The “vaccibus” is idling in a Montreal strip-mall parking lot. Inside is a fully fledged mobile vaccination clinic: Vials of Pfizer thaw in a blue camping cooler and nurses stand ready where rows of seating have been torn out. The only thing missing is unvaccinated people.
Quebec is in the midst of a push to reach the final 10 per cent of its population that hasn’t been inoculated against COVID-19. Public-health authorities are waging a guerrilla campaign, using unconventional means to reach the holdouts and sending out vaccination “ninjas,” as one health authority spokesperson called them, to reach isolated groups.
Some days, progress is slow: After an actionless hour, Amélie Thiffault, co-ordinator of mobile vaccination for the health services centre of north Montreal, leans out of the old white bus and calls to teenagers on their lunch break, offering “un petit vaccin.”
But the province’s hard-won successes in this jab drive, launched last month by junior health minister Lionel Carmant, may have things to teach the rest of the country. And more than a year into a mass vaccination campaign that has already reached about nine in 10 Canadian adults – but left enough unprotected to fill up hospitals – lessons are timely.
“Every vaccinated arm these days is a victory,” Ms. Thiffault said.
The provincial government is starting from a premise that can be easy to forget as anti-vaccine protesters occupy downtown Ottawa: Many who have not received their shots can still be persuaded to. Various studies have put the share of that population who are strict anti-vaxxers at somewhere between 25 and 60 per cent, said Mr. Carmant. That means more than half of the unvaccinated are likely reachable.
Two groups make up this persuadable cohort, the minister argues, and they have little in common with the vocal conservatives who have led the self-described freedom convoy. The first is people who have not received their shots because of literacy or cultural barriers – often new immigrants – and the second is those who suffer from mental illness or precarious housing.
The state is offering an “outstretched hand” to these people, Mr. Carmant said – this time, containing a carrot, rather than a stick. As Quebec phases out its vaccine passport system by March 14, it is seeking less coercive ways of encouraging vaccination.
At a newly opened clinic in a downtown health centre in Montreal, staff offer little things that can make the process smoother, such as a printer to produce proof-of-vaccination QR codes for those who don’t have a smartphone.
The CLSC Sainte-Catherine, as it’s known, serves many homeless clients who may feel more comfortable being vaccinated on site, where they have regular meetings with their social workers, said Elaine Polflit, its co-ordinator for vulnerable populations and crisis intervention at the local health services provider. Her staff is also able to provide Indigenous clients with cultural resources and translators.
The unvaccinated people who come through her clinic, which has been open for about three weeks, are not hardened in their opposition to the vaccine, Ms. Polflit said. “What we’re seeing is not the people who are in Ottawa right now – it’s not conspiracy theories, it’s not anti-vax.”
Rather, her clientele consists of people who have anxieties about vaccines, who have poor access to information and little contact with the health system, and whose mental health or living situation have made them isolated. The clinic may only vaccinate 25 or 30 people a day, she said, but that reflects the beginning of a new, more bespoke phase in the inoculation campaign.
“At first our goal was to vaccinate the masses,” she said. “Now we can take approaches that are tailor made.”
The other techniques Quebec public-health agencies are trying – some novel, some tried-and-true – include sending shuttle buses into undervaccinated neighbourhoods and going door to door on streets where government data says vaccine uptake is lower.
In West-Central Montreal, authorities have printed pamphlets in at least 16 languages and deployed front-line workers from many of the area’s roughly 130 nationalities. New arrivals from countries with a history of war or government abuse are often skeptical of government messaging, so it helps to have spokespeople from those communities, said Christine Touchette, director of front-line services for the West-Central Montreal health network.
In other cases, fear of government stems from negative experiences in Canada. Vancouver resident Stephanie Allen said an elderly female relative of hers in Montreal refused to get vaccinated because she has experienced so much racism in the Canadian health care system.
“You present symptoms, your concerns are not taken seriously, they’re downsized, you’re told that you’re confused,” Ms. Allen said. “I’ve seen among a lot of my aunts and relatives … ‘I don’t trust the vaccine. It’s this system that has always neglected me, why would it care about me now – why would I trust it?’ ”
The relative vaccine hesitancy of Black and Indigenous people in Canada, according to a StatsCan survey in fall 2020, reflects the failure of the Canadian state to build trust with those communities, said Arjumand Siddiqi, division head of epidemiology at the Dalla Lana School of Public Health, University of Toronto.
Centuries of neglect and abuse can’t simply be overcome by targeted vaccination campaigns, Prof. Siddiqi said. “In some ways there are no quick fixes. … The lesson is that going forward, we need deep investment.”
In the meantime, Mr. Carmant, who was born in Haiti, said his own ancestry could be an asset in this vaccine drive, since he shares an immigrant background with some of the people he is trying to reach. He boasts that Quebec gave 18,800 first doses between Jan. 24 and Feb. 11 – before the campaign has even reached “cruising speed.”
This is a time of small victories, as those numbers suggest. Reaching the final 10 per cent is full of pitfalls. On the vaccibus last week in the multicultural borough of Saint-Laurent, the problems were small and technical. To avoid stigma for the vaccine-skeptical, the bus bore only a little paper sign advertising vaccines, making it hard to tell what the vehicle was doing there. It was so mobile, meanwhile – with three different appointments in the same day – that by the time ground teams had spread the word in the neighbourhood, the bus was getting ready to move on.
Still, the single shot delivered that morning was a happy event. Theresa Twenewaa was getting her third dose – working at a hotel, she had to be vaccinated – and she laughed and chatted with staff as she rolled up her sleeve. The native of Ghana was leaving an appointment at the bank, located in the same parking lot, when she spotted the strange idling vehicle and wondered, “What’s that?”
In 15 minutes, she was on her way, boosted and content. The guerrilla campaign had notched another needle in another arm.
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