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A paramedic stands outside the Maxwell Meighen Centre helping homeless people in Toronto on Feb. 24, 2021.Nathan Denette/The Canadian Press

Canada’s largest city announced Sunday that it will start fast-tracking the vaccination of homeless people in order to prevent shelters from becoming incubators for the spread of COVID-19.

The City of Toronto issued the directive as its local homeless people are being hit with fast-spreading COVID-19 variants and as communities across the country consider accelerating their own plans to inoculate those living on the streets.

While Canada’s first round of vaccinations focused on medical workers and seniors’ homes, most in the general population are still awaiting their turn. Meanwhile, public-health officials in large cities have been trying to push homeless people to the front of the line, but must first get clearances from their provinces, which set the priorities for which groups get vaccinated.

Coronavirus tracker: How many COVID-19 cases are there in Canada and worldwide? The latest maps and charts

In Ontario, homeless people were not initially considered a Phase 1 priority population for vaccine rollouts, and the province has not yet officially announced any changes to its list. Government officials did not respond Sunday to requests for comment.

Moderna, Pfizer, AstraZeneca or Johnson & Johnson: Which COVID-19 vaccine will I get in Canada?

Canada pre-purchased millions of doses of seven different vaccine types, and Health Canada has approved four so far for the various provincial and territorial rollouts. All the drugs are fully effective in preventing serious illness and death, though some may do more than others to stop any symptomatic illness at all (which is where the efficacy rates cited below come in).

PFIZER-BIONTECH

  • Also known as: Comirnaty
  • Approved on: Dec. 9, 2020
  • Efficacy rate: 95 per cent with both doses in patients 16 and older, and 100 per cent in 12- to 15-year-olds
  • Traits: Must be stored at -70 C, requiring specialized ultracold freezers. It is a new type of mRNA-based vaccine that gives the body a sample of the virus’s DNA to teach immune systems how to fight it. Health Canada has authorized it for use in people as young as 12.

MODERNA

  • Also known as: SpikeVax
  • Approved on: Dec. 23, 2020
  • Efficacy rate: 94 per cent with both doses in patients 18 and older, and 100 per cent in 12- to 17-year-olds
  • Traits: Like Pfizer’s vaccine, this one is mRNA-based, but it can be stored at -20 C. It’s approved for use in Canada for ages 12 and up.

OXFORD-ASTRAZENECA

  • Also known as: Vaxzevria
  • Approved on: Feb. 26, 2021
  • Efficacy rate: 62 per cent two weeks after the second dose
  • Traits: This comes in two versions approved for Canadian use, the kind made in Europe and the same drug made by a different process in India (where it is called Covishield). The National Advisory Committee on Immunization’s latest guidance is that its okay for people 30 and older to get it if they can’t or don’t want to wait for an mRNA vaccine, but to guard against the risk of a rare blood-clotting disorder, all provinces have stopped giving first doses of AstraZeneca.

JOHNSON & JOHNSON

  • Also known as: Janssen
  • Approved on: March 5, 2021
  • Efficacy rate: 66 per cent two weeks after the single dose
  • Traits: Unlike the other vaccines, this one comes in a single injection. NACI says it should be offered to Canadians 30 and older, but Health Canada paused distribution of the drug for now as it investigates inspection concerns at a Maryland facility where the active ingredient was made.

How many vaccine doses do I get?

All vaccines except Johnson & Johnson’s require two doses, though even for double-dose drugs, research suggests the first shots may give fairly strong protection. This has led health agencies to focus on getting first shots to as many people as possible, then delaying boosters by up to four months. To see how many doses your province or territory has administered so far, check our vaccine tracker for the latest numbers.

But Toronto Public Health circulated a statement on Sunday saying cities have now been effectively cleared by the province to vaccinate homeless people – and now, homeless outreach workers in several of the province’s cities say they hope to start moving in coming days. In mid-January, a pilot project targeting those living at 100 shelters in the city was put on hold because of a shortage of the Pfizer-BioNTech vaccine owing to delays in delivery to Canada.

Councillor Joe Cressy, who chairs Toronto’s Board of Health, said in an interview that city officials had been long seeking these powers.

“We have been clear that we would like to see a vaccine prioritization list based on risk – and clearly that involves not just those who are older, but also those who are most vulnerable, like our homeless.”

A study published in January in the Canadian Medical Association Journal Open found that, during the first wave of the pandemic, homeless people in Ontario were 20 times more likely than the general population to be hospitalized from the virus, more than 10 times more likely to require intensive care for COVID-19, and in excess of five times more likely to die within three weeks of first testing positive.

Several other Ontario municipalities also plan to start vaccinating homeless people, and that work has already started in other provinces.

The Vancouver Coastal Health authority opened four clinics in the Downtown Eastside at the end of January to offer the vaccine to anyone sleeping outside, living in shelters, social housing or single-room hotels.

Last week, Guy Felicella, a peer clinical adviser for the health authority’s regional addiction program, joined one of two groups of nurses that fanned out across the Downtown Eastside to find residents who missed getting jabbed at those earlier clinics. Mr. Felicella said at least 100 people received their dose from his team, including a man with a walker who got immunized while sitting in a hotel stairwell.

“You can’t expect people to come to you, because people have challenging lives and busy days and, also too, withdrawal waits for nobody – and definitely not a COVID-19 vaccination,” Mr. Felicella said.

Montreal announced in January it had been cleared by the Quebec government to inoculate homeless people and about 1,000 people were vaccinated, said Fiona Crossling, general director of a non-profit group in the city known as Accueil Bonneau. That’s still a small fraction of the city’s homeless population, Ms. Crossling said, but it appears to have helped tamp down the spread of COVID-19 in shelters.

In Alberta, people living or working in homeless shelters will be vaccinated in the second half of the provincial immunization program’s phase running from April to September.

Experts say the vaccination campaigns for homeless people face challenges – the population is by nature itinerant; its members can be vaccine-hesitant; they don’t necessarily have cellphone and e-mails, and some people are reluctant to fill out complicated consent forms.

“We have to have different strategies for different locations to make it work well,” said Wendy Muckle of Ottawa Inner City Health. She added that, “We just have to really be creative and open to lots of different ways of doing things.”

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