Ontario may not be able to administer COVID-19 shots inside long-term care homes and retirement homes immediately due to concerns that one of the vaccines the province is set to receive could deteriorate with too much movement.

Prime Minister Justin Trudeau announced on Monday that Canada expects to begin receiving its first doses of Pfizer’s yet to be approved vaccine next week and should have up to 249,000 doses by the end of the month.

While Ontario is expected to receive about 85,000 of those initial doses, it remains unclear whether it will be able to use them to vaccinate long-term care home residents at first.

Speaking with reporters during a briefing on Monday afternoon retired General Rick Hillier, who is leading the province’s vaccine task force, said that officials have been told that the data around moving the Pfizer vaccine from the ultra-cold freezers that it will be stored in is “uncertain” and that might force the province to initially only conduct vaccinations at large vaccine centres.

That, in turn, could mean that the province will be unable to conduct a large-scale vaccination of long-term care residents and will have to focus its early efforts on the staff that work in those facilities instead.

“If that is the case and we don’t know all the details yet we will establish vaccination sites right there (where shipments are received) and people will have to come to the vaccination site as opposed to taking the vaccine into those long-term care homes right away,” Hillier said. “Obviously many of the residents in those long-term care homes could not come out to a vaccination site. So what we will do in that case is have the people working in those long-term care homes come to the vaccination sites. We will vaccinate the people who work there, the personal care workers, the health-care workers, those essential visitors who are also crucial to their care, and that in and of itself will change dramatically the risk to the residents in those long-term care homes.”

The Pfizer vaccine has to be kept at – 80 C and Health Minister Christine Elliott said on Monday that there are more than 21 hospitals in the province with the ultra-cold freezers needed to store it. The vaccine will also be delivered in specially built boxes packed with dry ice that it can remain in for upwards of 10 days, providing officials with another temporary means to store it.

But Dr. David Williams, Ontario's chief medical officer of health, said during a subsequent briefing on Monday that Pfizer has indicated that physically moving the vaccine could lead to its deterioration.

That has lead to questions around whether it will be possible to physically go ito long-term care homes and vaccinate residents.

"What we’ve been told by the company, by Pfizer, is that besides keeping the cold temperature, there is also a desire to limit the amount of movement because too much movement around can also cause a deterioration of the product. So that is the physical movement, shaking and agitation," Williams said. "So that’s their recommendations at this time and of course we have to follow what the company is saying. As I said before, if we are going to give the vaccine, we want to make sure it is as efficacious as possible so right now we are following the strict guidelines from the company."

A total of 2,391 long-term care residents in Ontario have died after being diagnosed with COVID-19, accounting for nearly two-thirds of all fatalities.

While Elliott said that the province is in discussions with Pfizer to determine whether there is some flexibility to “move the vaccine slightly” in order to vaccinate long-term care residents she acknowledged that we may have to wait until the Moderna Inc. vaccine gets approved.

That vaccine, which has also completed its Phase 3 trials, only needs to be kept at – 20 C.

“As soon as we can move the vaccines we want to be able to establish special vaccination sites and go into these long-term care homes and offer the residents the opportunity to have the vaccine. But we may not be able to do it right away,” Hillier conceded on Monday. “We are planning for both cases.”

Province reveals groups that will be prioritized first

Ontario expects to receive a combined 2.4 million doses of the Pfizer and Moderna vaccines in the first three months of 2021. Because both of those vaccines require two shots spaced out by three to four weeks it will only be enough to vaccinate about 1.2 million residents.

On Monday, Hillier revealed that the first phase of the province’s distribution plan will last two to three months and focus on health care workers, residents, staff, essential caregivers, and other employees of congregate living settings that provide care for seniors, adults in Indigenous communities and adult recipients of chronic home health care.

The second phase, he said, will begin around April and will last for six to eight months with a focus on ensuring every other Ontarian who wants the vaccine can get it.

The third and final phase, he said, will essentially turn the administration of the vaccine into one similar to the robust system that distributes flu shots with pharmacies, physicians offices and public health units all playing a role.

“That is when the vaccination sites, which will characterize a lot of Phase One and Phase Two will start to disappear, he said.

The Ontario Long Term Care Association has said that there will be a need for 624,000 individual vaccine doses just to protect residents, workers and essential caregivers in the province’s 626 licensed long-term care homes.