, approved by their supervisor/manager and submitted for input into the Region’s payroll system
to support the accurate processing of employee pay, and benefits (e.g., sick time, vacation time) in
accordance with relevant collective agreement requirements. Payroll costs for employees delivering
and supporting the Vaccine Program, are reported in this program in our financial system along with
other expenses incurred. Employee expenses (e.g., mileage) are approved by their supervisor/manager
prior to payment.
External Financial Reporting
Financial reports are also provided to the Ministry of Health upon request, and more regularly on a
quarterly basis as well as following Year End. The Region of York financial records are audited annually
with the Public Health Settlement reports also audited prior to submission to the Ministry of Health.
Financial reports are reviewed and approved by management and delegated signing officers in
accordance with Regional policies and by-laws prior to submission to the Ministry of Health.
DOCUMENTATION AND REPORTING
Surveillance and Monitoring
As part of surveillance and monitoring, the following goal is identified:
1) To inform vaccination strategies during each phase of roll-out by monitoring and reporting of five
key areas:
• Vaccine inventory, distribution and wastage
• Vaccine administration and coverage
• Barriers to vaccine uptake
• Public awareness/opinion/beliefs on COVID vaccination
• Adverse events following immunization (AEFI)
Cross Tabulations for Analysis: These analyses will be included as part of all the surveillance indicators
listed as part of this document, as relevant:
• Demographics (e.g., age, sex, municipality)
• Socio-demographic groups (e.g., race, occupation, language, country of birth)
15• Priority populations targeted in Phase 1 and Phase 2
• Facility setting type
• Time trends
• Residents and staff breakdown and coverage
• Vaccine product type and dose # and dose timing
Vaccination Surveillance Indicators
Table 2. Vaccination surveillance indicators
Key Area Surveillance Indicators Data Sources
Vaccine inventory, Number of vaccines: COVax;
distribution and • Received
wastage • Distributed Vaccine Operations
• Returned due to wastage Program Data
Vaccine • Number and proportion doses administered COVax;
administration and • Number and rate of individuals vaccinated
coverage • Number and proportion of population that has Census;
received at least one dose
• Proportion of individuals who have received 2nd CCM
• dose within guidelines
Vaccine Operations
• Number and proportion of facilities vaccinated
• *Many indicators here have cross tabulations. Program Data
See list above
Adverse events Number of confirmed AEFIs CCM; COVAx
following
immunization Number and proportion of serious AEFIs Rate of AEFIs
(AEFI) per total doses administered
Vaccination Surveillance Indicator Development Plan
These indicators will be further explored:
Table 3. Surveillance indicator development plan
Key Area Sub Areas Notes
Public awareness / To collect public opinion/awareness of the Survey to be developed
opinion / beliefs on COVID- 19 vaccine and some reasons or
COVID vaccination barriers for vaccine hesitancy and refusal.
To achieve this robust surveillance plan laid out above, additional access and ability to extract
information from COVAX will be needed. At the time of writing this plan, YRPH is only able to report
using the vaccine inventory report as well as the summary client and dose administration report.
Currently, this provides a high-level ability for reporting looking at the Home specific coverage (e.g., (%)
16by staff, residents, caregivers) but does not allow for greater understanding at the PHI level for
comprehensive jurisdictional reporting.
COVAX Solution for Health Units
YRPH has already begun the use and implementation of COVAX for our immunization efforts. The
Infectious Diseases Data Management and Systems team with the support of a project manager have
leveraged the Ministry training sessions and materials to create a robust training plan and supporting
materials for our staff. This team will be dedicated towards training of new staff who join the mass
immunization efforts over time to ensure the use of COVAX for all clinical documentation. In addition,
additional practical training opportunities are under exploration to ensure staff retain their skills using
the system over time.
YRPH has begun and will continue to use COVAX for inventory management, clinical documentation
and reporting support. YRPH will continue to monitor additional releases of the system to ensure
maintenance skillset and ongoing training and orientation.
We are also working towards point of care entry into COVAX as training rolls out broadly to all staff and
community partners support the immunization effort. This will ensure timely entry of information into the
system and ability to inform surveillance and reporting accurately.
EVALUATION APPROACHES
Table 4. Evaluation approaches
Program Overview York Region COVID-19 Vaccine Program
Target Audience • York Region vaccination clients including priority populations
• York Region Public Health Staff
• York Region vaccine administrators (i.e. Paramedic Services, facility
staff, community partners etc.)
• York Region partners that play a role in vaccination
• York Region residents
Evaluation Goal (s) • Determine the efficiency and effectiveness of York Region Public
Health’s (YRPH) COVID-19 vaccination program
• Determine the level of uptake, barriers, and facilitators for the COVID-
19 vaccine in York Region
Evaluation • How equitable was the immunization program?
