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Samekh Nadeem, 12, watches as his brother Sion Nadeem, 13, receives his Pfizer BioNTech COVID-19 vaccination at a clinic at the Embassy Grand Convention Centre in Brampton, Ont. on May 25, 2021.

Fred Lum/The Globe and Mail

Half the members of Sunidhi Sharma’s social circle have been vaccinated but it’s them, rather than the unvaccinated, who are keeping her from getting the jab.

None of the 22-year-old restaurant cashier’s friends or colleagues have had the novel coronavirus, so hearing friends’ accounts of developing fever and body aches after receiving their first dose has worried her more than COVID-19 itself.

“It feels a bit scarier, so I’m not sure whether I should go for it or not,” said Ms. Sharma, who immigrated from India in 2019 and now lives in L6P, a postal code in northeast Brampton, Ont., that has logged the highest per capita cases of COVID-19 in the province.

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She’s part of the 27 per cent of adults in Peel Region, west of Toronto, who have still not received their first dose of the vaccine, despite being eligible for more than a month.

Concerns about the highly contagious Delta variant, which now makes up one-quarter of COVID-19 cases in Peel, have prompted political and health leaders to call for an accelerated rollout of second doses of the vaccine in the area. A British-based study found that the variant reduced effectiveness of the Pfizer and AstraZeneca vaccines to just 33.5 per cent after one dose, but that two doses are nearly as effective against Delta as they are against Alpha (the variant first associated with Britain).

But there is a worry that people like Ms. Sharma, and others who haven’t yet rolled up their sleeves because of logistical barriers, vaccine shopping or hesitancy, may be left behind.

People waiting to receive their Pfizer BioNTech COVID-19 vaccination, line up outside at a clinic at the Embassy Grand Convention Centre on May 25, 2021.

Fred Lum/The Globe and Mail

Despite being the hardest-hit city in Ontario, Brampton’s vaccination campaign got off to a slow start. Relatively few Brampton pharmacies offered shots early, and community pop-ups and workplace clinics took weeks longer to come online than they did in Toronto.

In L6P, overall coverage is still slightly below the provincial average, despite the area receiving extra vaccines, and Peel being the first public-health unit to open vaccines to everyone over 18. Seniors, in particular, are being left behind in L6P, with 69 per cent of people over 80 covered, compared with a provincial average of 83 per cent, according to the non-profit Institute for Clinical Evaluative Sciences.

This month, a team of researchers launched the COVID CommUNITY-South Asian study, a federally funded project that will investigate both vaccine effectiveness and hesitancy in South Asian communities. In Peel, 55 per cent of infections have been among South Asians, though they make up 32 per cent of the population. The team hopes to recruit 1,500 vaccinated and 1,500 unvaccinated participants in the Vancouver and Toronto areas – including Brampton.

“If health care workers from the South Asian community were hesitant to get the vaccine, they could have a very significant negative ripple effect in the community around them,” said principal investigator Sonia Anand, a professor of medicine and epidemiology at McMaster University in Hamilton. “Because if you say, ‘Well, if this ICU nurse is not getting the vaccine, then I’m not getting it, because she must know something I don’t.’ ”

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Two people wait to be called to a station where they will receive their Pfizer BioNTech COVID-19 vaccination at a clinic at the Embassy Grand Convention Centre on May 25, 2021.

Fred Lum/The Globe and Mail

On an evening in late May, just days after the Embassy Grand vaccine clinic in L6P had opened, the lineup snaked around the parking lot out front. The queue was filled with young teens, accompanied by parents and other relatives. The province had just dropped the age of eligibility for a first shot to 12.

But in that queue were many who had been eligible for weeks or even months.

Nancy Chandhi, a 31-year-old international student who moved to Brampton from the Indian state of Punjab in April to study business management at Conestoga College, came to the Embassy Grand for a shot with her six housemates.

A week earlier, they had walked away from their appointments at the Brampton Soccer Centre, one of Peel’s mass vaccination sites, because the site was administering the Moderna vaccine. The Pfizer-BioNTech and Moderna shots, which both use mRNA technology, performed nearly identically in clinical trials and real-world studies.

