Objectives
Prior to the 2016-17 flu season, Ontario distributed influenza vaccine to community pharmacies via two mechanisms: one inside the Greater Toronto Area (GTA) and the other outside. Issues related to the acquisition of influenza vaccine have been cited by pharmacists as a barrier to providing immunization to patients. A survey was conducted during the 2015-16 influenza season to understand the experience of community pharmacies in acquiring the vaccine and to assess the impact of distribution practices on patients, pharmacists and pharmacies

Methods
A random and proportionally representative sample of 400 community pharmacies participating in Ontario's Universal Influenza Immunization Program (UIIP) across the 36 Public Health Units was identified. Screening and recruitment of respondents was done by phone prior to survey launch. Descriptive analyses were conducted.

Results
The survey was completed by 193 respondents. Results suggest that under this distribution system, many community pharmacies experienced issues acquiring influenza vaccine, especially early in the season. One third of pharmacies (32.7%) reported that the first order of influenza vaccine did not arrive in time for the start of their immunization initiative. Most pharmacies (97.3%) reported patients asking for the vaccine prior to first order fulfillment, almost half of pharmacies (40.6%) reported instances where they could not provide vaccine, and 39.2% reported being out of vaccine more than 5 days during flu season. Pharmacies estimated losing between 10-50 opportunities to vaccinate due to fulfillment issues

Conclusion
With the recently implemented wholesaler distribution system for pharmacies outside the GTA in the 2016-17 flu season, our data provides a necessary snapshot of past practices through which the new distribution system can be more readily assessed to ensure that previous inefficiencies are not repeated; and that the influenza immunization needs of Ontarians are being met with improved, timely and consistent access to the vaccine for community pharmacists.