An injection of hope: What we learned from the vaccine rollout

Deep into the third wave of the COVID-19 pandemic, Canada is racing to catch up with a virus spreading and mutating across the globe at an incredible pace. No longer is the collective goal to “flatten the curve” – this time, armed with vaccines, the aim is to break the chain of infection altogether.

In this three-part series, YFile investigates the COVID-19 vaccine as an injection of hope for recovery. Today, in part two, we look at vaccine access, equity and rollout.

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Imagine you are someone working in a highly exposed job in a hot-spot community during the COVID-19 pandemic. Imagine that without this job, you cannot pay your rent, feed your family or meet your responsibilities. Imagine this job does not offer personal days, sick pay or time off from your regular schedule.

Now imagine all this means that despite desperately needing it, you cannot access a vaccine for COVID-19.

This is just one example of the unfair burden the novel coronavirus has placed on marginalized populations. The pandemic has disproportionally affected people who are already facing systemic inequities within our society – structural, racial, economic and so on – resulting in higher transmission and case counts, less access to health resources, and unfair working and living conditions among these populations.

The vaccine rollout has been no different.

“There is more to consider in terms of vaccine uptake than the vaccine decision or intention – a lot of people may have the intention to get the vaccine but are running into barriers in terms of availability, access or timing,” says Eric Kennedy, assistant professor at York University in the Disaster and Emergency Management program. “There are many people who want to take this vaccine but encounter substantial barriers.”

Numbers from the Science Advisory Table during the vaccine rollout, he says, indicate higher rates of vaccination among those in lower risk categories, which highlights the structural and logistical barriers preventing equitable vaccination opportunities.

“It has not necessarily been made clear that we’ve been doing a good job of protecting those communities that are the most vulnerable,” he says.

Professor Steven J. Hoffman agrees. Hoffman is the Dahdaleh Distinguished Chair in Global Governance and Legal Epidemiology, a professor of global health, law and political science, and the director of the Global Strategy Lab at York University.

When looking at data for Toronto, he says wealthier people have had better access to the vaccine over those living in poverty and in marginalized communities. Take the Jane and Finch area, for example. This community, says Hoffman, has a greater burden of COVID-19 and more severe consequences of the virus, yet the high-risk factors there were not immediately considered in the province’s vaccination strategy.

“If you were running a vaccine rollout in the most effective way possible, you would consider the full range of risk factors and you would plan accordingly,” he says. “The way Ontario has fared during this pandemic is largely the result of decisions made by our provincial government. Those decisions have sometimes had deadly consequences.”

Eventual changes to vaccine distribution in Ontario – such as prioritizing hot-spot postal codes, holding vaccination campaigns within workplaces and offering extended-hours vaccination clinics – have addressed some of these barriers.

This was an attempt to correct the “double inequity that comes from both the unfair burden of this virus on people who face conditions of marginalization and lower access to vaccines for those same populations,” says Hoffman, who says this strategy came too late.

“Once you know this is a global pandemic, you want to make sure your jurisdiction is ready for vaccine rollout. That didn’t happen here.”

The rollout in Ontario, he says, has been “pretty terrible” and was delivered with a slurry of confusing communications about the vaccine, a lack of consistency in delivery and difficult-to-follow protocols.

“This is my area of research, and at times I myself have been so confused by the province’s messaging,” he says. “It was changing so fast, and communication has been terrible – and it doesn’t actually all make sense. It makes it really hard for people to keep track, and so we are at the stage where it is increasingly important for the government and public health authorities to make it as easy as possible for people to be vaccinated.”

This rings true when looking at populations that lack the tools to access information – language, technology and health-care supports like provincial health insurance, for example.

However, both Hoffman and Kennedy agree that the vaccination rate in Canada is tracking well – especially compared to other G20 countries – and both say decisions made by the federal government have been successful in addressing other vaccine challenges.

Kennedy applauds Canada’s decisions around vaccine procurement and says the strategy to “spread our eggs in multiple baskets” allowed the country to respond with agility.

“There have been a lot of complaints about not having domestic vaccine production capacity, but if we had focused on one or two domestic vaccines alone, it would have been a huge gamble on availability and effectiveness. Instead, the strategy we took was to establish a large number of options and be able to pivot toward the most effective and available vaccines.”

He cites this as the “hidden gem” of the federal COVID-19 response.

And we are getting there, however slowly.

Using these experiences to inform policy around pandemic planning and response, and equity in public health and safety, will be the key to managing future outbreaks of COVID-19 and preventing the spread of highly transmissible disease going forward.

To guide and change policy, it will be crucial to recognize that decision-making around vaccines is not always based on rationale, but can be rooted in logistical barriers, lack of opportunity and cognitive fatigue.

“Disaster communication is often very local and tangible: community members turn to emergency managers for real-time information about the threat they're facing, like a fire, flood or tornado,” says Kennedy. “But this case is dramatically different. The duration, complexity and interconnectedness really demands a more collaborative approach in engaging the public.”

This means taking dialogue seriously, rather than just disseminating facts, and understanding people’s values, challenges and expectations.

The UN Research Roadmap for the COVID-19 Recovery, a report led by Hoffman in his role as scientific director of the Institute of Population and Public Health at the Canadian Institutes of Health Research, outlines national and international strategies for the COVID-19 recovery period and puts this people-first perspective at the forefront.

The report, issued in November 2020, advocates for policies that are informed by evidence, address inequalities and prioritize human rights within a framework of five main pillars: health systems and services; social protection and basic services; economic response and recovery programs; macroeconomic policies and multilateral collaboration; and social cohesion and community resilience.

Hoffman remains positive that a more equitable balance can be achieved, and there is progress being made to policy around vaccine rollout provincially and federally.

“We live in a world where people, systems and generations are all interdependent,” says Hoffman. “That’s why I am pouring all my time and energy to encourage a better recovery – one that is more equitable, more resilient and more sustainable. I think those are the three key variables we need to think about, and I am hopeful – because if not now, then when?”

Read part one here: yfile.news.yorku.ca/2021/06/09/an-injection-of-hope-herd-immunity-where-are-we-now. For part three, visit: https://yfile.news.yorku.ca/2021/06/15/an-injection-of-hope-covid-19-and-the-road-to-recovery/.

By Ashley Goodfellow Craig, deputy editor, YFile

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