Questions • What was the uptake of the vaccine in the general population and
what factors influenced and inhibited the uptake of the vaccine?
• What was the vaccine hesitancy level in the general population and
what factors contributed to the vaccine hesitancy?
• How efficient was the vaccine administration process?
o Were the process objectives met? (e.g. scheduled administrations
at congregate settings)
• What was the effectiveness of the vaccine administration and data
collection process?
o Were vaccination targets met? (e.g., wait times, timeliness of
services, coverage rates)
• What was the effectiveness and efficiency of the interjurisdictional
collaboration (E.g., community partners)?
17PROPOSED METHODOLOGY
York Region Public Health will employ a process-outcome evaluation utilizing a Real Time Evaluation
approach with mixed methods of data collection as listed in Appendix F.
COMMUNICATION AND ENGAGEMENT
Building on the public’s collective core desire to end this difficult pandemic chapter, as well as tapping
into our inherent human nature to want to help and protect one another, the York Region 2021 Mass
Immunization Communication Plan will support a successful roll-out of mass immunization within our
community – aiming not only to build trust in the COVID-19 vaccine itself, but in York Region
government as a whole.
Communications will need to be flexible and adaptable to the situation as it evolves. Audiences and key
messages may change over time based on Ministry direction, vaccine availability and other factors. As
York Region is a large and diverse community with nine local towns and cities including a variety of
rural and urban areas, communication efforts will consider language barriers and translation needs,
accessibility, special needs of vulnerable populations (i.e. seniors) and other factors which may prove
to be a barrier to communication.
Three Central Objectives:
1. Increase vaccine awareness and understanding
2. Increase vaccine uptake – toward 75% population vaccination goal
3. Dispel misinformation, myths and harmful untruths which contribute to vaccine hesitancy
(see appendix D – vaccine hesitancy communication best practices)
Key Strategies and Tactics
• Direct communication to all stakeholders leveraging all available channels, internally and
externally
• Identify opportunities to develop catered messaging to address potential barriers for
vulnerable populations, newcomers, English as second language and other identified
audiences with special communications needs (considering translation and accessibility)
• Leverage York Region’s internal departments and program areas (e.g. Access York,
Diversity and Inclusion, Housing Services, Social Services: Homelessness Community
Programs, Ontario Works, Children’s Services) to help inform our approach for hard to reach
populations, or populations who have been disproportionally impacted by the pandemic
• Leverage community partnerships (Welcome Centres, community agencies, United Way
Greater Toronto, school boards, health care partners, local municipalities and businesses)
to help extend the reach and accessibility of our messages
• Humanize the importance of COVID-19 immunization (i.e. telling personal stories, appealing
to moral and ethical responsibility, persuasive campaign messaging about urgency,
kindness)
• Create dedicated media opportunities and supporting materials to encourage
positive/neutral and wide coverage
• Identify staff and community ambassadors to help champion immunization message (e.g.
community leaders, faith leaders, health care practitioners, local non-profit leaders with
substantive influence)
18• Leverage national/international vaccine hesitancy data (Ipsos, Angus Read, DAVS
Environics) to understand vaccine hesitancy in our community and inform our response
• Access insights from our internal early priority vaccination groups to inform ongoing
hesitancy messaging
• Create campaign(s) specifically geared to address vaccine refusal/hesitancy
• Align with and leverage provincial vaccine hesitancy messaging/campaigns where possible
• Collaborate and share resources with neighbouring Public Health Units
• Partner with health care providers, local municipalities, other identified community groups to
help extend reach of information
• Educate to prevent against vaccine fraud; track, monitor and address ongoing fraud
concerns and/or new threats/major factors feeding misinformation
Progress to date
• Dedicated york.ca/COVID19 web pages (4.8 million views)
• Key Messages, media interviews and response to high volume of daily media inquiries
• Internal communications to York Regional Council, senior management and staff, more than
1,500
• Weekly MOH Video Updates (Internal and External audience)
• Dedicated employee intranet web page (71,000 visits in 2020)
• Weekly municipal partner updates meetings to share key updates
• Ongoing updates to COVID-19 Information for Health Professionals
• Social media posts and social inbox inquiry responses (3,490 posts)
• Media kit (Media Protocol, Share Your Stories with York Region Public Health,
#IGotMyVaccineinYR signage, Photo/Video Release consent) finalized for LTC, Retirement
home and congregate settings
• Immunization clinic communication support for LTC and RH (Preparation memos, FAQ
documents for staff/residents, fillable forms and operational document support)
• Internal Vaccine FAQs for Access York call centre and staff to support public inquiries
• Ongoing response letters for public inquiries from various sources
• Comprehensive messages for health care providers shared through Public Health’s existing
notification processes / ENS system
• Webinar on vaccine hesitancy held by AMOH for approximately 170 local health care
professionals – promoted through existing Public Health Matters eblast
• Vaccine presentations for various public audiences, such as chamber of commerce
• York Region Public Health’s Immunization program video
• COVID-19 Vaccine: What You Need to Know video
• Preliminary research and peer health unit consultations regarding vaccine hesitancy
• Supportive vaccine infographics: Vaccine Roles & Responsibilities, York Region version of
provincial placemat
Challenges
• Developments under the provincial rollout plan are typically conveyed with short notice to
the local public health unit level, requiring extremely quick mobilization and action, often
allowing little time for advance planning
19• Our local approach is subject to the developing timeline under the provincial three-phase
vaccine distribution implementation plan. Local efforts will be largely determined by the
ongoing updates and adjustments under this plan, as well as uncertainty related to the
availability of vaccines
• Vaccine information (fact sheets, guidance documents for health care professionals,
information on side effects, etc.) typically do not arrive from the Ministry of Health with
enough advance notice to inform our communications or serve our early vaccine recipients.
