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Dr. Paul Glove speaks with Yannick Iyamu, 5, at the Black Creek Community Health Centre during a pop-up COVID-19 vaccine clinic in Toronto on Dec. 17.Christopher Katsarov/The Globe and Mail

How do you convince parents they should get their young children – kids 11 and under make up 12 per cent of cases of COVID-19 – vaccinated? In Toronto’s hard-hit northwest end, community workers have learned that sometimes it’s better not to mention vaccines from the get-go.

Instead, they’ve sent doctors and nurses to Clippers and Combs, a semi-regular event the local Black Creek Community Health Centre organizes where braiding and haircutting services are offered for free to residents (the population the centre serves is majority Black). While a mother is waiting for her daughter’s hair to be braided, which can often take an hour, a nurse might approach her to ask whether she and her child are vaccinated, listen to her concerns, gently correct misinformation and let her know about a nearby kids’ vaccine clinic.

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On Friday, the centre hosted a pop-up at a public housing tower where they served free food and had a prize giveaway – and also offered vaccinations and provided information to parents who were taking a “wait and see” approach with their kids. There may only be a handful of “conversions” each time, but they add up.

While the highly contagious Omicron variant has put a greater urgency on vaccinations, the health care professionals and community workers in neighbourhoods with high case counts but low vaccine uptake have learned in the past year that they must sprint while also running a marathon.

Mass vaccination clinics can feel like “a factory line,” and people who might have questions or unease about the process feel as if they’re being rushed through, their legitimate concerns dismissed, says Mar Lyn, a project co-ordinator at Black Creek CHC. “We try to make it more warm, more friendly, more hospitable, more intimate, so that we can have those concerns and fears reconciled before going ahead.”

The federal government approved use of the Pfizer-BioNTech Comirnaty vaccine for children 5 to 11 a month ago, but uptake has been slow in some regions. Across Canada, 31.6 per cent of children in that age group had received one dose as of Dec. 11. In Alberta, as of Dec. 14, 24.7 per cent had. In Ontario, as of Dec. 17, the uptake was 34.1 per cent.

The numbers are changing quickly (just a week and a half ago, only 20 per cent of Ontario children in that age group had gotten their first dose), but there is a worry they aren’t picking up fast enough to keep with the exploding cases of Omicron.

In many communities across Canada, adults who were open to getting vaccinated themselves haven’t taken their elementary-aged children to get the jab for a range of reasons: Some face logistical barriers, many are hesitant because they mistrust the government, and others are worried about side effects. Health leaders and community organizers in those communities have had to look back at lessons learned from the past year of vaccine outreach to adults to come up with creative solutions.

When vaccination began for five to 11-year-olds in Brampton’s L6P neighbourhood, which as of Dec. 5 had logged the fourth-highest per capita cases of COVID-19 in the province, Priya Suppal was optimistic. The opening weekend at the largest vaccine site in the city, at which Dr. Suppal is medical director, was fully booked. But after a week, the numbers dwindled and doctors realized they needed to include local places of worship in their outreach efforts, just as they had earlier in the year when vaccines became available for the adult population. The South Asian COVID Task Force and the Canadian Muslim COVID-19 Task Force are in talks with the Great Lakes Masjid in Brampton mosque to host a vaccine pop-up.

“It helps build trust in the community when we work with these institutions that people trust,” Dr. Suppal said.

She predicts the rate of vaccination for kids will surge over the holidays. “Parents in Brampton are immigrants, many of whom work multiple jobs. Some of them simply don’t have the time to go the vaccine clinics and take a day off after that. I really think there will be an uptick during the holidays because parents and students will have more free time.”

The South Asian COVID Task Force has been trying to talk to that demographic directly, and address their worries. First, they tried social-media posts in South Asian languages, but those had little impact. They realized they needed doctors speaking to parents directly on Punjabi news media and addressing specific concerns.

In one TV appearance on a local channel this week, Simerpreet Sandhawalia talked about one of the biggest fears doctors have been hearing about from communities in Brampton: infertility. “There is no infertility caused by this vaccine. It is safe for your children. We know that the virus can cause harm to children as well, so this is your chance to protect them,” the doctor said in Punjabi.

In Thorncliffe Park, a neighbourhood largely populated by immigrants in apartment towers, volunteer community ambassadors have been working since the early days of the pandemic, first to share basic information about the virus and how it spreads, and now to get as much of the neighbourhood vaccinated as possible. One of the most effective strategies in the dense neighbourhood is simply going to door-to-door down apartment hallways.

Some parents are afraid their children are too small and weak to handle the vaccine. They worry about allergic reactions. They just want to “wait and see” how other children respond to immunization first, says Karma Lhamo, acting manager for community development and special projects at the Neighbourhood Organization, which serves Thorncliffe Park.

When parents say they plan to book at some point, an ambassador will offer to make the appointment on the spot. If they say they don’t plan to vaccinate their kids, that gets entered into a log and the ambassador will make a repeat visit to the apartment later to talk to them again (so long as they haven’t refused any more visits).

Standing in the doorways of their apartments, some parents share that they’re waiting till the holiday break to take their child to a clinic, similar to what Dr. Suppal has seen in Brampton. They worry that if their children suffer any side effects from the vaccine – a fever, for example – they might be out of commission for a few days, and it’s easier to navigate that when school isn’t in session.

The M3N neighbourhood, which is served by Black Creek CHC, has the second-highest per capita cases of COVID-19 in the province, but the centre’s executive director, Cheryl Prescod, has learned that talking about data and making arguments in favour of vaccination that are science-based simply aren’t effective with some people.

What has worked, though, is highlighting the logistical challenges that remaining unvaccinated – or having one’s kids be unvaccinated – can pose. If a child gets sick with COVID-19 and has to isolate at home, that could have dire consequences for their essential worker parent, who may not have any paid sick leave. Missing work could mean being late with a rent payment.

“People have lost housing and so much more. It’s those social determinants that really have to be matched to our approach, rather than the science,” Ms. Prescod said.

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