High-risk areas urgently need improved access to vaccines

ICU admissions in Ontario are the highest they’ve been since the pandemic began. The variants of concern (VOCs) that are driving this third wave are associated with a 63 per cent increased risk of hospitalization, 103 per cent increased risk of needing intensive care and, significantly, a 56 per cent increased risk of death. The illness can peak later, making it hard to trace; it may be infectious for longer periods; and unvaccinated 40- and 50-year-olds are getting infected in high numbers. Indeed, the patients occupying the province’s ICUs are younger and younger.

Provincial leaders continue to hem and haw about opening up retail and dining when what we should be doing is rapidly expanding vaccine access to include younger age groups, those with pre-existing conditions and essential workers.

Through our work with the South Asian Health Network, a health education advocacy group we founded in 2020, we’ve been on the ground combatting vaccine hesitancy in these high-risk groups, organizing vaccine town halls and creating sharable resources that cut through the noise.

But there is also concurrent sky-high demand for the vaccine. People in high-risk jobs, with chronic conditions or with disabilities are all desperate to get a first shot, legitimately worrying for their safety in the third wave.

It is such conflicting messaging to tell these individuals that they are at high risk and should continue to stay home but are not a priority for vaccination and we don’t know when they will be. It’s frustrating to hear there are thousands of doses sitting unused in freezers in some parts of the province but you still have to wait. It’s exhausting to keep up with the changing criteria at each of the sites: some take >50 with chronic conditions, others >70; some you have to be a resident, others not. It’s worrisome to wonder if there are secret standby vaccine lists you don’t know about.

If high-risk people in high-risk areas are eagerly waiting to be vaccinated and there are empty slots at vaccine sites across the province, what are we waiting for?

First, all vaccine centres in high-risk areas should institute standby and pre-registration lists for the next eligible cohorts. If last-minute spots are available or there is unused vaccine at the end of the day, the thousands in the next priority cohort should get one.

Second, those living in high-risk postal codes should be able to get vaccinated wherever they can in the province. It seems exceptionally inequitable that areas with lower burden of disease and higher socioeconomic status have been lowering age limits much more quickly than high-priority areas, especially when these regions only allow those living within their specific postal codes to access vaccination spots while neighbouring residents suffer.

Third, it’s time to aggressively drop the age cohort in high-risk areas and do whatever we can in terms of resources and logistics to extend hours and offer more appointment slots. Can sites be open 24/7 to accommodate those who work or have family obligations? This is especially important because the bulk of current infections are in younger essential workers while data from the Science Table indicate that vaccinations are not reaching populations at highest risk.

Fourth, we need to meet people where they are. This includes taking vaccines via mobile clinics to warehouses, manufacturing and processing facilities, to migrant workers, places of worships and community centres.

Fifth, as we increase the volume of traffic at existing sites, we need to make sure they have adequate staffing and support to provide a safe and efficient experience. We also should ensure sites are accessible for those with mobility challenges, can overcome language barriers and can provide information to address last-minute hesitations or concerns. Vaccine sites should also not be a source of virus exposure, but we’ve heard concerning accounts of people waiting in long lines or being asked to exchange their fitted mask for an ill-fitting one.

Finally, it’s clear that the multiple safety updates concerning the AstraZeneca shot are causing an erosion of public trust around this vaccine that will be difficult to undo. It would be wise to communicate exactly which vaccine a person is being scheduled for upfront to avoid no-shows or booking issues related to AstraZeneca.

Broadening eligibility aggressively at our existing sites won’t take away spaces from high-risk groups that have been eligible for some time but remain unvaccinated. We need more resources, community partnerships and alternative methods to reach members of these groups.

And we need to remember that lockdowns do not prevent the occupational transmission chains of COVID that have been driving the pandemic in Peel and the GTA. Essential workers who have no choice but to leave their homes and work as teachers or factory workers can bring a VOC home and infect their entire family. At some inflection point, we have to include high-risk essential workers on our list to be urgently vaccinated. That time is now.

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Seema Marwaha


Seema Marwaha is a general internal medicine physician, educator, researcher and journalist in Toronto.

Sabina Vohra-Miller


Sabina Vohra-Miller is the co-founder of the Toronto-based Vohra Miller Foundation, which aims to improve the health of the planet and its people.

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