A few points to clarify vaccine distribution in Ontario.

1. We get ~400K doses of Pfizer weekly. It shows up like clockwork. It gets distributed throughout the province in ~1-2 days & there is very little at the end of the week. This is administered at mass vaccine clinics. https://twitter.com/ASPphysician/status/1382153670452723712

2. We get several hundred thousand doses of Moderna every 2 weeks. Also rapidly shipped to locations in the province. For various reasons, Moderna shipments are occasionally delayed. There is very little Moderna in freezers at the end of the 2 weeks.

3. We have infrequent large boluses of AstraZeneca. This is administered by primary care in 6 Public Health Units, and by ~1400 pharmacies throughout the province.

It is available to anyone 55 years of age and older.

4. On the day of vaccines delivery, for a brief period of time there are a lot of vaccines. Kind of makes sense.

Throughout the week they are quickly administered.

It looks like most of the provinces are comparable in terms of their ratio of delivered:administered @jm_mcgrath

5. So what is the deal with so many "in the freezer"?

Well at the beginning of the week there is plenty of Pfizer/Moderna but that quickly get administered. We then wait for the next shipment.

There is ~2 day supply for wiggle room if there are supply chain issues.

BUT

6. What's left in the freezer?

AstraZeneca.

A lot of it.

It's not exactly flying off the shelves for the 55+ crowd unfortunately.

7. Even with ~1400 pharmacies & PHUs administering AstraZeneca, it moves SLOWLY in many areas.

Expanding primary care's role and outreach would help, but perhaps may not solve this issue.

See below: https://twitter.com/nilikm/status/1382033517618548740?s=20

8. It's pretty clear why the uptake of AZ is slow. There have been some preventable & perhaps less preventable communication (& policy?) issues at various levels.

@picardonhealth has a great article today that is relevant here: https://twitter.com/picardonhealth/status/1382662482095837188?s=20

9. We could probably administer significantly more AstraZenca vaccine through some combination of:

1) transparent & effective communication
2) lowering age cutoff below 55
3) expanding role of primary care
4) other/etc.

10. There are several of areas for improvement on the vaccine rollout , like improving access in high-burden neighbourhoods, sorting out confusing sign-up systems, communicating ever-changing guidance, lowering barriers, etc.

BUT having said all that...

11. Ontario is administering >100000 vaccines on most days.

While I am grateful for the increased supply of Pfizer & Moderna (this really kicked in on March 22nd), we truly don't have enough to vaccinate everyone is Phase 2 now, and still have to triage.

12. But we are making significant headway.

A few examples of lowering barriers in communities most in need:

1. https://bit.ly/32fzwRR 
2. https://bit.ly/3mMSyIG 
3. https://bit.ly/3dZyMWk 

There are more examples & this will expand with growing supply.

13. I appreciate how this particular topic of distribution & freezers can get politicized & can be rather polarizing.

I really try my best to avoid all that & get to the actual issues at hand.

I hope this clarifies a few points.

14. There are obvious areas for improvement on the vaccine rollout (see above), but somethings are still going rather well.

We have to quickly address the issues & continue to work toward a rapid & equitable #COVID19 vaccination program.

Addendum: @GurdeepA and I discussed some of this today on @CP24Breakfast. https://twitter.com/CP24Breakfast/status/1382699508593725444?s=20

Last point: Reading through some of the comments - I wouldn't attribute hesitancy as the sole contributor to slow AstraZeneca rollout, but it cannot be ignored either.

Really the last point:

To sum up...

Burn rate for Pfizer: Fast
Burn rate for Moderna: Fast
Burn rate for AstraZenca: Slower (for various reasons)