The province's response to the H1N1 pandemic is being reviewed in a report issued by the Health Quality of Alberta. Health officials hope the 92-page report that outlines 18 recommendations will benefit public health planning going forward.

The report comes after the health minister asked the council back in February to conduct a review of the province's response to the H1N1 pandemic last year.

The report details some of the most difficult communication challenges related to the ongoing changes of the mass immunization clinics, which include the decision to encourage all groups to get immunized.

When the clinics first opened last fall, all Albertans were encouraged to get vaccinated despite policies in place that high-risk groups get the shot first. The report shows a "decision was made at a high level" to encourage all groups to get immunized.

The report also notes, "clinics had not been staffed for the crowds that responded to the invitation that communicated 'no one would be turned away'".

"One was the need to be flexible and so if you are flexible you change as you go along -- and yes that was a difficult part of changing the focus, but certainly we saw that as the way to go," said senior medical officer of health for Alberta Health Services Dr. Gerry Predy.

Clinics were eventually shut down for four days after line-ups grew longer, and supplies started to dwindle. The review team found "no evidence decision-making for keeping the clinics closed for four days until November 5, 2009.

Alberta Health Services' chief medical officer of health Dr. Andre Corriveau says it was a difficult decision for them to make.

"We knew we were going to hit a wall in a couple days so we had to make a decision, it was not an easy decision to make."

The report states "the decision to close the clinics and keep them closed until November 5, 2009 was unique in Canada and was not based on accurate vaccine inventory data."

The review team also notes that Alberta Health and Wellness estimated a wastage range of 10 to 20 per cent of vaccine in the first week alone, which would "equate to 32,000 to 64,000 doses. The report went on to say while staff encountered some difficulty in withdrawing the correct number of doses the first few days, "that number appears high given public health's experience in manipulating reconstituted medication and using vaccine."

The government has accepted and agreed with 17 of the recommendations and took one under advisement. 

"The one thing that I know we can improve on and I know we did that in the later stages is to get all the agencies together, alberta management agencies, and of course public health," said Premier Ed Stelmach.

Some critics suggest the report shows the province dodged a bullet.

"If this had of been a more virulent and more serious disease than it had turned out to be we would have significant casualties because of the lack of preparedness on the part of the provincial government," said NDP Leader Brian Mason.

Corriveau says they made decisions at the time based upon the information they had.

"Given the information available and the circumstances at the time there is not a lot that I say we would have done differently," he said.

The report outlined of all the high risk groups, which included those at risk for complications, children aged five and younger, health care workers and pregnant women, only children were vaccinated above the national level.

With files from Sonia Sunger