This prompts the need for each health unit to develop independent products in a short time
frame and may lead to errors and inconsistency over time
Strengths
• Highly committed and competent staff, working diligently to meet the emerging demands as
quickly as possible
• Having York Region Public Health embedded within the larger York Region government
allows for easier connections to wrap-around social service supports throughout the
immunization program rollout.
• Good collaboration and partnership with local hospital partners, and willingness from local
health care practitioners to support the immunization program
• York Region has Mass Immunization Planning as a standing portfolio within our Health
Emergency Planning team and as a result there were significant plans already in place prior
to COVID-19
• Mass immunization preparations began early in the response. In spring 2020, a mass
immunization planning group was activated
• To prepare for newer methods of vaccine delivery, York Region conducted both drive-
through and mobile clinics pilots using the flu vaccine, with promising results
• Numerous pre-existing communications channels, partnerships and ongoing collaboration
within the community
• Communications learnings and experience from H1N1
• Dedicated York Region contact centre (Access York)
Contact Information:
• HEOCCommunications@york.ca
• YR.Corporate.Communications@york.ca
CONTINGENCY PLANNING
York Region as a whole has a robust business continuity program and policy to ensure all programs are
adequately prepared for any potential disruptions. As it relates to immunization clinic sites, loss of staff,
loss of site and loss of technology are critical components of the planning. Public Health is supported
very closely by Information Technology teams to ensure adequate support for a loss of technology and
measures are in place to ensure technology back ups (e.g., additional server locations, back up
connectivity) as well as York Regional Police and Security for any additional support.
As part of the business continuity planning work, the following considerations have either been actioned
or are underway:
20• Backup generators are available for both the main vaccine depot as well as for clinic sites to
support continued cold chain
• Paper documentation is available for all sites in the case of a loss of technology
• Mifi’s and phones with hot spot capacity are available to ensure back up connectivity
• Processes and detailed procedures are available for all staff on site related to handling a
medical emergency and is part of training and orientation
• York Region has a severe weather plan in place for continuity
In addition to the existing plans and contingencies, work is underway to ensure plans are in place for
each clinic site based on the model of the clinic and the facility itself.
21APPENDIX A – VACCINE PRIORITIZATION YORK REGION
YR Priority Population
Immunizarion Plans (0
APPENDIX B – TERMS OF REFERENCE MASS IMMUNIZATION ADVISORY
TOR-COVID-19_Mass
_Immunization__Advi
APPENDIX C – TERMS OF REFERENCE EXTERNAL PARTNER TASK FORCE
TOR COVID Vaccine
Task Force .pdf
APPENDIX D – VACCINE HESITANCY – COMMUNICATION BEST PRACTICES REVIEW
Vaccine_Hesitancy-Co
mmunications_Best_Pr
22APPENDIX E – STRUCTURE MASS IMMUNIZATION ADVISORY AND WORKING GROUPS
23APPENDIX F – EVALUATION METHODOLOGY
Evaluation Question Sub-question(s) Data Source How will information be
used?
1. How equitable was the • Determine how
How equitable was process of identifying • Survey: equitable the
the immunization priority populations who • York Region vaccine
program? are more severely residents administration
• York Region program was
impacted by COVID (e.g.,
vaccination • Determine how to
health, job loss, economic make
impact, etc.)? Was it clients
including immunization more
equitable, evidence-based priority equitable during
and applied consistently? populations implementation
• York Region • Determine if there
2. What was the uptake of the Public Health are unique factors
Staff (i.e. or characteristics
vaccine in the priority
health equity contributing to
populations? What were vaccine hesitancy
the demographics of team)
• York Region in the priority
priority populations who populations
vaccine
received the vaccine? Did • Determine the
administrators barriers to vaccine
they receive it in a timely
(i.e. Paramedic uptake in priority
manner? (e.g., number of
Services, populations
people who took single
facility staff,
dose and double dose)
etc.)
