The rollout of the COVID-19 vaccines in care homes in Canada

Samir Sinha (Department of Medicine, University of Toronto; National Institute on Ageing, Ryerson University)

Cameron Feil (National Institute on Ageing, Ryerson University)

Natalie Iciaszczyk (National Institute on Ageing, Ryerson University)

In November, prior to the arrival of its first vaccines, Canada’s National Advisory Committee on Immunization (NACI) recommended the first stage of immunizations be given to residents and staff in seniors’ homes, adults over 70, health-care workers, and adults in Indigenous communities and emphasized this in its subsequently COVID-19 vaccination guidelines released in December 2020[1].

Under the Canada Health Act, the jurisdictional responsibility for the provision of health care falls to its provinces and territories.  Each has released their own corresponding vaccination rollout strategies based on their individual priorities, that now include vaccinating all LTC residents and staff by February 2021.  Additionally, four provinces: British Columbia, Nova Scotia, Prince Edward Island (PEI), and Ontario have also included family caregivers  of LTC residents as part of the initial populations being prioritized for vaccination.

Of the 939,050 doses of the Pfizer-BioNTech and Moderna vaccines that the federal government has delivered to each of Canada’s provinces and territories on an equal per capita basis, 81% of these doses have been administered as of January 22, 2021.  While each province had received sufficient vaccine doses to deliver initial doses to their entire LTC populations, which total at least 425,000 individuals[2], different approaches to their vaccine rollout strategies have seen large discrepancies occur in each being able to vaccinate LTC residents, staff, and family caregivers quickly across Canada.

As of January 5, 2021 fewer than 4,000 (5.5%) of Ontario’s 72,000 LTC residents had been given an initial dose of the Pfizer- BioNTech or Moderna vaccine, and over 26,000 (26%) of its more than 100,000 LTC staff. British Columbia, by comparison, had by January 4, 2021 given a first dose to over 4,700 (20%) of BC LTC residents and 11,600 (50%) of its LTC staff[3].

As of January 22, 2021 provinces that have vaccinated high proportions of their designated LTC populations receiving publicly-funded LTC include PEI (100%) and Alberta (100%) as of Jan 15th and 17th respectively, British Columbia (90%), Quebec (87%) and Ontario (60%) as of January 22nd.  We have yet to accurately determine the results of other provincial/territorial LTC vaccination campaigns, and the federal government has not been keeping overall numbers around the vaccine rollout in LTC settings as well.

A critical reason for the fragmented rollout across Canada’s LTC settings has been how its provinces/territories had originally set up their vaccine distribution programs.  The northern territories and more rural and remote settings of Canada’s provinces are relying on the use of the more easily transportable Moderna vaccine which only began to be delivered to the provinces and territories at the end of December to vaccinate their LTC residents.  Some initial concerns about the ability to transport the Pfizer-BioNTech vaccine into LTC settings meant that some provinces like Ontario decided to prioritize its use via hospital distribution centres where able bodied LTC staff and family caregivers could receive their vaccine while waiting to use the Moderna vaccine for its LTC residents. 

Pfizer, however, provided broadened transportation guidelines to the Public Health Agency of Canada on December 18 on how to safely transport its vaccine into LTC settings.  As a result, Quebec established half of its initial vaccination centres in its LTC settings to facilitate resident vaccinations with the Pfizer-BioNTech and BC quickly adjusted its rollout strategy to begin moving its larger supply of this vaccine into LTC homes by December 23, to get its LTC residents vaccinated.  On the other hand, Ontario which initially decided against bringing its Pfizer-BioNTech vaccines directly into LTC settings began to do so as of January 5th as it began to face widespread criticism around its slow vaccination rollout in its LTC settings[4].

Moreover, even in provinces where vaccination efforts in its LTC settings have appeared to be comprehensive, many residents and staff have in reality been left out. For example, in Alberta, while 100% of 27,000 residents in publicly funded LTC facilities have been vaccinated, 10,000 residents of exclusively private ‘undesignated’ LTC and retirement homes were not included in its initial or first stage of the vaccine rollout because the death toll in these settings has been deemed to be ‘less heavy’ compared to those of publicly funded LTC settings.  Regardless, all LTC settings have collectively represented 66% of Alberta’s death toll, where 73% of LTC settings have experienced at least one COVID-19 outbreak, the most of any other province in Canada[5].

Another issue which is coming to light is that, while over 90% of LTC residents appear to be accepting a COVID-19 vaccine, varying levels of vaccine hesitancy are seeing highly variable uptake ranging from 20-70% and less than 50% overall uptake of the COVID-19 vaccine by staff in these settings due to a variety of unaddressed issues and concerns.[6]

Finally, many Canadian provinces and territories have not released detailed data or updates pertaining to their LTC vaccination roll-outs.   With a recent announced slow-down of Canada’s Pfizer-BioNTech vaccine shipments from Europe, and no new deliveries expected the week of January 25 all of Canada’s provinces and territories have had to revise their vaccine rollout-strategies including now considering delaying the administration of the second doses of its vaccines.  Provinces like Ontario have indicated that they will not do this to their LTC resident population and will also further prioritize any remaining vaccine towards prioritizing the vaccination of its LTC residents first to meet its goal of administering a first dose to all of its LTC residents by February 15th.  While most of Canada’s largest provinces have or will have already accomplished this by the week of January 25th, a recent modelling study released by the Ontario Government’s Science Table helps to underscore the value of vaccinating all LTC residents as soon as possible. In their study, they noted that if Ontario had prioritized getting all of its LTC residents vaccinated by January 31, 2021 vs February 15, 2021 would help to avert at least 600 new COVID-19 infections and 115 deaths by March 31, 2021[7].

Across Canada, vaccination of LTC residents, staff and famil caregivers, where prioritized, is expected to be the main priority across most Canadian jurisdictions heading into the week of January 25, 2021.

Sinha S, Feil C and Iciaszczyk N. The rollout of the COVID-19 vaccines in care homes in Canada as of 25th January 2021. Article in, International Long-Term Care Policy Network, CPEC-LSE.

[1] National Advisory Committee on Immunization (NACI) December 12, 2020. Recommendations on the use of COVID-19 vaccine(s).  Accessed Jan 24th at:

[2] Statistic Canada. Type of Collective Dwelling (16), Age (20) and Sex (3) for the Population in Collective Dwellings of Canada, Provinces and Territories, 2016 Census. Accessed Jan 24th at:

[3] Global News Canada. ‘A senicide’: Strategic missteps, logistical hurdles plague Ontario’s early vaccine rollout. January 23, 2001.  Accessible at:

[4] Global News Canada. ‘A senicide’: Strategic missteps, logistical hurdles plague Ontario’s early vaccine rollout. January 23, 2001.  Accessible at:

[5] Globe and Mail. ‘Thousands of Albertans in private seniors’ facilities still awaiting vaccines, not atop priority lists’ January 21, 2001. Accesible at:

[6] Toronto Star. ‘Uptake for the COVID-19 vaccine has been high among Toronto’s long-term-care home residents. For staff, not so much’. January 16, 2021. Accessible at:

[7] Nathan M. Stall et al. on behalf of the Ontario COVID-19 Science Advisory Table. ‘The Impact of the Speed of Vaccine Rollout on COVID-19 Cases and Deaths in Ontario Long-Term Care Homes’. January 21, 2021.  Accessible at:

2 thoughts on “The rollout of the COVID-19 vaccines in care homes in Canada”

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