Healthcare workers from Humber River Hospital administer a second dose of the Pfizer COVID-19 vaccination to Sylvana Creglia inside Caboto Terrace, an independent seniors residence, on April 1, 2021 in Toronto.Cole Burston/Getty Images
The parts of Ontario hit hardest by COVID-19 are the same places where vaccine uptake among the elderly is lowest, according to new data that highlight the need to boost immunization efforts in high-risk communities.
The non-profit Institute for Clinical Evaluative Sciences (ICES) found that only 49.7 per cent of people over 80 outside of nursing homes have been vaccinated in neighbourhoods that have reported the highest infection rates since the start of the pandemic.
By contrast, first-dose coverage among the elderly is highest – about 70 per cent – in parts of the province that have reported the fewest COVID-19 cases to date.
Overall vaccination coverage, regardless of age, is also highest in places barely touched by the coronavirus.
“The hope is that more people in the high-risk areas would get vaccinated,” said Jeff Kwong, a senior scientist at ICES. “It’s actually the opposite. It’s the areas where there’s been low-risk which have higher [vaccine] coverage.”
The new data reflect a pattern that has held true throughout the pandemic: The people who most need protection from the coronavirus are often the hardest to reach, with language barriers, poverty, erratic schedules at essential jobs and a mistrust of government complicating their efforts to get help.
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The data also help to explain why thousands of future vaccination appointments at Toronto’s mass vaccination centres were going unfilled, despite city officials pleading with people to sign up. The provincial government agreed on Thursday to allow anyone over the age of 60 to book appointments at mass vaccination centres in Toronto and Peel Region, home to the virus-battered cities of Brampton and Mississauga.
For residents of high-risk neighbourhoods, the age has been dropped to 50 at many hospital-based vaccination centres and community clinics, said Councillor Joe Cressy, chair of the Toronto Board of Health. “By targeting the most vulnerable and targeting the areas with the most transmission, we save lives and we beat this pandemic sooner,” he explained.
Community health leaders say that it simply takes more time, effort and innovation to run a successful vaccination campaign in a high-risk neighbourhood than it does in places where everyone speaks English, is computer savvy and has a car to drive to a mass vaccination centre.
Neighbourhood vaccination and case statistics in Montreal show similar disparities between some poor and well-off neighbourhoods.
Overall, about 21 per cent of the city’s residents are vaccinated. Montreal North, a low-income area with a high percentage of workers in lower-paying health sector jobs, had carried the highest caseload in the city since the pandemic began, but below-average vaccine coverage. About 17 per cent of area residents have been vaccinated.
In contrast, the well-off Montreal enclave of Westmount has had about half the city’s average case rate but 29-per-cent vaccination coverage. Montreal West, the Town of Mont-Royal and several middle-class western suburbs are other areas with lower-than-average case rates but higher-than-average vaccination coverage.
In Ontario, the new ICES analysis, released Thursday as an update to the organization’s COVID-19 dashboard, did not mention any specific neighbourhoods. Instead, it divided the province into forward sortation areas (FSAs) – designated by the first three characters of a postal code – by COVID-19 risk and vaccine uptake.
But Dr. Kwong told The Globe and Mail that, in the case of Toronto, several FSAs stood out as having a high percentage of people vaccinated (17 per cent or more) and a low COVID-19 burden throughout the pandemic. They included Rosedale, Forest Hill, Lawrence Park and Leaside, some of Toronto’s wealthiest enclaves.
COVID-19 vaccine coverage
for those over 80 in Ontario
Vaccine coverage (%) per 100 population by
neighbourhood risk. 1=high incidence of neighbour-
hood infection, 10= low incidence
Risk
Vaccine coverage*
49.7%
1
54.6
2
59.3
3
65.7
4
66.1
5
65.5
6
65.3
7
71.8
8
69.1
9
70.2
10
64.0
Overall
*% of Ontarians who have received at least one dose
THE GLOBE AND MAIL, SOURCE: ICES ONTARIO
COVID-19 vaccine coverage
for those over 80 in Ontario
Vaccine coverage (%) per 100 population by neighbourhood
risk. 1=high incidence of neighbourhood infection,
10= low incidence
Risk
Vaccine coverage*
49.7%
1
54.6
2
59.3
3
65.7
4
66.1
5
65.5
6
65.3
7
71.8
8
69.1
9
70.2
10
64.0
Overall
*% of Ontarians who have received at least one dose
THE GLOBE AND MAIL, SOURCE: ICES ONTARIO
COVID-19 vaccine coverage for those over 80 in Ontario
Vaccine coverage (%) per 100 population by neighbourhood risk.
1=high incidence of neighbourhood infection, 10= low incidence
Risk
Vaccine coverage (% of Ontarians who have received at least one dose)
49.7%
1
54.6
2
59.3
3
65.7
4
66.1
5
65.5
6
65.3
7
71.8
8
69.1
9
70.2
10
64.0
Overall
THE GLOBE AND MAIL, SOURCE: ICES ONTARIO
On the other side of the ledger were seven FSAs with the highest COVID-19 risk scores and the lowest vaccination coverage (less than 9 per cent). Six were in the city’s northwest area and a seventh was Thorncliffe Park, a high-rise neighbourhood that serves as a landing pad for new immigrants.
Thorncliffe Park is also home to a recently opened mass vaccination hub.
Jen Quinlan, chief executive officer of the Flemingdon Health Centre, one of the organizations running the hub, says they’ve managed to fill the slots with an ambitious educational campaign in multiple languages, one that relies on the help and influence of trusted locals.
Those community ambassadors have been indispensable, she said.
Arshi Ali, a community ambassador with Flemingdon Park Health Centre, said overcoming vaccine hesitancy in her community remains a challenge. (Located next to Thorncliffe Park, Flemingdon is similar demographically, but is part of a different forward sortation area, one that also includes well-off neighbourhoods.)
“People are not motivated,” Ms. Ali said, in part because of videos disparaging COVID-19 vaccines that have spread like wildfire on local WhatsApp groups.
But reluctant people often come around if someone they trust answers questions in their own language, said Ms. Ali, who herself speaks Urdu, English and some Punjabi and Hindi.
Ms. Ali said she has seen a “huge improvement” in her friends and neighbours who have agreed to be vaccinated.
“What I noticed was their fear, their anxiety, suddenly dropped,” she said. “I also noticed ... that those who already got vaccinated in the community, they are the great source to promote and encourage other people to be vaccinated soon.”
With a report from Les Perreaux
Kelly Grant