• York Region
3. What factors contributed to
partners that
vaccine hesitancy in the play a role in
priority populations and vaccination
what was done to address • Debrief
these factors (including sessions with
building on community YRPH staff
partnership, influential administering
communication strategy, vaccines
etc.)? • COVAX-ON
database
4. What was done to make • Census data
vaccines accessible for the • Environics
priority populations (e.g.,
access to booking system,
vaccination location, AODA
accessibility, translation
services, etc.)?
• What was the population’s • Determine the
What was the awareness and knowledge 1) Survey: level of uptake for
uptake of the about the vaccine and their • York Region vaccines in the
vaccine in the vaccination clients general population
intentions regarding
general population including priority • Determine the
vaccination?
and what factors populations barriers and
• What was the uptake of the
influenced and • York Region facilitators to
vaccine in the general residents vaccine uptake in
the general
24inhibited the uptake population? (e.g., number 2) COVAX-ON population and
of the vaccine? of people who took single database how to address
dose and double dose) 3) Census data those barriers
What were the
demographics of the
general population who
took the vaccine?
• How did the vaccination
coverage rates affect
disease transmission
(number of days to herd
immunity), severity of
illness, number of
hospitalizations, number of
ICU- beds occupied, etc.?
• What were the barriers to
vaccination for general
population (e.g., access to
booking system,
vaccination location,
translation services,
childcare, etc.)?
• What are the positive
influencers/change agents
to vaccination?
1. How many people were 1) COVAX-ON • Determine the
What was the vaccine hesitant? What database level of vaccine
vaccine hesitancy were their characteristics? 2) Census hesitancy in the
level in the general 3) Environics general population
population and database • Determine how to
2. What factors contributed to
what factors address the
vaccine hesitancy in the 4) Survey: vaccine hesitancy
contributed to the general population? • York Region in the general
vaccine hesitancy? population
residents
• Determine
common
characteristics
amongst those
who are vaccine
hesitant
How efficient was 1. Did the vaccination • Determine if the
the vaccine implementation meet each 4. COVAX-ON vaccine
objective planned? database administration
administration 5. Document process was
process? 2. How efficient and effective Review of efficient in regard
was the staffing model for YRPH internal to the use of
• Were the the clinics? (e.g., was there logs resources and
enough staff to meet 6. Debrief meeting objectives
process
needs, were there clear sessions with • Determine if the
roles and responsibilities vaccine
25objectives for staff in the implemented YRPH staff administration
met? clinics) administering process was
vaccines efficient in regard
to the use of
• Were 3. How efficient was the
7. Survey:
resources and
• York Region
vaccination execution/vaccine meeting
administration? (e.g., wait Public Health benchmarks or
targets met?
times, timeliness of Staff targets
(e.g., wait
services, coverage rates, • York Region
times, ability to meet vaccine
timeliness of minimum/maximum administrators
services, vaccination rate (i.e. Paramedic
thresholds)
coverage Services,
rates) congregate
setting facility
staff, etc.)
• York Region
partners that
play a role in
vaccination
1) How effective was the • Determine the
What was the appointment mechanism 1) Debrief sessions effectiveness of the
effectiveness of for the vaccination? with YRPH staff vaccine administration
administering process
the vaccine • Determine the
administration 2) How effective was the data vaccines
effectiveness of the
and data collection tool for vaccine 2) Survey:
data collection process
administration and • York Region
collection vaccination clients
process? reporting (i.e. COVAX)?
including priority
populations
3) Were there sufficient • York Region Public
supports and resources Health Staff
available for the clinics
• York Region
(e.g. IT)?
vaccine
administrators (i.e.
4) Were best practices for
Paramedic
IPAC and OH&S followed
Services, facility
at the clinics?
staff, etc.)
• York Region
5) How effective was the
partners that play a
vaccine and supplies
role in vaccination
management and
distribution? (e.g., delivery
and receiving, storage and
handling, cold chain and
wastage, allocation,
inventory management,
etc.)
6) How effective was the
internal communication in
keeping clinics staff,
26management, and
suppliers informed about
clinics operations?
7) How effective was the
external communication?
(e.g., general
communication about
vaccine and coverage to
the public, specific pre-
vaccine and post-vaccine
communication for the
clients)
• • Determine the
What was the 1) How efficiently do • Survey: overall efficiency of
effectiveness and jurisdictions work together • York Region Public collaboration
efficiency of the in terms of communication, Health Staff between York
interjurisdictional roles and responsibilities, • York Region Region,
collaboration? direction, and how did it vaccine community
affect the following administrators (i.e. partners, program
systems: supply, Paramedic delivery partners
distribution, storage and Services, facility and other
transportation, information staff, etc.) jurisdictions YRPH
and tracking, financial, and • York Region and is working with
workforce systems? other jurisdictional
partners that play a
role in vaccination
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