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Albertans enter a COVID-19 mass immunization clinic in downtown Calgary on Monday, May 17.Jeff McIntosh/The Canadian Press

Demand in Alberta for second doses of COVID-19 vaccines has fallen sharply, as hundreds of thousands of people still have not yet had their second shots despite being eligible.

The province already has among the lowest vaccination rates in the country when it comes to first doses. The apparent slowdown in demand for second shots is happening at a time when the government has lifted virtually all public-health restrictions as part of the most aggressive reopening plan in the country.

Alberta’s low rates have raised concerns about whether the province will be able to achieve the high level of protection many experts believe is needed to keep COVID-19 at bay. There are also fears that people who don’t follow through with a second dose will remain at risk from more-contagious variants that have shown the ability to more easily infect people who have only had a single dose.

And while demand for second doses has also dipped recently in some other provinces, including Ontario, experts note that Alberta’s comparatively low rates for first doses mean fewer people overall will be fully immunized over the long term if the province can’t convince more people to get vaccinated.

Across the province, 74 per cent of eligible people 12 and over have had at least one dose of a COVID-19 vaccine, the second lowest rate in the country ahead of only Saskatchewan.

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Alberta led the country in second doses early on, partly because it fully vaccinated more people before extending intervals but also because low first-dose demand prompted the province to open up second doses to everyone sooner than elsewhere. About 55 per cent of the province has two doses, behind Manitoba, Ontario and all three territories, but still higher than the national rate.

The province has administered an average of 29,000 second doses a day in the past week, compared with a weekly average of about 56,000 at the end of June. There were about 19,000 second doses administered on Tuesday.

Provincial government data show there are as many as 520,000 people who would be eligible for their second dose because they had a first shot at least 28 days ago but have not had it. Another 134,000 had their first shot in the past four weeks and are waiting to become eligible.

Tom McMillan, spokesman for Alberta Health, said in an e-mail that some of the decline may be related to problems with Pfizer shipments at the end of June, which caused some appointments to be rescheduled. He also said that the start of summer may have prompted some people to delay their second doses because of vacation schedules.

He urged anyone who hasn’t booked their second dose to do so: “Now is the time.”

Mr. McMillan said health officials are working to increase vaccine uptake through education, including an advertising campaign and editorials from Deena Hinshaw, the Chief Medical Officer of Health, that have run in rural newspapers. Alberta Health is also working to make it easier for people to get vaccinated through temporary and mobile clinics.

The province had received about one million more doses of COVID-19 vaccines than it had administered as of July 7, the most recent data available, and many mass vaccination sites and pharmacies have appointments available this week, in addition to walk-in clinics.

Demand for first doses plummeted at the end of May and recently only a few thousand first doses have been administered a day.

The province launched a lottery with three $1-million payouts and other prizes to entice people to get vaccinated, but that hasn’t appeared to have significantly increased demand among people who haven’t been vaccinated. The province has already awarded one of the jackpots, and the remaining draws are only open to people who are fully immunized, which the government hopes will convince holdouts to schedule second shots.

Jim Kellner, an infectious-disease expert and pediatrician at Alberta Children’s Hospital in Calgary, said the province’s vaccine coverage is “good, not great.” Without higher numbers of people fully vaccinated, he said the province would remain at risk of significant outbreaks.

“We’re up against it now with variants, and with each of the successive variants, but particularly with the Alpha variant and Delta variant, we know that you really need two doses of vaccine to be fully protected,” he said.

“If you get one dose, you’re decently protected but not as well and likely not as for long.”

Dr. Kellner said people likely feel less urgency to get vaccinated after Alberta removed all public-health restrictions. The government has sent the message things are safe even at the current levels of vaccination, he said.

“There’s a risk that we shot ourselves in the foot here because by opening up widely and by making public pronouncements that we’re doing well enough to open up, any incentive to get that second dose has been going away,” he said.

Jean-Christophe Boucher, a University of Calgary political science professor who has conducted research on the causes of vaccine hesitancy, said public-health officials face problems with any vaccine that requires a booster when it comes to ensuring people get those subsequent shots.

Dr. Boucher said other jurisdictions such as Israel and Britain have also had problems getting some people to show up for their second dose. He said the urgency people felt to get that first shot has faded because some will conclude they have enough protection already, especially as infections continue to decline.

“There is a part of the population who got vaccinated because they were afraid of COVID,” he said.

Many people became eligible for vaccines during a punishing third wave that brought back significant public-health restrictions. But the province is now fully open, with just a few dozen new infections a day compared with 2,500 at the peak of the third wave.

Dr. Boucher agreed that opening up as quickly as Alberta did removed incentives to get vaccinated because the government can no longer make the argument that people need to get vaccinated in order for life to return to normal.

He said the province’s refusal to consider policies such as vaccine passports – Premier Jason Kenney has repeatedly ruled out the idea – or other measures tying vaccines to additional privileges means that people who either haven’t had their first shot or are waiting for a booster likely won’t feel any urgency to book a shot.

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