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For underserved populations, the return of barriers – including distance to vaccination sites, the need to make appointments and a lack of clear information about why and how to get their doses – is creating challenges at an inopportune time, some experts say.Lars Hagberg/The Canadian Press

During the early COVID-19 vaccine rollout across Canada, community organizations and health agencies in Hamilton mobilized to deliver doses to those hardest hit by the virus.

Special clinics were created for specific racialized groups. Vaccine ambassadors attended community events to provide culturally relevant information about the shots and answer questions in people’s first language. Health teams were dispatched to high-rise apartments in areas of the city that were under-vaccinated.

Since then, however, these programs have largely disappeared as funding has evaporated, according to Ameil Joseph, an associate professor in the school of social work at McMaster University.

“We worked pretty hard to develop unique programming to serve some of the most disproportionately impacted and the hardest to reach,” he said. “I feel like some of the barriers that we had recognized and tried to address are back up again.”

While many Canadians are finding it easier than ever to get COVID-19 shots now that many pharmacies readily offer them, access to vaccines and boosters has dwindled for some. In parts of the country, pop-up clinics, mass vaccination clinics and outreach programs have become less frequent and less active as demand has declined. Yet for underserved populations, the return of barriers – including distance to vaccination sites, the need to make appointments and a lack of clear information about why and how to get their doses – is creating challenges at an inopportune time, some experts say.

As governments across the country have dropped infection control measures such as requirements to wear masks, vaccines are being relied on almost exclusively to control the pandemic. But with new variant XBB.1.5 expected to drive up infections again, only 25 per cent of the population in Canada has received a dose in the past six months.

Amy Tan, a clinical associate professor at the University of British Columbia’s faculty of medicine, sees a paradox in Canadian authorities’ approach to COVID-19.

“They’re putting all their eggs in the vaccine basket, yet not making it easy at all to get the vaccine,” she said.

Social inequities that were apparent during earlier phases of the vaccine rollout still exist, Dr. Tan said, adding that many people don’t have paid sick days to recover from vaccine side effects. Language and cultural barriers also persist. Meanwhile, B.C.’s immunization website is “very confusing and frustrating to navigate,” she said. “And I’m saying that personally as a British Columbian with personal experience who’s super-motivated and super-informed to get vaccines for myself and my family.”

According to the Vancouver Coastal Health authority, local public health units and community clinics are providing COVID-19 vaccines only for infants and children, ages six months to 11 years. Everyone else must go to a pharmacy.

Meanwhile, Manitoba has one continuing vaccine clinic and several pop-up clinics. People wanting a vaccine are encouraged to speak with their health provider or visit a pharmacy, a provincial spokesperson said in an e-mail.

In Ontario, Nancy Waite, a professor in the school of pharmacy at the University of Waterloo, said relying on pharmacists to deliver COVID-19 shots extends a trend that began before the pandemic with other vaccines, such as for influenza and shingles. Many people prefer the convenience of getting their vaccines on weekends and evenings, and many know and trust their local pharmacists, she said.

But research conducted by Dr. Waite and her colleagues show there are “vaccine deserts” in parts of the province. Though nearly 75 per cent of Ontario’s community pharmacists are authorized to give vaccines, some areas have limited to no access. While the researchers found this to be the case particularly in rural areas, Dr. Waite noted that even in urban areas, there isn’t always a nearby pharmacy.

About 50 per cent of pharmacies in Ontario are independent, and they don’t necessarily have the resources that large chain pharmacies have to be able to give injections, she said. For example, smaller pharmacies may not have the physical space to offer privacy, or the money to send pharmacists for training on immunizations. Some pharmacies also lack the staff to do so.

Dr. Waite said it’s important to support community pharmacies, and to get vaccines to where people are. That could include having a visiting pharmacist or nurse offer vaccines at veterinary offices to reach people in farming communities, or holding pop-up clinics at grocery stores, churches and barbershops, she said.

Besides making vaccines as convenient as possible, there’s a need for clear public messaging around them, Dr. Tan said.

Masks are no longer required in most places and people aren’t regularly reminded that COVID-19 is still a problem, she said, yet officials have conveyed that the country is in a good place because of vaccines.

“There’s no situational awareness that COVID is still a problem. So it’s like a self-perpetuating cycle, right?” she said. “There’s going to be no sense of urgency to actually put in the effort to get a COVID vaccine.”

The National Advisory Committee on Immunization recommends a six-month interval between doses, though it says a shorter interval of at least three months can be considered “in the context of heightened epidemiologic risk.” The timing between doses varies across the country. Saskatchewan, for example, recommends that anyone aged five and older receive a booster dose four months after their previous dose. In Newfoundland, boosters are available five months after a previous dose. In Ontario, the recommended interval is six months, and the minimum interval is three months.

Back in Hamilton, Dr. Joseph warned that the decline in vaccine outreach could have lasting consequences. Early advocacy work to increase equitable access had helped counter health misinformation and disinformation, and highlighted systemic issues that disproportionally affect the most marginalized in society, he said.

“When those aren’t addressed, they will just continue. They will foster mistrust. They will make it difficult for people to implement any kind of care initiative for these populations in the future,” Dr. Joseph said.

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