Quebec has given the majority of its COVID-19 vaccine doses to seniors but Ontario has not, reflecting the provinces’ diverging immunization strategies that will be tested as the country enters a third wave.
Since the vaccination campaigns began, Quebec has focused more than Ontario on vulnerable older people and a narrower group of family caregivers and front-line health-care professionals. Quebec also delayed second doses from the start, allowing it to reach more people.
Now Ontario is facing pushback for prioritizing professions such as naturopaths, chiropractors and registered massage therapists and vaccinating firefighters and some police officers before most of the province’s adults who are 65 and older.
The Quebec government, meanwhile, has encountered anger of its own because disabled and chronically ill people, family doctors, cancer patients, first responders and other people under 65 but at risk of exposure are waiting for a shot.
The decisions made by the country’s largest populations in vaccinating the most vulnerable seniors will be crucial in the coming weeks. Health experts say Ontario has entered a third wave of a virus that has predominantly killed older people, and Quebec is gambling on partial immunity for long-term care residents in the face of more contagious variants.
With limited supply from the federal government, experts say the most important thing is to reach as many seniors as possible.
“Bad outcomes of COVID-19 – death, ICU admissions and hospitalizations – are very highly concentrated among older persons. I understand that there may be good societal reasons to keep some proportion of vaccines going into arms of other citizens in certain at-risk occupations and vulnerable communities,” said David Naylor, co-chair of the federal government’s COVID-19 Immunity Task Force and a professor of medicine at the University of Toronto.
“But the highest priority must be to get first doses into elderly people.”
According to the latest figures from Ontario, about 40 per cent of the province’s 1.36 million vaccine doses administered so far have gone to those 65 and older. By comparison, Quebec has given 58 per cent of its shots to people 70 and over. The rate reaches almost 70 per cent for people 60 and over. (Quebec did not provide a breakdown from age 65.)
However, the two provinces have both used about 30 per cent of doses for the 80-and-over population, with Quebec focusing specifically on the hot-spot Montreal area.
The two provinces have also differed in how they are using the vaccines. In Quebec, almost all vaccine recipients received only one dose while Ontario used about 20 per cent of doses for second shots. About 100,000 residents in long-term care and retirement homes in Ontario and 65,000 staff have received booster shots, while almost none have in Quebec. Ontario has now paused second doses for up to four months. Death and illness rates have plummeted in both long-term care home systems.
Quebec’s decision to delay second doses for long-term care will play out in the coming weeks, said Isaac Bogoch, an infectious diseases physician who sits on Ontario’s vaccination task force. “We don’t know if that’s the smart approach to do,” he said.
Ontario officials say the province will quickly catch up. Ontario’s centralized booking system launched Monday, although some regions had been offering 80-and-up residents their shots earlier. As of Thursday, health officials said 47 per cent of the province’s adults 80 and over, about 322,000 people, have had at least one shot, and 65 per cent have a shot or an appointment for one. Some areas of the province, such as York and Halton Regions near Toronto, are moving on to those 75 and over.
Other Ontario regions are choosing their own high-risk populations: In Niagara, public health has made it a priority to vaccinate staff at special-needs schools. The local public health unit has vaccinated 1,500 educators, both the public and Catholic school boards said in a joint release on Wednesday.
Dr. Bogoch said Ontario mostly stuck to the recommendations from the National Advisory Committee on Immunization during its first phase: those living and working in long-term care, front-line health care workers, all Indigenous adults, and those over 70, beginning with those over 80.
“It shouldn’t come to anyone’s surprise that many front-line health care workers are in their 20s, 30s, 40s, 50s. Many Indigenous populations are also in their 20s, 30s, 40s, 50s,” Dr. Bogoch said. Dirk Huyer, co-ordinator of Ontario’s outbreak response who sits on the vaccine-distribution task force, said the province is balancing both age and risk, and keeping the health system afloat.
Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, said vaccinating health care workers is a top priority. But he said Ontario should have stuck closer to the front lines.
“I think we went too far and we used a lot of our best defence for the third wave, and vaccinated people who were both at low risk of exposure and also at low risk of bad outcomes,” said Dr. Stall, who works with COVID-19 patients and has been vaccinated.
Erin Ross, 64, of Burlington, Ont., said she was surprised to learn that employees at her physiotherapist’s office – including the front desk staff – had received vaccine jabs before her 87-year-old aunt in Halton region, west of Toronto.
“I was actually really ticked off,” Ms. Ross said. “It doesn’t, to me, seem really right.”
The Quebec government has stuck closely to a shot priority list set out by the province’s independent, expert immunization committee in December, with age as the primary factor. The government and committee made exceptions to the age rule for about 250,000 front-line health care workers and 35,000 people in isolated and Indigenous communities. Montreal’s public health authority also immunized hundreds of homeless people and announced Thursday it will vaccinate younger adults in two Montreal neighbourhoods with spikes in variant cases.
The province also delivered more vaccine doses to Montreal, the city with the greatest share of cases and deaths in Canada throughout the pandemic, meaning older people outside the city have to wait.
“If we had all the vaccines needed, they could just do everyone, but it has to be arranged in a certain order,” said Dr. Maryse Guay, a professor of medicine specializing in immunization and community health at the University of Sherbrooke, who sits on the Quebec immunization committee. “The age criteria was easier to manage.”
Quebec’s immunization committee will publish new recommendations for the under-65 vaccination campaign later this month.
With a report from Caroline Alphonso in Toronto
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