Sabotaging Prevention

In early 2021 I waited nearly eight hours in an online queue to book COVID-19 vaccinations for myself and my family. Along with over 29 million other Canadians (reliable data was not reported by Alberta), we waited while the vaccine was made available in phases, in priority from the most vulnerable to those who were believed to have the most resilience. We waited for rigorous clinical testing, while a national and global supply could be accumulated, while provincial systems of distribution and storage could be established. The wait was not without stress and anxiety. But even in a province where elected and aspiring leaders were spreading dangerous and alarmingly untrue rhetoric and promoting the so-called Great Barrington Declaration, most Albertans trusted that there would be a vaccine available for everyone. In part, this trust was anchored by the oversight of federal health officials and nonpartisan public health bodies issuing recommendations based on the best available evidence – not political pandering.

After months of worry for the wellbeing of ourselves, our families, and our communities, for many Albertans getting a vaccine was not merely the key to relaxing restrictions on our daily lives – it was the power to avoid mass death and disability. In 2021, waiting in the queue felt like agency.

In 2025, waiting in the vaccine queue feels like powerlessness. Helplessness, after 8 hours of ringing the 811 booking line only to be disconnected as the operators were overwhelmed. As I dialed again and again, with the website and multiple tabs of walk-through guides open on my screen, it felt like I was watching myself in two different timelines: the one where vaccination was lauded, encouraged, and facilitated in accordance with the best available scientific evidence and rooted in the principles of public health; the other, a labyrinthine quest to navigate disinformation, conspiracy theories, indifference, and outright lies. In one, the health and lives of Albertans is paramount; in the other we are expendable to be sacrificed on the altar of political advantage.

How did we get here? Where did these two possible futures diverge? Why was I – along with so many other Albertans – still waiting?

UCP Immunization Policy: limiting supply, restricting eligibility, imposing cost barriers

In August 2025, the government of Alberta, via one of its many ministries of not-quite-healthcare, announced that it would be undertaking a radical overhaul of the province’s Covid-19 vaccination program. As the federal immunization initiative and associated funding had ended, responsibility for procurement and delivery of vaccines reverted to the provinces and territories. For the autumn/winter 2025/26 season, Albertans would be required to “pre-order” their intended vaccines – and pay a one-hundred-dollar administration fee. After several years of seemingly random changes to vaccine availability – from multi-hour queues booking online, to large-scale AHS immunizing blitzes in vacant warehouses and ‘for lease’ Pier One buildings, to private pharmacies – as well as a non-existent strategy to tackle the largest measles outbreak in North America, the announcement has only added to a widespread sense of confusion and disorganization. Combined with local and international anti-vaxx movements armed with disinformation and ivermectin, the lack of a coherent approach or consistent, evidence-based messaging by the province has made navigating immunizations a minefield for Albertans.

The policy shift was justified in a statement by Adriana LaGrange, Minister of Primary and Preventative Health Services: “In previous years, we’ve seen significant vaccine wastage. By shifting to a targeted approach and introducing pre-ordering, we aim to better align supply with demand – ensuring we remain fiscally responsible while continuing to protect those at highest risk.”

Alberta broke ranks as the first province not offering free, universal access to the vaccine (although the Quebec government has now issued similar conditions, including a fee). The new policy not only imposed financial and access barriers, it also created a sense of scarcity: despite requiring a pre-order, the government of Alberta determined in advance the number of vaccines that would be ordered and would not commit to ensuring a dose would be available for every Albertan who wanted one. The key words used were, “pending availability.”

According to City News, “The province said it has ordered 485,000 doses of COVID-19 vaccine for the fall of 2025 — about 250,000 fewer doses than were administered last year.” This figure does not seem to be reflective of any data regarding the number of Albertans with underlying conditions or the number of people actively seeking the vaccine – it is predicated on fewer people seeking the vaccine than in previous years. If 500 000 Albertans with qualifying conditions make appointments to get vaccinated under the priority phase, some 15 000 vulnerable people would be left doubly at risk: a lack of individual protection and an insufficient base for community-wide immunity. Those who booked vaccination appointments under subsequent phases may not receive their shots once the initial supply is allocated.

The fundamental principle of public health as preventative health is that the cost is justified for the greater objective – saving lives. This relies on government facilitating public immunization programs that make it as easy as possible for as many people as possible to access in order to gain the widest possible coverage. The “return on investment”, even in strictly financial terms, is many magnitudes higher than the costs to public services and the wider economy of doing nothing. The fee is only one mechanism by which the UCP government is restricting access.

