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People listen to a speaker during a rally and march organized by those opposed to COVID-19 vaccination passports and public health measures in Vancouver on Sept. 8.DARRYL DYCK/The Canadian Press

Health care systems across the country are scrambling to avoid disruptions in service ahead of mandatory vaccination deadlines, as tens of thousands of workers in the sector remain unvaccinated despite the threat of unpaid leave.

The likelihood of large numbers of workers being suspended as soon as Oct. 15 – when Quebec’s policy comes into effect – has providers staring down the prospect of major staffing gaps in hospitals and long-term care homes amidst a fourth wave of COVID-19, and on top of existing labour shortages made worse by pandemic burnout.

In Laval, Que., health administrators are calling retirees and offering bonuses to lure departed employees back to work, while in Ontario and British Columbia one private nursing home company is holding prize draws for vaccinated workers as an inducement for those who haven’t yet received their shots.

Contingency plans include postponing annual check-ins for home-care recipients in Quebec and stretching shifts from eight to 12 hours in some B.C. long-term care homes.

While vaccination rates in the health care sector are high overall, some provinces appear to be lagging. In Ontario, where long-term care employees are the only health workers who face government-imposed vaccine requirements, authorities have left the door open to imposing a wider mandate, and several hospitals have self-imposed mandates for staffers.

Organizations representing Canadian doctors and nurses continue to support vaccine mandates for their members. In the meantime, said Dr. Katharine Smart, president of the Canadian Medical Association, “There’s likely going to be some short-term pain.”

Quebec’s health minister, Christian Dubé, acknowledged on Thursday that 25,000 health care workers in the province were not yet fully vaccinated, including 13,000 who hadn’t received a single dose.

That has put pressure on the regional authorities who deliver health services in Quebec. The Centre intégré de santé et de services sociaux (CISSS) de Laval, located in a suburb of Montreal, has about 800 unvaccinated employees, half of whom have not received a single shot – a small proportion of its roughly 11,000-person work force, but enough to create a significant hole in services if all of them are placed on unpaid leave.

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Chantal Friset, associate CEO of the CISSS, said she was alarmed when she first saw a list of unvaccinated employees and has been on a recruitment blitz since then. Laval is trying to attract retirees and others who have previously worked in the health system. The provincial government is offering $12,000 bonuses to former nurses who return to work.

The hiring spree is going “relatively well,” Ms. Friset said, although the CISSS is also “starting to make contingency plans for the most pessimistic case.” The centre doesn’t expect to postpone medical procedures, but some services may be disrupted, like annual check-ins for home-care patients.

On Thursday, Mr. Dubé said he was “extremely encouraged” by the province’s efforts to recruit replacement workers, part of a broader effort to combat chronic understaffing in the province’s health care system. Just over 1,000 nurses have been hired full-time, with 1,900 more in negotiations, against a goal of 4,000, he told a news conference.

Some health care workers have not been swayed by Quebec’s carrot-and-stick approach to encouraging vaccination. Mélanie Gignac, president of Le Syndicat des professionnelles en soins de Montérégie-Ouest (FIQ-SPSMO), said a few of the nurses and auxiliary nurses she represents are so exhausted by the pandemic that they would be happy to be suspended. Some have received one dose in order to have a short reprieve before returning to work once they get their second.

On Tuesday, B.C. extended its vaccination deadline for workers in long-term care and assisted living facilities, because of concerns about staffing in the sector. Those workers were previously required to be fully immunized by Oct. 12, but must now have at least one dose by Oct. 12, and receive a second dose within 35 days of the first.

Bonnie Henry, B.C.’s Provincial Health Officer, issued an order last month requiring all health care workers in the province to be immunized as of Oct. 26. A spokesperson for the Ministry of Health said Thursday that a first dose is required for those workers by Oct. 26, with a second dose needed between 28 and 35 days after the first.

Vaccination levels vary widely in the province between health professions and regions. Matthew Chow, president of Doctors of B.C., said 97 per cent of doctors in the province have been fully vaccinated.

In three out of five B.C. health authorities, over 90 per cent of long-term care staff are fully vaccinated. But in the province’s north, where nursing shortages were an issue even before the pandemic, only 79 per cent of workers have received both doses.

Figures obtained by The Globe and Mail from an Alberta Health Services employee show that, as of Oct. 4, the majority of health care workers in many parts of the province had not yet confirmed they were fully vaccinated. The Calgary zone had the highest rate of vaccination confirmation, with 55 per cent of AHS employees reporting they had received both shots.

Overall, only half of Alberta’s health care workers have confirmed that they are fully vaccinated, with less than a month to go before the province’s mandatory vaccination deadline on Oct. 31.

James Wood, a spokesperson for AHS, said that there are many fully vaccinated workers who have not yet submitted their proof of immunization, which isn’t required until Oct. 16. Mr. Wood said AHS knows that the vast majority of health care workers are fully vaccinated, so the organization does not expect large-scale impacts.

He added AHS-operated sites have contingency plans in place in the event of staffing shortages, but he said the health authority can’t discuss those plans until it has a clearer sense of how staffing might be affected.

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