Ms. Chandhi hadn’t heard anything particularly bad about the Moderna product, but so many friends had recommended Pfizer-BioNTech that a sense of “brand loyalty” had developed in her circle.

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At Peel Public Health’s fixed clinics, where about 40 per cent of all doses have been administered, 6 per cent of booked appointments last week were no-shows. But the no-show rate at pop-up clinics and hospitals has been much higher, said Priya Suppal, a Brampton family doctor who has worked at several of the vaccination sites in the city, including the Embassy Grand, where she is one of the medical directors.

After the initial surge of teens when it first opened on May 17, the site has seen a daily no-show rate of about 15 per cent to 20 per cent. Some clinics have reduced their hours or closed. One day last week, a clinic in Brampton had capacity to administer 600 daily doses and only did 50, Dr. Suppal said.

Hyder Ali, 41, receives a Pfizer-BioNtech vaccination from registered nurse Julia Noce at a clinic at the Bramalea Civic Centre in Brampton, Ont. on May 17, 2021.

Fred Lum/The Globe and Mail

With cases of the Delta variant rising, she said the government should immediately move to opening up second-dose vaccinations to everyone over 18 in COVID-19 hot spots such as Brampton – but the variant is also good reason to keep pushing those first doses, she said.

With so few appointments booked in recent weeks at her clinic, her team has had time to canvass local gurdwaras, temples and supermarkets to draw people in, and they’ve learned why so many are still without first doses. There are the long-haul truckers who are only at home one day a week and have had difficulty finding an appointment, there are home-bound seniors who are unable to drive themselves to a clinic, there are warehouse workers whose schedules are too unpredictable to book an appointment weeks ahead of time, there are international students who mistakenly believe they must pay to get a vaccine.

“I think we have to sort of go full steam ahead with second doses, but really continue our efforts on [first doses],” Dr. Suppal said. “We don’t want to have all these mutations out and about and people getting sick all over again.”

For Muntaz Alli, the president of the Brampton Islamic Centre, vaccinating locals who are on the fence requires buy-in from trusted community leaders and institutions. In April, the city asked the mosque to hold a pop-up vaccination clinic. It ran from April 30 to May 11 and administered 6,200 first doses. A team of volunteers engaged with community members on social media and WhatsApp – a major source of local news and information – to encourage residents to come to the pop-up clinic.

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“When community members heard about the [mosque’s] pop-up, their worries went away because it was their local community holding the vaccination clinic,” Mr. Alli said.

Leaders in Brampton’s Black, African and Caribbean communities followed that model when they launched a four-week pop-up clinic at the Bramalea Civic Centre in the L6T postal code, which has the lowest vaccination rate – 54 per cent – in the region.

They dispatched community ambassadors into apartment buildings and grocery stores to spread the word about the clinic and found Black doctors, nurses, staff and volunteers to work there. But the battle against vaccine hesitancy has been formidable.

Angela Carter, executive director of the Brampton non-profit Roots Community Services, said there is a well-founded mistrust of a health care system that has not always treated Black people well.

Some tell her “the government is inflating the numbers” of COVID-19 infections. Or explain, “I am not going anywhere, so I don’t need to get the vaccine.” Others say, “I don’t know what’s in the vaccine. I don’t know how it’s going to affect my body.”

The weekend soft launch of the clinic in mid-May was busy and celebratory, but a few days later, appointment bookings dropped and organizers pivoted to allowing anyone who qualified to walk in and get a shot.

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Marsha Brown, manager of community programs and services for WellFort Community Health Services, at a clinic at the Bramalea Civic Centre on May 17, 2021.

Fred Lum/The Globe and Mail

Marsha Brown, the manager of community programs and services for WellFort Community Health Services, said even as the government’s focus shifts to second doses, the work to ensure residents get their first doses must continue long after the Bramalea Civic Centre pop-up closes on Friday.

“Knowing the mistrust, the hesitancy and the resistance that’s there, if we didn’t carve out a space and focus on our community, they could very easily just fall through the cracks and get forgotten,” she said.

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