'It really isn’t very clear': Effects of AHS reorganisation unknown professor says

Lorian Hardcastle, University of Calgary associate professor, discusses Alberta’s health care system and the availability of vaccinations with Alberta Primetime host Michael Higgins.

This interview has been edited for clarity and length.

Michael Higgins: Let's start on that lack of vaccine availability at medical and nurse practitioner clinics. It's been reported the government doesn't have a vendor for vaccine distribution and that a contract with a company expired in April. What is to be made of that rationale?

Lorian Hardcastle: I think it's problematic and that they need to address that issue and find a vendor that's willing to take on that contract, or work with the existing vendor to find terms and conditions they're amenable to, because having vaccines available in your own family doctor's office or your own nurse practitioner's office may be more convenient for people than going to a pharmacy.

Also, your own trusted health care professional may be able to persuade people to get vaccinated who might not otherwise take the initiative to go to a pharmacy.

MH: This is not just COVID and flu shots correct? It involves a number of publicly-funded vaccines?

LH: Yeah, absolutely. I think that having those available at your family doctor or at your nurse practitioner's office, any vaccines, whether we're talking about COVID and flu vaccine or other vaccines, is really important because those are your health care professionals. Those are the people that you go to and that you trust for advice. They can take steps to try to encourage people to get vaccinated.

MH: If this is not temporary and goes unresolved, how much of an impact might it have on vaccination rates in our province? Are there potential consequences?

LH: I worry that it could negatively affect vaccination rates because you have people who are going to go out of their way to seek out vaccines wherever they're available but then you have people who are only going to do it if it's if it's made convenient, or if someone encourages them to do that.

Really, your primary care provider is the ideal person to remind you about the availability of vaccines and encourage you to get them if you're already in the office for other reasons.

MH: In the past, the province would employ vaccine awareness campaigns encouraging Albertans to go and get their shots. How likely is that to be the case this year?

LH: I think we've heard a concerningly little amount from this government on vaccines, in light of the flu and COVID season that's upon us. Instead of talking about vaccines being safe and effective and encouraging people to get them which you would expect of a government, what we're hearing is rhetoric around vaccine freedoms and the right not to be vaccinated, and that's just not where we need the focus from the government to be right now.

MH: The fall sitting of the legislature will soon be here and high on the list of priorities for the government is updating the Alberta Bill of Rights, including the right to decide over vaccination and other medical decisions. As someone focused on health law and health policy, what will you be watching for in the actual amendments?

LH: There already is a legal right to refuse medical treatments, the charter covers off that right already. So it's not clear how much broader than that right to refuse medical treatment this might be.

I wonder if this might prevent, for example, employers from requiring employees to get vaccinated. I think, for example, about long-term care facilities or other sectors that work with vulnerable people, and I wonder if these legislative amendments might prevent those kinds of employers from being able to require vaccines.

MH: Would you consider that strengthening the Bill of Rights around bodily autonomy? What would be your perspective on that?

LH: Certainly the goal, from the government's perspective, would be to advance individual rights and to appeal to that segment of their base that was against vaccinations and was against how COVID was handled, but I think those rights have to be balanced against the public good and the public good is a high uptake of vaccinations.

MH: We're roughly one month shy of a full year since the Smith government announced the overhaul of the health care system. At that time, you wrote a column questioning changes and whether or not they would improve patient care. What's your assessment of progress made by the government nearly one year in?

LH: We haven't heard a lot from the government on what progress they've made. As someone looking in from the outside, I haven't seen a great deal of progress, although perhaps there are things going on internal to government.

But I think my concern remains that there are significant issues with the health care system around things like staffing, and we don't need this chaotic reorganization to distract our efforts from those considerable problems that should be government's focus.

MH: In terms of transparency, how clear is the path forward for Alberta's health system at this point?

LH: It really isn't very clear. The government announced, at a very high level, the kinds of changes that it was making to break up AHS and to create these four new organizations that each deal with a different sector of the health care system, but beyond that we really don't have a lot of details.

There's also a lack of transparency around what this is going to cost and the basis for why they are doing these reforms in the first place. What evidence are they relying on? What jurisdictions are they looking to with models like this?

Because from my perspective, the evidence points towards a different model, one that's more integrated and more akin to what Alberta already had.

MH: Alberta's infrastructure minister traveled to Boston at the beginning of the month. He was meeting with officials and touring health infrastructure projects. Is there anything to glean from that in regards to how the health system moves forward?

LH: I think there are examples in other jurisdictions of health care successes or high performing health systems, and so looking at other health care systems is always useful.

Although looking to the US as a model can be problematic, given the issues that they have with equity and with access and with cost. So you really have to be cautious when you're looking to the US as an example.