The first batches of the Pfizer and Moderna COVID-19 vaccines are here and are being distributed to priority groups like those in nursing homes, healthcare workers and remote Indigenous communities. But as additional shipments arrive, a comprehensive communication and vaccine distribution program will be a necessity.
Over the coming months, Canada will have to quickly immunize its 37.7 million citizens, all within an environment of incomplete information, vaccine hesitancy and varying access to health and social supports. To do that, we must act upon the truths about equity, diversity, decision-making and health system logistics that the pandemic has laid bare. To succeed, Canada’s immunization strategy will have to lean on influential community leaders, family doctors and public health.
Communities consisting of predominantly immigrant, ethnic or other marginalized citizens have been hardest hit by the pandemic. This is no surprise. These groups do not have the same access to health and social supports like income, job and housing stability as well as stable childcare and eldercare.
Canada is one of the most diverse countries in the world, with immigrants comprising 20 to 50 per cent of many cities. I grew up in Thorncliffe Park, a densely populated neighbourhood in east Toronto where 89 per cent of the population lives in high-rise apartment buildings. The majority are well-educated, visible minorities who immigrated to Canada. Household incomes average $50,000 per year. Crowded buses, crowded homes, crowded parks are the norm as are cultural practices based on the primacy of relationships with extended family, religious and social leaders. I grew up surrounded by other voices, other cultures, other religions, other ways of living and learning.
Having since studied and worked in different communities, from the remote northern Cree community of Moose Factory and the sparkling, ocean-side Halifax to the multicultural hustle of Scarborough and the spacious, spare beauty of Calgary, I have come to appreciate the uniqueness of each. Canada is more than hockey and maple syrup.
Canada’s diversity should be incorporated into any vaccination strategy.
Vaccine hesitancy is a significant issue with only 57.5 per cent of Canadians saying they are very likely to be vaccinated for COVID-19. Factors include age, education level and immigration. In fact, one-third of healthcare workers in Canada are immigrants, with the number rising to 79 per cent in cities like Toronto. Even among healthcare workers, 45 per cent expressed vaccine hesitancy. Concerns centered on efficacy, safety and the speed of vaccine development.
Clear, reliable information about the vaccine should be relayed via multiple channels, using multilingual, culturally appropriate and easily accessible strategies to support decision-making.
Family doctors are an obvious source of advice as 84 per cent of Canadians trust their physicians. However, people tend to seek health information from personal networks, extended families and religious leaders as well as in internet searches and social media before contacting their physician. This is especially true among immigrants. Despite this, centralized communication systems usually do not use influencers closest to people, including community organizations and religious leaders, to design and disseminate key information.
Previous experiences with government and healthcare shape how people react to government recommendations around health. In 2019, most Canadian immigrants arrived from India, China, the Philippines, Nigeria, Pakistan, Syria, Eritrea, South Korea and Iran, countries that struggle with transparency and trust. Healthcare in many of these regions is available only to the privileged few. Even in Canada, Indigenous, Black and other people of colour have suffered institutional racism. All this impacts what and who is trusted.
A strategy that includes the expertise and reach of religious leaders, community influencers and family doctors will be more persuasive and relevant.
A similar decentralized strategy is necessary to navigate the logistics of vaccine distribution. Local networks between family physicians and public health should be given the authority and funding to co-design locally relevant vaccine distribution programs.
After all, family doctors are more geographically accessible than hospitals for many citizens. Even during lockdowns in hard-hit provinces like Ontario, 96 per cent of family physician offices continued to provide care. Limited vaccine supplies mean we need the infrastructure to identify and track priority populations, necessitating access to a person’s medical and social history. Family doctors routinely record this information because community-based family medicine by nature is comprehensive, continuous, first-contact and person-centered.
Decades of experience have refined the approach family doctors use for vaccinations, even those requiring multi-dose regimens for infants, children and adults. Family physician offices are experts in identifying those in need, administering vaccines, managing side effects, tracking immunizations and calling patients back for booster doses. Both the Pfizer and Moderna vaccines require two doses to reach maximal efficacy. Evidence shows that, outside school settings, tracking vaccine administration, telephone call-backs and relationships with family doctors improve the uptake of multi-dose vaccination programs.
The COVID-19 vaccines hold the promise of moving beyond a pandemic reality. To reach that reality will require not only learning from the lessons of the past, but acting on them in innovative, community-based ways.
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I totally agree. Prevention must come before treatment whenever possible, especially in a pandemic where millions have died and more to share the same fate.
