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The Pfizer-BioNTech COVID-19 mRNA vaccine is shown at a vaccine clinic during the COVID-19 pandemic in Toronto on Dec. 15, 2020.

Nathan Denette/The Canadian Press

Large numbers of workers in Canada’s long-term care homes are hesitant to be vaccinated, raising concerns about the effectiveness of efforts to protect vulnerable seniors.

While employers cannot compel workers to be vaccinated, public-health advocates are searching for ways to persuade staff in care homes to accept that the vaccines for COVID-19 are safe and effective.

Staff in long-term care facilities have been among the first in Canada to be offered the vaccines, which started arriving in mid-December.

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In B.C., seniors in long-term care account for the majority of deaths attributed to COVID-19, and the province hopes nearly 80 per cent of staff at the facilities will be immunized. But a survey conducted in December by SafeCare BC, the workplace safety association for long-term care homes, found only 57 per cent of staff want to get the shots. The anonymous survey, which had almost 1,500 responses, indicated more than a quarter were uncertain if they would be vaccinated.

“We are experiencing about 50 per cent saying no,” said Hendrik Van Ryk, chief operations officer of H&H Care Homes Ltd., which operates five facilities in B.C. and three in Alberta. On-site managers are offering daily safety briefings to answer staff questions, but he said he is worried about what will happen if not enough workers are vaccinated. “We’ll have continued outbreaks if we only have 50-per-cent vaccination. And we can’t, as an employer, tell people, ‘You need to do this.’ ”

Labour lawyer Richard Press, a partner with DLA Piper, said employers do have some levers, but cannot demand vaccination as a condition of employment.

“You’re asking somebody to inject physically into their body a manmade substance. And I don’t believe that any employer has a unilateral right to enforce that kind of action,” he said in an interview. Employees who balk at vaccination, however, may face consequences: They might be asked to work outside of direct patient care, to wear additional personal protective equipment, or to take shifts during which physical distancing is easier. They could be asked to take a leave of absence, possibly without pay.

British Columbia tested the authority of vaccination requirements in an arbitration case brought by the BC Nurses’ Union in 2006. The tribunal upheld a hospital policy that nurses must be vaccinated during an influenza outbreak or take an unpaid leave of absence. But Mr. Press said policies have varied in recent years, and the issue is best worked out between unions and employers.

Tim Guest, president of the Canadian Nurses Association, said his union is strongly encouraging the country’s 400,000 nurses to be vaccinated against COVID-19. He said his organization believes vaccines are effective and safe. “And we trust that the regulatory process led by Health Canada to approve both the Pfizer and Moderna vaccines were appropriate.”

He said some members are still anxious about getting the shots, which are a new kind of vaccine. “I don’t think it’s surprising that there is some hesitancy with some individuals, because I think we’re at varying levels of informing ourselves and becoming comfortable with the science.”

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Miranda Ferrier, president of the Canadian Support Workers Association, which also represents many front-line workers in long-term care, said attitudes are shifting as more workers are vaccinated. Early in the week, she said, most of her members were ready to refuse the vaccine. “But now there seems to have been a turning of the tide,” she said.

Ms. Ferrier said government and public-health officials should bear some responsibility for vaccine hesitancy after a difficult year for her members: “Personal-care workers are burnt out, they’re exhausted, they don’t know what information to trust.”

She said employers should pay workers to take the time to get vaccinated, but those who remain unwilling to get the shots can expect to be sidelined in an outbreak. “You know you can work in long-term care without a flu shot, but if you go into outbreak, you can’t work. We already have that policy in place for the flu. So I can definitely see governments doing the same thing with COVID.”

Staff at Ontario long-term care homes have been offered the vaccines since mid-December, but had to travel to centralized hospital clinics because of the handling requirements for the Pfizer vaccine. Brian Hodges, chief medical officer for Toronto’s University Health Network, said the operators of UHN’s pilot vaccination site saw that a significant number of nursing-home workers were reluctant to trek to the downtown clinic.

While travel was a barrier, Dr. Hodges said, “the psychological part is huge.” He is now leading teams of vaccinators into long-term care homes with the Moderna shot, which is easier to store and transport, and learning first-hand just how nervous some front-line workers are about being among the first to receive COVID-19 jabs.

At Cedarvale Terrace in Toronto on Monday, Dr. Hodges said four personal-support workers approached him with concerns. “I answered their questions and gave them a chance to think about it. … Then they all lined up and had the vaccine.”

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Maya Goldenberg, a philosophy professor at the University of Guelph, has just completed a book on vaccine hesitancy. She said effective communications must be grounded in an understanding of what drives concerns. “People are really shocked when health care workers are not on board with vaccines,” Dr. Goldenberg said. But she added that hesitancy can be driven by a mistrust of the public-health institutions rather than scientific illiteracy.

She noted that long-term care workers, many of them immigrant women, have experienced institutionalized racism and have fewer reasons to trust the authorities who assure them the vaccine is safe. “They’re more likely to trust leaders in their community – organizers, religious leaders.”

Tara Moriarty, an infectious-diseases researcher at the University of Toronto who has been tracking deaths in Canadian long-term care homes, projects that the rate in the coming months will be “horrifying.” On Monday, she launched an outreach program, using video conferencing, to provide care-home workers with an anonymous forum where they can get answers. She said the response has been overwhelming.

“The most effective way to deal with vaccine hesitancy and concerns is to meet one-on-one, or something like one-on-one, but it’s enormously time-consuming,” she said. “They may not want to ask those questions in their place of employment, because a lot of people are afraid of losing their jobs.”

With a report from Kelly Grant

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