The distribution machine behind Quebec's COVID-19 drug stockpile and pharmacy flu vaccines
MONTREAL -- Demand for the flu vaccine this year in Quebec is sky high, and appointments may be hard to come by.
Still, pharmacies that ordered flu vaccines will all receive their supply by November 1, in time for the start of the province’s campaign, according to Hugues Mousseau, Director General of the Quebec Association of Pharmacy Distributors (AQDP).
“It’s going quite well,” Mousseau said late last week, as he showed CTV around McKesson Canada - a vast drug wholesaler and distribution centre in St-Michel.
It’s one of eight independent drug distributors around the province. They are the behind-the-scenes machines that maintain the flow of necessary drugs and treatments between the manufacturers and the end-users: hospital patients and the average person filling a prescription.
It’s the first time a camera has been allowed inside the federally and provincially regulated facility in nearly two decades. The business operates “almost 24 hours a day, seven days a week, with 150 employees," says operations manager Francois Trepanier.
That morning - and every morning, they set to work unloading and cataloguing hundreds of boxes of incoming pharmaceutical products.
But not surprisingly, when an automated door snapped open, admitting us into a walk-in refrigerated storage room – there wasn't one box of flu vaccine left.
In the current COVID-19 climate, vials of flu vaccine don’t sit on the shelves for long. Shipments arrive from a public health department warehouse every two weeks and are immediately loaded onto trucks and delivered to community pharmacies.
So far, they’ve delivered about 585,000 doses of flu vaccine to the 1,600 pharmacies offering free shots this year.
The distribution team is still waiting for an additional 65,000 doses to complete the pharmacies’ orders. Together, the 650,000 vaccines represent approximately one-third of all the stock purchased last January by the Quebec government for this season.
But with pharmacy phone lines ringing off the hook, supply is not meeting demand.
“The question is whether we’ll be able to provide them with more quantities than they originally ordered,” Mousseau said. As of Oct. 30, pharmacists have asked for 200,000 extra doses.
“We’re working very closely as an association of distributors with public health authorities to find ways,” and Mousseau says he hopes to get a response by mid-November.
Only then will pharmacists know if they can open new appointments in the months ahead.
Any extra doses they receive would come from the government’s remaining and finite 1.3 million plus doses.
Pharmacist-owners are also permitted to arrange to transfer doses among themselves as long as the vaccines are kept cool during transport (2-8 degrees) if, for example, one store has more interest from the public than another.
COVID-19 drug stockpile, preventing drug shortages
With the province mired in a second wave, ensuring the availability of vaccines, COVID-19 drugs and other prescription medications is a top priority right now.
Each drug eventually prescribed to patients in hospitals, CLSC’s and long-term care homes in Montreal is channelled through the 150,000 square foot McKesson Canada facility on Pie-IX Blvd.
That includes one of Quebec’s COVID-19 drug stockpiles.
The exact list of drugs in that stockpile is a closely-guarded secret now. Last April, Premier Francois Legault created some panic when he publicly said the province might soon face a shortage of anaesthetics and other drugs needed to treat patients with the disease.
Health-care workers were only just learning back then that patients in the ICU, on respiratory support and in palliative care needed drugs “in amounts that differed from other illnesses,” said Mousseau.
“Inhalers were in high demand, the ones used by asthmatic patients. There were no shortages, but they were harder to come by, and inventory levels were a bit lower.”
As a result of lessons learned during the first wave, the government now uses medical and pharmacy consultants to identify which drugs could be in higher demand and which medications they could substitute for those in short supply.
In response, drug distributors adjusted their purchasing model. Mousseau says they’ve increased their 30 day drug inventories to 90 days to create a buffer.
“That’s exactly what we were able to do in the context of the first wave, and that’s what we’ve done in the second wave. We’ve invested to increase our inventory and add additional weeks of critical products needed.”
Mousseau says right now it’s running quite smoothly.
Getting the balance right during a pandemic requires shrewd forecasting on the part of distributors. Drugs come with expiration dates, and if the wholesalers invest in more significant inventories of medicines that aren’t required in the end - they face a loss.
“Our cost structure is dependent on Health Canada, and federal regulations and our revenues are dependent on provincial regulations.”
Manufacturers in Canada have a legal responsibility when they anticipate a shortage to issue a status report. They post the updates on the Drug Shortages Canada website.
Pored over by industry members, the public information also prompts mitigation measures on the part of pharmacists.
Last March and even today, most customers are only permitted to fill prescriptions for one month, and no longer.
“Between the pharmacist's supply and the distribution centre's supply, they’re sometimes able to delay by several weeks, the time a shortage is actually declared to the time at which the end-user feels the impact. And most often I would say out of the hundreds of shortages that are declared on that site every year a very small minority of them actually will impact patients,” said the AQDP's director-general.
Mousseau and his colleagues in the industry are closely monitoring the development of a COVID-19 vaccine. They have already started discussing the process and what could lie ahead if they are tasked with getting a vaccine out to Quebecers.
16,000 different products from opiates to vitamins
Craning our necks as we filed up and down the facility's isles, we learned there are 16,000 different products piled on palettes, stacked on shelves and in refrigerated rooms.
Among them are pills, liquids and injectable drugs from 200 authorized patented and generic drug manufacturers, as well as your average bottles of vitamins.
Narcotics are locked away in a highly secure vault that remained off our tour schedule. The vault is strictly off-limits to anyone except employees who get pre-approved after passing a security background check, as per federal regulations.
The workers on the afternoon and evening shifts assemble the orders for all the pharmacies in Western Quebec.
“Every day we ship about 1,000 deliveries,” says Francois Trepanier, "which represents about 1,125 units to customers.”
McKesson’s operations manager says the first wave was very challenging for his team.
“In panic time, we have 200 per cent requests from the customer. So it was really difficult, it was really hard.”
Employees stepped up, he said, working overtime to fill the trucks and get out the orders.
Now they’re doing it all again.