Boxes of some of the first 500,000 of the two million AstraZeneca COVID-19 vaccine doses that Canada has secured, at a facility in Milton, Ont., on March 3, 2021.Carlos Osorio/The Canadian Press
Millions of COVID-19 vaccines set to pour into Canada will carry a tiny barcode that would allow the package to be tracked all along the supply chain, and could even help to connect a patient’s digital vaccination record to a specific dose. That level of tracking is taking place in other countries such as the United States – but won’t happen in Canada because the country lacks the technology to scan those barcodes.
It’s a frustrating gap for those who have been pushing for such an ability since the 1990s. As a recent Deloitte report on the COVID-19 vaccination campaign pointed out, these barcodes can go a long way to “reduce errors and improve efficiency and safety.”
The technology is available – cellphones and tablets can scan these barcodes with the right software. But the barcode issue reveals larger problems with Canada’s fragmented and outdated health infrastructure – it involves 14 jurisdictions doing 14 different things, sacrificing efficiency for independence.
Currently, some provinces are tracking supplies by manually updating spreadsheets and logging by hand the lot number of administered vaccines. Ontario and Quebec have devised a more advanced database of their available vaccines, but it still relies on someone manually entering the serial numbers of vaccine shipments.
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Other countries have figured this out: Vaccinators in the U.S. are scanning COVID-19 vaccine shipments and individual doses, allowing states to build accurate and timely databases of who has been vaccinated. Ireland and Turkey are also relying on these barcodes. The World Health Organization is encouraging every country to use them to promote efficiency and fight counterfeiting.
Dr. Robert Van Exan, former director of health and science policy at Canadian pharmaceutical giant Sanofi Pasteur, said tracking with barcodes in Canada “should have been written in the pandemic plan.”
There was a plan to make these barcodes central to Canada’s public-health system, and there was a time when Canada was ahead in digitizing its health system “by a decade,” Dr. Van Exan said. Canada’s 1998 vaccine strategy first proposed barcoding vaccines to promote efficiency and accuracy. The 2003 SARS epidemic, and the creation of the Public Health Agency of Canada, hastened that work.
In normal times, Canada administers millions of vaccines a year for diseases such as mumps and influenza. Provinces slowly adopted digitized immunization records in the early 2000s, but continued entering all the data manually: Audits of some provincial systems found fully 15 per cent of immunization records were incomplete, nearly a quarter had inaccurate information, and crucial data was missing from one in five adverse-reaction reports.
In 2007, Ottawa tapped an advisory group made up of industry experts, including Dr. Van Exan, to plan the implementation of these barcodes. The total cost, the advisory group found, would have then been around $265-million, but they projected savings of $1-billion in the decades to come. They handed Ottawa a plan to start barcoding vaccines in warehouses, hospitals, clinics and pharmacies by 2014.
This barcoding capability was an integral part of a broader digital infrastructure project known as the Vaccine Identification Database System (VIDS). Ottawa set up VIDS as a proof of concept for a single, national digitized public-health system to track infectious disease outbreaks and vaccination campaigns.
Ottawa contracted IBM Canada to build a permanent vaccination version of VIDS, called Panorama. That’s where things “fell off the wagon,” Dr. Van Exan said. “IBM built a system that can’t read barcodes.”
Beset by delays and cost increases, some provinces dropped the project. Even some provinces that stuck with Panorama have still not installed crucial components of the system. None of the provinces’ systems work with one another.
“This is one of the big flaws in the whole damn system,” Dr. Van Exan said.
He noted it was particularly frustrating for the vaccine industry, which had spent years and significant amounts of money retooling their factories to add a whole new system of labelling.
As Canada dawdled, other countries have aggressively pursued this technology. The U.S. has been scanning these barcodes since 2012. India has a massive vaccine-tracking system which runs on a smartphone app, made possible by barcode-scanning.
Deloitte wrote last year that these barcodes will be “critical” for a quick vaccine rollout. When the U.S. government hired Deloitte to build a new vaccination-tracking platform, it specifically included barcode-scanning capabilities.
When Canada sent out a request for proposals last November for new IT systems to support the vaccine rollout, it asked for technology to enable barcode scanning – Deloitte won that contract as well. At a vaccine briefing last week, The Globe and Mail asked if Ottawa, or any of the provinces, had developed this barcode-scanning capacity.
Joelle Paquette, director-general for vaccines at Public Services and Procurement Canada, said the department was “not aware of this issue.”
One of the COVID-19 vaccines approved by Canada is made by Pfizer-BioNTech. Pfizer told The Globe that each tray of 192 vials has a 2D barcode which resembles a QR code and “gives item number, lot number and expiry date when scanned.” Canada’s contract with Novavax requires it to include 2D barcodes on all aspects of the vaccine packaging, including the vial.
For these barcodes to be fully effective, Canada would need a modern vaccination database – something the provinces largely still lack. There’s still some hope that if Canada makes a concerted effort, it can address this gap.
“It’s definitely not too late for the short term,” said Alicia Duval, senior vice-president of GS1, a non-profit organization that devises international barcoding standards. “And it’s definitely not too late for the long term.”
Some Canadian experts and organizations are still trying to make it work. In Alberta, digital health company Okaki has developed a vaccination-tracking system, complete with barcode-scanning capabilities.
“At the University of Alberta, the health centre would run a flu clinic,” said Cathy McDermott, Okaki’s senior public-health consultant. “So, with three laptops, three clerks, a printer and a barcode scanner – that’s key – we used to run 1,000 people a day through [the clinic].”
Okaki’s software meant that those thousands of vaccinations were logged accurately – and could send that data immediately to the provincial health system.
The Alberta company now supplies the software to nearly 100 First Nations health services and private pharmacies.
Asked whether Okaki could scale this technology up, if asked, Ms. McDermott didn’t hesitate: “Oh, yes – of course.”
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