Thoughtful comments, Dr. Alam. Trusted communication(by Imams, Clergy, community workers/leaders) and taking the vaccine to the vulnerable populations would be key to increasing vaccine uptake. For example, in Thorncliffe park, (where I cut my teeth too!) having a vaccination site at a local community centre, so that front line workers/other high risk groups would not need to travel to remote vaccine sights on public transit. Off hours/extended hours of vaccinations will also increase uptake by hourly workers not having to take unpaid leave to access the vaccine.
Even if ivermectin is proven to be therapeutic (it has not yet, as it is still in the experimental stage), it is a treatment and not prevention. Vaccines are for primary prevention and so you do not contract a disease; once you’ve caught it, there is indeed growing evidence that some people may benefit from ivermectin.
“Experts have taken to social media to quell misinformation and address common concerns about Pfizer’s messenger RNA (mRNA) COVID-19 vaccine, performing an important public service in support of robust vaccine uptake. However, some scientific information is being oversimplified to the point that it is misleading. The public’s decision to take a vaccine whose long-term risks are unclear should be a well-informed one. Clear communication is crucial to the process of informed consent and for building public trust in the fight against vaccine hesitancy.”
https://www.kevinmd.com/blog/2021/01/upholding-the-principles-of-informed-consent-in-the-fight-against-vaccine-hesitancy.html
“Concerns centered on efficacy, safety and the speed of vaccine development.” And may I add lack of/or extremely-limited animal testing and no long-term safety trials, especially as these are novelty mRNA (messenger RNA) vaccines, granted for emergency use. Those all seem like significant concerns to me about which we don’t yet know the ramifications. Many health care workers are understandably hesitant to rush to be first in line. The likelihood of vaccine injury appears to be high, and discussions of mandatory ‘show-your-vaccine papers’ are alarming, to say the least.
Many thanks for your thoughtful suggestions.
John
Vaccine Hesitancy could be addressed in part if physicians and nurses assigned to deliver the vaccines engage patients in the necessary discussions to get an informed consent . People are entitled to the info to help them understand how they would benefit form the vaccine and the risks of the vaccination . They also need to know if there are possible side effects, what alternatives there are to these vaccines ( which appear to be none) and what may happen if they don’t get vaccinated. That’s the basic info all health providers and others need to be making available to patients in language and on terms that they can understand.
I recently heard on a recent broadcast of CBC’s Black Coat White Art of a programme in Quebec where there are vaccination counsellors that can talk to patients about vaccines and answer any of their questions . It appeared from that report that the counsellors were more successful than the physicians in having peiople accept the vaccinations. All the way through that radio programme I thought the real point was being missed — that the physicians were not providing the patients with the info they needed to understand their choice about the vaccination and were not providing the info required to be provided by the physicians to the patients as part of getting an informed consent . This programme was being discussed as ft it was a brilliant step forward when in fact it should have justy highlighted what a poor understanding health practitioners have about their requirement to provide the info necessary to obtain an informed consent . I don’t have any problem if additional people are helping provide patients with information about vaccines if that info is accurate but no matter what info is provided by info sheets , counsellors, videos, the physicians and nurses are still responsible to provide the info required for an informed consent and not just rely that these secondary sources will give the patients the info they need to make an informed choice .
and yes I am following up with the physician that does White Coat Black Art as I was more than upset about how this counselling programme was presented as a new and wonderful idea and nothing in that programme addressed the requirement so health practitioners providing treatment to get an informed consent which is based on giving patients the information needed to make a choice and to answer their questions and hopefully address their hesitancy to get the vaccination.
Wrong. There are alternatives. In addition to the many drugs in the news this past year another one named Ivermectin has promise! This is a very common antiparasitic which has been used for decades to treat other dna and rna viruses. How come you have never heard of it?? Is it because BigPharma wants to make money on vax and cant make money on this cheap easily accessible drug? Why have Japan, Russia and Mexico and several African countries had success with this drug and we don’t even hear abouy it. How would you feel if someone you loved was dying from COVID and your doctor refused to try this drug because the medical community won’t agree to its use for some reason? Why are therapeutic drugs being vilified? Is it because Bad Orange Man tweets about them? Are we playing medicine or politics?
Or is it because all the nations that agreed to Pfizer already prepaid billions before the vax even arrived and man how stupid would a PM look if they now said “ooops we could have used a cheaper drug”. Of course we will push this vax we already paid billions for, even if it has side effects or doesn’t fully work (spoiler – even Pfizer says it wont guarantee the vax prevents you fron catching COVID in the community).
Google some studies on Ivermectin around the world – look up actual studies not cbc news.
the photo with this article: the subject is vaccines… this tech appears to be taking blood.