Lessons from influenza A (H1N1) vaccination in 2009

During the influenza A (H1N1) pandemic in 2009, Quebec experienced the first mass vaccination of the entire population. As a second experience approaches, protagonists explain what to do and, most importantly, avoid.

Véronique Lauzon
Véronique Lauzon

In 2009, while Minister of Health and Social Services, Dr Yves Bolduc saw the flu pandemic A (H1N1) coming with concern. “We knew it was a virulent virus that could kill many people. ”

The first wave hit from May to the end of July 2009. And as the second wave hit, Quebec was preparing for a population-wide vaccination campaign, which then represented more than 7 million people.

One of the big challenges was of course to convince as many Quebeckers as possible of the importance of the vaccine. But as explained by Dr Gaston De Serres, epidemiologist at the National Institute of Public Health of Quebec (INSPQ), this virus certainly did not have the same virulence as COVID-19. “So the incentive for people to get vaccinated was lower than for COVID-19. ”

On the day the massive vaccination campaign began, October 26, 2009, a 13-year-old Torontonian died of influenza A (H1N1). “There people understood that it could kill children,” D explainsr Bolduc, who is under the impression that this sad event at the time encouraged many people to go to a vaccination center.

Overall, Quebec can be “proud of its achievements,” concluded the General Public Health Service’s 2009 report on pandemic influenza vaccination. The authors recall that at the end of the vaccination campaign, 55.9% of the population vaccinated, while the Canadian average was 45%, a percentage already better than that of other industrialized countries such as Australia (25%), the United States (20%), Japan (12%), France (8%) and England (7%).

The estimate we made at the time was that Quebec was one of the places where it was best managed in the world.

The dr Yves Bolduc, Minister of Health and Social Services during the influenza A (H1N1) pandemic

Although vaccination coverage was higher than other places, David Levine, who was president and CEO of the Montreal Health and Social Services Agency at the time, confided that 56% was less than the government wanted. “We would have liked 70%. This is the grade we’ve given ourselves for some sort of immunization at a level that blocks the spread. ”

The fact that the second wave ended in mid-December and that experts thought a third wave was unlikely has certainly caused people willing to receive the vaccine to change their minds. “It was a very interesting blanket indeed, but it would have been even bigger if the second wave had continued,” said Dr From Serres.

According to them, anti-vaccines are no more numerous now than they were then. “I think there are more people who are in favor of the COVID-19 vaccine because the risk of not taking the vaccine is much higher than in 2009 [pour la grippe A (H1N1)] ”, Emphasized Mr. Levine.

Contribution of opposition parties

For the former health minister, the Quebecers’ reaction to the 2009 vaccination is in large part due to opposition parties, who have rallied behind him to send a clear signal to the population. At the time, one of Quebec’s strengths was not to play politically. We played welfare and health, ”said Mr Bolduc, who returned to work as a doctor after his time in politics.


In 2009, the delegates Amir Khadir (Québec Solidaire), Bernard Drainville (Parti Québécois), Éric Caire (Action Démocratique du Québec, absent from the photo) and the Dr Yves Bolduc, then Minister of Health and Social Affairs, was vaccinated “together” against influenza A (H1N1).

Yves Bolduc is convinced that the moment when Amir Khadir (Québec Solidaire), Bernard Drainville (Parti Québécois), Éric Caire (Action Démocratique du Québec) and he were vaccinated “together” was one of the turning points of the campaign. “In these cases, at some point, people have to stop making an opponent’s speech. ”

Senator Kelvin K. Ogilvie, who participated in the investigation Canada’s response to the 2009 H1N1 flu pandemic, goes even further. It is important to have harmonized messages across Canada. To gain and maintain public confidence, it’s important to have a consistent message across the country. “Many voices, one message,” the study summarized. For this former chair of the Research Canada Committee on Health Research, this was not the case in 2009 and is still not the case with the COVID-19 pandemic, while every province has measures and measures in place. different opinions on different issues.

The lesson to be learned from 2009 is the absolute necessity of a national strategy. But in all cases, Canada has never managed to be good at national strategies.

Kelvin K. Ogilvie, former Chairman of the Research Canada Health Research Committee

In Quebec, the main difficulty faced by the public health network was the delivery of vaccines, we read in the report of the Direction de santé publique. Even with everything in place to vaccinate many people in a short period of time, the amounts of doses delivered to Quebec by Health Canada were less than expected.

Problems with the supply of vaccines will also be one of the obstacles Canadians face during the COVID-19 campaign, De Serres said. “Since the number of doses will be limited, they will come in gradually over the next year. So it will not be like when we have a flu vaccination campaign, where all doses are ready and everything ends quickly. In the case of COVID-19, it is really the supply that will be the limiting step, far more than the number of vaccinators and the number of people who want to get vaccinated. ”

As in campaign A (H1N1), it is therefore necessary to set priority groups, such as health workers and vulnerable people. According to Mr De Serres, it could also be considered, as in 2009, to vaccinate as a matter of priority the so-called remote population groups “with very limited hospital resources”.

While the Legault government has just reversed its decision to allow Christmas gatherings, Yves Bolduc had exactly this advice to give: Don’t be afraid to reverse your decisions. “If the picture has changed, we have to adjust”, he concludes, convinced that he thinks so far that the province is doing well with the pandemic.

The successes of the influenza A (H1N1) vaccination campaign


Since 2005, working groups have been planning the organization of possible mass vaccinations. This preparation is one of the reasons for the smooth running of the campaign in 2009, say the authors of the Directorate-General for Public Health assessment of influenza A (H1N1) vaccination. “It appears that lengthy preparation has been a key element in the success of the mass vaccination operation,” we read. “It showed that the health network was quite capable of setting up large vaccination campaigns,” said Dr.r Gaston De Serres.


“The adaptability and speed with which one can constantly adapt to new data or guidelines has been one of the strengths of the organization of this campaign,” the report’s authors wrote. In this regard, Yves Bolduc recalls that Quebec then had “highly regionalized” public health. “One of the weaknesses in the COVID-19 file is that Public Health is much defeated and more centralized, which does not help with the management of COVID-19. ”

Good communication

Several times the report of the Directorate-General of Public Health emphasizes that good communication is essential for the success of a vaccination campaign, both internally and with partners and the population. . Since there have been many changes and last minute guidelines, good communication is crucial. “Experience shows that the effort must be continuous to avoid an interruption in the information cycle,” the study says.

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