This policy shift is neither politically neutral nor morally neutral – as we have seen with the tragic consequences of this government’s approach to measles immunization. Dr. Darren Markland, an intensive care physician at the Royal Alexandra Hospital in Edmonton (who sadly and suddenly passed away in September), raised “significant concerns about the mechanism by which people are able to obtain vaccines this year. Making access to vaccinations as easy as possible has always been key for getting our vaccination rates up, and in fact, [this] process seems to be the opposite. It's a tariff on health care, and that is not what we are supposed to be doing to keep the vulnerable safe.”

It is essential, therefore, that we break down and evaluate the claims made by the Premier and Minister of Primary and Preventative Health. Are they supported by reliable evidence? Will these policy changes have the impacts this government attests? Will those impacts actually cause more harm than good for many Albertans?

Claim: “Significant vaccine wastage”

The province has claimed that during the 2024-25 respiratory virus season, more than 400 000 doses went unused or expired. When COVID-19 immunization was federally managed, supplies were monitored and managed to ensure coverage gaps were met and that wastage was minimized. Initiatives were created to donate as many surplus doses as possible to other regions and countries around the world. Why would the province not have a vaccine donation program in place? All public health programs recognize that some spoilage of doses is inevitable – it is factored into the cost-benefit. In a 2022 study, Aubrey et al report that:

According to a survey conducted by The Canadian Press published in November 2021, Canada has reported the wastage of over one million doses of COVID-19 vaccines (Djuric & Osman, 2021). This amounts to 2.6% of the vaccine supply delivered to the provinces that responded to the survey (Djuric & Osman, 2021). Of these, 120,578 doses were discarded due to expiry (Osman, 2021). The total amount of wasted doses varies widely by province or territory, from approximately 10% of doses being wasted in Alberta and Nunavut to 0.3% in Nova Scotia (Djuric & Osman, 2021; Osman, 2021). The Public Health Agency of Canada (PHAC) has stated that it aims to keep the number of vaccines going unused in the country to under 5%. (Aubrey et al. 2022)

The authors of this study point to many practical methods to reduce wastage due to spoilage, expiry, or damage, and recommend that public health jurisdictions seek creative partnerships to find avenues for distributing as many vaccines as possible as they approach the expiry date, including through partnerships with community organization and businesses.

Alberta has also had successful initiatives to reduce wastage of COVID-19 doses:

“Open vial wastage can be reduced by having vaccination centres report their available supply of doses daily, such as via an online portal, while increasing demand in parallel, when needed, via targeted outreach to unvaccinated individuals, who could be allowed to get vaccinated without an appointment. Another option is overbooking vaccine appointments to overcome no-shows. I6tn the Canadian province of Alberta, for example, overbooking appointments to avoid wastage from no-shows led to waste on site being reported at only 0.3%.” (Aubrey et al. 2022)

Moreover, one of the biggest factors in vaccine wastage, after damage and transportation or storage errors, is vaccine hesitancy. According to a widely-cited paper in the British Medical Journal, “public trust in vaccines plays an important role, and this trust is highly influenced by communication and the spread of misinformation.” Preventative health relies on immunization programs that educate the public and raise awareness about the benefits of immunization to themselves and wider society. This government is failing on both pillars of public health – awareness and access.

It is also highly disingenuous for the Minister and Premier to decry “wastage” when their own policies have imposed barriers to access and contributed to declining uptake of the vaccines. The confusion around the latest protocols for COVID-19 vaccination follows on from a chaotic respiratory virus season in the autumn of 2024/winter 2025, when a lapsed distribution contract meant local medical clinics and family physicians were unable to administer the vaccine to their patients. The change in policy saw the number of clinics administering many vaccines (including COVID-19, influenza, pertussis, tetanus and others) drop dramatically from between 500 and 600 to 20-25. While the majority of COVID-19 and influenza vaccinations in 2024/25 were administered via AHS public health centres and pharmacies (approximately 1600 province-wide), the province has further reduced pharmacy access for the 2025/26 season.

At the end of August, just weeks before the COVID-19 vaccination pre-booking was to go live, I asked my local public health centre if they would be one of the locations for distribution. None of the nurses or administrative staff had hear any details beyond the news releases, and had assumed the vaccines would be delivered to pharmacies like the previous year. The very place Albertans are meant to go for public health advice and for logistical information on receiving vaccines was not able to provide either.

