Though Canada has administered about 10 million doses of COVID-19 vaccines, there are still no clear, written guidelines on what behaviours vaccinated individuals might be able to resume once immunity ostensibly kicks in. Can vaccinated grandparents finally hug their unvaccinated grandchildren? Can two friends who have only received their first doses spend time together indoors? What activities can fully vaccinated Canadians engage in that partially vaccinated individuals – that is, those who are still waiting for their second doses – cannot?
The short answers – or so we are left to infer – are “no,” “no,” and “nothing.” When asked during technical briefings over the last few weeks about instructions for vaccinated Canadians, both Chief Public Health Officer Theresa Tam and Deputy Chief Public Health Officer Howard Njoo have said, in better-sounding words, to change nothing and sit tight. “For now, the key message is that everyone needs to keep up with their personal protective measures,” Dr. Tam said back on Mar. 23, by which time about 4 million Canadians had received at least one shot. The U.S. Centers for Disease Control had released instructions for vaccinated Americans two weeks earlier.
Dr. Tam added that it was still “too early” to revise public health guidelines, even though the phenomenal real-world efficacy of COVID-19 vaccines in preventing serious illness and death was already apparent from data from Israel, Britain and other countries with accelerated vaccination rollouts. Since then, the CDC has released results from a study showing that mRNA vaccines appear to prevent both symptomatic illness and the transmission of COVID-19. But the instructions from Canadian public health officials still remain the same: act as if you haven’t been vaccinated. Zoom with your grandchildren, stay six feet apart, and don’t socialize unmasked and indoors with anyone outside your household.
If Canadians were sociopathic cyborgs who could function without meaningful and diverse human interaction for a year – and then yield to a request to continue distancing for an indefinite period of time – then this instruction would be appropriate. But normal people have a breaking point, and asking them to continue distancing themselves from everyone, even after receiving one or two doses of vaccine, might be it. Indeed, it’s hard to reconcile how health officials can continue to emphasize the vital importance of getting the vaccine while at the same time undermining its efficacy by insisting that behaviours of those who receive it cannot change.
Canadian health officials face an added communications challenge in trying to explain why a single dose of vaccine is believed to be effective enough to stretch the interval between doses by up to four months, but simultaneously not effective enough to allow partially vaccinated individuals to ease up on some restrictions. Canada’s first-dose-first focus might be the right call in terms of offering some protection to as many people as possible as quickly as possible, given that variants are spreading in multiple provinces. But it leaves partially vaccinated Canadians in a weird sort of limbo that no Canadian health authority has meaningfully attempted to address.
Indeed, this pandemic has highlighted how public health instruction often ignores the realities of human nature; that in the absence of sanctioned harm-reduction measures, people will simply decide for themselves what activities they feel are safe. There are of course good reasons why Dr. Tam and others might be reluctant to offer guidelines on loosening restrictions for fully or partially vaccinated individuals, including the fact that the positivity rate in some regions is the highest it’s ever been, and also that vaccines do not offer 100 per cent protection against infection. Some people – particularly older, immunocompromised and other vulnerable people – might still get sick, and we simply don’t yet know how well one dose of the Pfizer vaccine, for example, protects us four months on.
Some people have also raised concerns about creating a sort of two-tiered society, wherein those who have been vaccinated are allowed certain “freedoms” that the rest of the population is not. But vaccination already divides society into two different classes: namely, those who are protected against severe illness and death, and those who are not. And if people are going to disregard public health instructions anyway – which we know some were doing even before vaccinations began rolling out – the prudent public health approach would be to provide them with specific instructions on how to increase social interactions in the safest way possible. Telling them to continue to lock down, even after vaccination, is to operate on the delusion that people are yielding to instructions as they were in March, 2020. They are not.
A vaccination program that leaves people to decide for themselves when and what activities might be safe is a vaccination program that’s only half-completed. At this point, guidelines certainly wouldn’t come “too early” – they’d be about 10 million doses late.
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