Honour system house of cards built on trust

Patience wears thin if people believe others are queue-jumping

Jack Knox, Times Colonist

Published: Thursday, November 05, 2009

Odds of winning Friday's $60-million Lotto Max jackpot: 28.6 million to 1.

Odds of dying of H1N1 in B.C.: maybe 88,000 to 1.

Odds of dying in a car crash: 100 to 1.

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Odds of dying of heart disease: 5 to 1.

Yet the lineups for deep-fried heart attacks at the fast-food drive-throughs are shorter than those at the lottery kiosks and flu shot clinics. Go figure. British Columbians must be attracted to long odds.

No, I shouldn't make light of the lines for the H1N1 vaccine, which has become this year's Tickle Me Elmo, or Wii, or Furbee, the must-have gift in limited supply.

Happily, we haven't seen the equivalent of the toy department tug-of-war. The flu-shot clinic at UVic continued yesterday as it began Monday, with the public displaying an orderliness that hovered between the resigned and the bovine, everyone willing to patiently wait their turn as long as others did, too. In good, egalitarian, Canadian fashion, we're willing to starve to death as long as no one else gets to eat, either.

Which brings us to yesterday's daily briefing by the provincial health officer, Dr. Perry Kendall. Much of it dealt with the question of queue-jumping, particularly as it applied to the Abbotsford Heat pro-hockey team, whose players were vaccinated despite not fitting the high-risk criteria.

Kendall said he will have a chat with the physician who vaccinated the team. Yet he acknowledged he doesn't have much of a stick to wave at doctors who break the rules. He could report a persistent offender to the B.C. College of Physicians and Surgeons, but it's uncertain if the offence would be considered serious enough to warrant disciplinary action. (In fact, the college, a complaint-driven organization, says it has yet to field such an allegation, so any response would be hypothetical.)

The Vancouver Island Health Authority expects to have doled out something like 120,000 doses by early next week -- enough for one in every six people. That includes 16,000 doses distributed to 461 physicians, says VIHA's Brett Hodson. Priority goes to remote, isolated communities and people in high-risk groups. Any physician can ask VIHA for the vaccine; it is doled out to doctors as it becomes available and on the condition that it be given without charge to those who fit the province's guidelines.

But there's nothing forcing doctors to stick to those priorities. A guy I know got a call from his doctor the other night. "Want a flu shot?" My friend had no underlying condition that should bump him to the front of the queue, but short of playing pro hockey or getting pregnant, there was no other way he was going to see a vaccine for a month. So he drove to his doctor's office, lined up with 40 others, none of them obviously in a high-risk category, and got the shot.

Yet other physicians report having trouble getting enough vaccine for those who qualify. Dr. Peter Houghton e-mailed to say how frustrating it is for a doctor who knows the needs of his patients to run short; he has been promised 50 doses within a day or two, but might not see more for another two weeks.

Kendall said there's no way to tell how much, if any, queue-jumping is occurring. It highlighted the fact that the entire vaccination program is run on the honour system, a house of cards built on trust, those getting the shots being counted on to be honest about their eligibility.

It might be true that the odds of actually dying of H1N1 are indeed long (Kendall estimates H1N1 could kill perhaps 50 people in B.C., well below the 200 to 800 that would typically die of seasonal flu) but the demographic is young, which makes parents nervous.

It's also true that the flu is widespread; at a guess, roughly a third of us might be hit over the course of both waves of the pandemic, Kendall says. No one wants to get sick.

Given those realities, given the widespread fear, it's admirable that people have been so good about waiting their turn as the vaccine is administered to those who need it most. But that patience will wear thin if they believe others are jumping the queue with impunity.

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