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There’s almost certainly another wave of COVID-19 coming to Canada in the weeks ahead – if it hasn’t started already.

Which means it’s time to start seriously gearing up for another round of COVID-19 vaccination.

But getting a clear message out about the importance of vaccination, all while recognizing the growing limitations of existing vaccines, is going to be a delicate balancing act for public-health officials. They need to recognize that seven months of Omicron subvariants, each seemingly more infectious (though thankfully not more deadly) than the last, has changed the landscape considerably. Persuading people to head to clinics and roll up their sleeves is getting harder.

Increasingly, people are tuning out pandemic news, but there are several noteworthy developments, good and bad, on the vaccine front. For starters, U.S. regulators have just approved shots for children aged six months to five years, and a similar decision should be imminent in Canada.

But planning to vaccinate young children is just one part of the puzzle.

The real challenge for public health is getting the reluctant to get their first, second and third shots while, at the same time, reassuring the worried that fourth shots are not necessarily urgent.

There’s a lot of catching up to do. Only 42 per cent of children ages 5 to 11 have received two COVID-19 shots. And, with only 56 per cent of the adult population having received a third dose of the vaccine, getting the remaining 44 per cent up-to-date is more important than getting a fourth dose into adults who are not in high-risk populations. (Although make no mistake: A large-scale rollout of fourth shots for adults will be an important weapon against the anticipated fall surge of the B.4 and B.5 subvariants of Omicron.)

Vaccination has slowed considerably in recent months. Currently, slightly more than 20,000 doses a day are being administered, down markedly from a peak of 600,000 daily a year ago. Public-health officials need to be less preachy and more frank about the limits of vaccination.

The problem with COVID-19 vaccines is two-fold: Immunity wanes fairly quickly and new variants are increasingly evasive. Practically, that means that four to six months after a shot, protection against infection is poor.

The good news though is that vaccines continue to offer fairly robust protection against hospitalization and death. Data from this past spring shows that while the vaccinated and unvaccinated have a similar risk of infection, the unvaccinated were about five times as likely to be hospitalized and seven times more likely to die than those vaccinated with three shots. (Deaths remain high given the sheer volume of infections.)

Among the public there is a dichotomous mix of indifference and urgency: those who want no more shots and those who want them now.

For the latter, the National Advisory Committee on Immunization (NACI) has recommended that a fourth dose “may be offered” to anyone over 12. It is particularly important for those at high risk: people over the age of 70; those living in congregate settings such as long-term care homes; and those living with chronic illnesses such as heart disease.

Canada being Canada, eligibility criteria vary considerably between provinces, of course. In Quebec, any adult can get a fourth dose. In B.C., access to the so-called second booster is limited to elders over the age of 70 (or 55 in Indigenous communities), and residents of long-term care homes.

Seemingly further complicating matters is that people should wait at least three months after COVID-19 infection and six months since their last shot to get a booster. Almost half of Canadians were likely infected with Omicron in the past six months; fortunately most of the 56 per cent of those who have a third shot got it more than six months ago.

For parents, the decision to get children vaccinated can be an especially challenging one. Protection is poor – 51 per cent for ages 6 to 24 months; 37 per cent for ages 2 to 5 years – and there is still the mistaken perception that COVID-19 infection is mild in children. But statistics don’t matter much when your kid falls sick and, overall, it is better for a child to be vaccinated than unvaccinated.

What is really needed at this point are vaccines that protect specifically against Omicron subvariants, but those are months away. In the meantime, we have little choice but to go all-in with the not-half-bad vaccines we have.

But that’s going to be a hard sell to an increasingly skeptical public that is fed up with the pandemic.

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