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A staff member at a vaccine clinic looks outside the clinic for people waiting to get their COVID-19 vaccine in Mississauga, Ont. on April 13.Nathan Denette/The Canadian Press

Most Canadians are behind on their COVID-19 vaccinations, putting many at greater risk of infection and severe outcomes as cases surge and new variants arrive.

Some experts say weak public messaging about the critical need to stay up to date with COVID-19 vaccination is partly responsible and add that communication efforts and policy decisions about vaccines, masks and other mitigation measures need to be stepped up in light of a pending wave.

“We are acting as though the threat of the spread of the virus has gone away,” said Nazeem Muhajarine, epidemiology professor at the University of Saskatchewan and co-lead of the public health, health systems and social policy impacts section of the Coronavirus Variants Rapid Response Network (CoVaRR-Net).

Only 17 per cent of Canadians have gotten a booster dose or completed their initial vaccine series in the past six months, according to the most recent figures from the Public Health Agency of Canada. Experts say this is a serious concern because vaccine-induced immunity starts to wane after six months.

While a majority of those infected will recover, a significant number of people, including frail seniors and people with certain medical conditions, remain at risk for severe illness and death. And the less that’s done to blunt the impact of a new wave, the more disruptive it will be in terms of absences at work, school and daycare closings, and supply chain problems.

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“As soon as people are eligible, they should be getting their boosters to keep them protected, at least over the winter period,” said Manish Sadarangani, a pediatrics professor at the University of British Columbia and director of the Vaccine Evaluation Centre.

Some individuals will have infection-related immunity if they have recently been ill with COVID-19. But experts say the immunity may not last long, as the virus can reinfect individuals, especially as new variants start to circulate more.

A new COVID-19 wave will also add additional pressure on hospitals across Canada, many of which are already struggling to provide care amid staff shortages and soaring demand.

“It doesn’t have to be very serious, the disease, to have an impact,” said Fiona Brinkman, a professor at Simon Fraser University who specializes in infectious disease genomics and is a member of the CoVaRR-Net.

She also highlighted the fact that new COVID-19 variants pose a greater threat to vulnerable individuals because some common treatments – monoclonal antibodies – don’t appear to work on them, notably on subvariant BQ. 1. Since many people can’t take another common treatment, Paxlovid, because it interacts with dozens of common drugs, it means there will be few treatment options left.

Health Canada approved two new bivalent vaccines in September and October that are designed to target Omicron-related variants expected to dominate in Canada. Experts say it’s too early to tell from real-world data exactly how well the new vaccines work at preventing infection and severe illness from newer variants that aren’t perfectly matched to the vaccines, but that the shots will still offer meaningful protection.

Only 14 per cent of Canadians have received two additional shots on top of their initial primary series. Some of that lag is likely owing to people having to wait after a COVID-19 infection or waiting for the bivalent vaccines, which became available in recent weeks. But some experts say this also indicates a lack of urgency and inadequate messaging about the importance of staying up to date.

“I think a lot of people are wanting to move on,” Dr. Sadarangani said. “Unfortunately, the virus has not moved on.”

He and other experts say they want the public to understand the importance of vaccines and wearing masks to reduce the spread of the virus.

“This is an evolving virus that is going to keep changing and keep trying to penetrate through that shield,” Dr. Sadarangani said. “We also need to keep our defences up to keep up with what the virus is doing.”