Claim: “Fiscal Responsibility”

Under the new out-of-pocket fee policy, the price per dose of COVID-19 vaccine is estimated at $100 – $110. In a June 2025 news release, the government asserted that the entire immunization program for 2025/26 will cost no more that $49 million, and that much of this cost will be offset by “cost recovery measures” – fees to patients. Yet the per dose figure appears based on CDC figures for purchase agreements, not bulk buying. Canadian negotiated purchase price had been 30-40% of CDC publicly listed price. What is Alberta doing and why isn’t it co-operating with other provinces to negotiate a more competitive purchase price?

A 2022 report from the CD Howe Institute goes further and breaks down the costs of Canada’s COVID-19 vaccine rollout against the costs to Canadian society of unconstrained illness caused by SARS-COV-2. Their analysis shows direct savings arising from the national mass vaccination campaign, as well as the indirect aversion of hospitalization and long covid costs. The report found that the vaccination campaign had further averted “ripple effect” costs to the economy due to lost work, the need to reimpose social restrictions, and the widespread economic suppression that would result from rampant illness. The authors of the report estimated savings of $188.1 billion to the Canadian economy in 2021 – the equivalent of $217.4 billion in 2025 dollars.

Per the CD Howe report, the cost for the national vaccine supply and implementation was approximately $3.7 billion, reaching more than 24 million Canadians with a total of over 50 million doses. The direct savings due to averted cases and hospitalization was estimated between $3.3 and $5.8 billion - leaving the initiative cost neutral under even the most conservative calculation. The statistical value of reduced mortality due to the vaccines – assuming one can put a price on lives saved – was estimated at $27.6 billion.

While calculating the value of indirect costs avoided is complex due to the many factors and evolving nature of the pandemic, the authors of the CD Howe report considered a counterfactual: what impact would have resulted from a 6-month delay in distributing the COVID-19 vaccine across Canada? Economic losses equivalent to 12.5% of national GDP – around $156 billion in 2021, or $180 billion in 2025 terms. For scale, 12.5% of Alberta’s GDP in 2025 would be over $44 billion – more than our provincial health and K-12 education budgets combined.

The report also noted, but could not quantify, the mental health benefits of the vaccine, as levels of anxiety and stress that had significantly increased during the height of the pandemic were reduced following the vaccination rollout.

A 2025 study, using a highly detailed model regression, compared the direct and societal costs of following the National Advisory Committee on Immunization (NACI) recommended COVID-19 vaccine approach Canada-wide to a “do-nothing” approach that ended routine COVID-19 vaccines for Canadians. Using the most likely scenarios around per dose costs, wastage, and current trends of illness and hospitalization, the net benefit was clear. Even when higher parameters around per dose cost and wastage were applied, it was still less costly to pursue a full vaccination program.

We can estimate what this might look like in Alberta by simplifying a few assumptions. Consider that the risk of hospitalization due to COVID-19 is between many times greater for unvaccinated people than for those fully vaccinated. When we break down the strictly financial cost to Albertans of hospitalization due to COVID-19, we can see that the claim of “fiscal responsibility” simply doesn’t hold.

Based on data from the Canadian Institute for Health Information (CIHI):

• Average total length of stay for COVID patients in Alberta = 3 days
• Average cost per COVID-19 hospital stay (excluding intensive care unit) = $36,677
• Average cost per COVID-19 hospital stay (ICU included) = $82,711
• Total cost of COVID-19 hospitalizations in Alberta 2023-24 = $104 675 669

Sources:
Canadian Institute for Health Information. COVID-19 Hospitalization and Emergency Department Statistics, 2023–2024 (Q1 to Q2) — Provisional Data. Ottawa, ON: CIHI; February 2024.
Canadian Institute for Health Information. Comparing Estimated Costs of COVID-19 Hospitalizations and Other Common Hospitalizations in Canada, January 2019 to March 2020, and January 2020 to March 2021. Ottawa, ON: CIHI; 2021.

In 2024-25, when so many vaccine doses were “wasted”, 3374 Albertans were hospitalized with COVID-19, and 413 Albertans died. The average cost for hospitalization alone would have exceeded $120 million based on the CIHI methodology. For 2025-2026 thus far, the Alberta Respiratory Virus Dashboard reports 241 hospitalizations due to Covid-19, 13 ICU admissions, and 17 deaths – at a cost of approximately $10 million.

The Alberta Medical Association released their own estimate of the costs averted by continued adherence to a rigorous and widespread COVID-19 immunization program. If just 10% of the population were deterred from getting vaccinated thanks to this Kafkaesque policy, the Province would be faced with approximately $130m in additional costs due to increased hospitalizations and ICU admissions this year alone.

This is a basic level financial cost; the cost to lives, livelihoods, families, and communities is far higher – and for many, incalculable.

Claim: “Protecting those at highest risk”

This claim by the Minister ignores the fact that the best protection for those Albertans most vulnerable to illness is a wide base of vaccine coverage across the whole population. Instead, the government’s policy constitutes, according to the Alberta Medical Association, “a policy based on confusion and radically reduced community access.” The varied framing of “most vulnerable” between statements made by the Premier, the Minister of Primary & Preventative Health, the NACI, and the booking website itself also created confusion over eligibility: the list of qualifying underlying conditions is buried three clicks away from the booking website, and is incomplete (not comprehensive compared to the NACI list). Many Albertans with common conditions were not aware that they would be eligible to receive the vaccine for free and in the first phase.

Within my own family, determining who was and was not eligible for the priority phase was frustrating and nonsensical. After the initial announcement I had assumed that my parents, both over 70, would qualify. My mom, a stroke survivor, did; my dad, her primary caregiver and the person most likely to transmit the virus to his wife, did not. My eldest child, with four qualifying conditions, had to wait a week longer for an appointment than my two youngest, with one each. Under-12s with an underlying condition were only being booked on a single date in the Edmonton area. The booking website as well as the 811 agent informed me that we would be asked to provide proof of our eligibility upon arriving at the clinic – without it, we could be turned away. While some of these conditions might be documented in a patient’s medical record, others might not. In the case of three of my children and myself, there was no documentation outside of private assessments provided by our family psychologist – who was bewildered by the number of clients asking whether she would need to provide them a letter or grant access to their personal psychological files. In the end, none of the public health staff at the clinic requested personal medical history beyond allergies and medications that might provoke an adverse reaction. But the hoops that I attempted to jump through would surely have exhausted and dissuaded many parents of children at risk, or seniors challenged by the lack of clarity, or people with common chronic illnesses who feared disclosing their personal mental health history.

Healthcare workers, who were prioritized nationally and provincially during the immunization round in 2021, had to raise hue and cry through their union representatives – UNA, HSAA – in order to secure free vaccines. Teachers were not included, but the offer of exemption of the $100 fee was used as a bargaining chip as ATA members signalled province-wide labour action.

The Alberta government’s approach does not take into consideration inequities regarding vulnerable populations and excludes racialized Canadians, First Nations, and those experiencing houselessness from the groups that should be given priority.

While on-reserve healthcare falls under federal jurisdiction, the logistics of immunization and other public health programs are a provincial responsibility. Health Canada relies on each province to order the appropriate number and type of vaccines to serve First Nations within its boundaries. According to sources within the federal health ministry, the Alberta government’s changes to COVID-19 vaccine eligibility were not communicated by the provincial Ministry of Primary and Preventative Health, nor were their federal counterparts informed of whether the Alberta had ordered sufficient vaccines to provide coverage for First Nations communities. Statements from Premier Smith and Minister LaGrange suggested the number to be ordered was an estimation based on the previous year’s uptake. Staff in the federal Ministry of Health resorted to drafting a letter to Minister LaGrange begging for clarification of these details that would enable them to plan the distribution of the vaccines to reserve communities. At the time of writing, they were still awaiting a reply.

While vaccination has been presented by this government as a matter of choice, in reality that choice exists only for a very few – those whose unions advocated for them, those who were able to endure hours on hold or navigate a series of baffling websites, those who were able to travel to a limited number of sites on an even more limited number of dates, those who were able to provide appropriate documentation of an underlying health condition. However, at each point the layers of immune coverage are narrowed and narrowed further in a perverse inversion of the principles of accessibility and prevention. And with each layer, the costs for Albertans increase.

So where does that leave Albertans? For these lucky/unlucky few, it offers a necessary degree of individual protection. But for our communities, and our province as a whole, this policy fails to offer a sufficient degree of protection. Preventative health is about more than the individual. The penny-pinching objectives of the provincial government do not hold up to even the most basic math, and so we must ask: what are the real motivations behind a vaccine policy that fails to prevent the impacts of severe illness? From my place in the hold queue, it felt like the only thing being prevented was preventative health itself. And that will have costs – wasteful, unnecessary, tragic costs. Costs that we can ill afford.

Photo credit: Photo by Daniel Schludi on Unsplash