Abdullah Shihipar directs narrative projects and policy impact initiatives at the People, Place & Health Collective (PPHC) at the Brown University School of Public Health in Providence, Rhode Island. Brandon D.L. Marshall is an associate professor of epidemiology at the school and is the founding director of the PPHC.
More than 15 months after the first COVID-19 case was identified in Canada, the pandemic is becoming more dire. COVID-19 cases, hospitalizations and deaths are rising and the variants are circulating widely in communities across the country.
Only about 11 per cent of the population has received one dose of a vaccine; only about 2 per cent are fully vaccinated. And while Canada’s vaccine rollout is rightly prioritizing the elderly, younger Canadians are now making up a larger proportion of hospitalizations in this latest surge: approximately 46 per cent of ICU admissions in Ontario in late March were amongst those who were under 59. They also make up the largest share of cases in the province – 80 per cent since January of this year. It’s a similar story in other provinces as well, with B.C. health officials reporting more young people in the ICU, and people under 59 now making up the majority of total cases.
Much of the impact on younger populations has to do with where people live and work. Bonnie Henry, B.C.’s provincial health officer, stated recently that COVID-19 is spreading through workplaces and in crowded housing conditions. If you look at a map of most provinces across the country, you’ll see that certain communities and workplaces have more COVID-19 cases while others are not as affected. Variants have also rapidly spread in Peel and Toronto neighbourhoods where more essential workers, recent immigrants and low-income people live.
Despite bearing the brunt of the pandemic’s impact, racialized minority, low-income and immigrant neighbourhoods have not been prioritized in the vaccine rollout. A March report by The Local Magazine found that none of the pharmacies located in the hard-hit neighbourhoods of Toronto were chosen to administer COVID-19 vaccines; as of Apr. 1, there were still just five.
If we want to tackle the latest surge, Canada’s governments must take vaccines to the places where Canadians are being infected the most. Governments must target these hot spots with vaccination, as Ontario announced it would do last week.
This approach works, and here in Rhode Island, we’ve seen that firsthand. The tiny town of Central Falls (home to only 20,000 people in 1 square mile, fewer than 20 per cent of whom are non-Hispanic white) has had the highest COVID-19 case rate for much of the pandemic. But in December, in addition to those aged 75 and up, the state began offering vaccinations to all adults who lived in two public housing projects in the town. By February, the Central Falls vaccine program had expanded to all adults, and weekly vaccination clinics were being held at local schools. The program, while not perfect, has been successful at bringing down the rate of infection. By February, Central Falls saw an 80 per cent decline in cases compared to a 65 per cent decline across the state.
For a hot spot vaccination approach to work, vaccines need to be offered to all adults in the country’s hardest-hit communities and workplaces. Of course, it is not sufficient to merely offer vaccines; in some communities, there needs to be door-to-door multilingual outreach that pro-actively registers people for their shots and arranges transportation if need be.
Some may question if hot spot vaccination is the right thing to do when the COVID-19 vaccine supply is so limited in Canada right now, but the experience of Rhode Island and other U.S. cities shows it is the most efficient and equitable approach. It makes epidemiological sense to vaccinate people who face both the highest risk of exposure and who are getting sick, according to the data.
Vaccine priority strategies that rely exclusively on age seem like common sense, since older persons have the highest rate of hospitalizations and deaths. But such approaches don’t account for the fact that different groups have dramatically unequal risk of exposure to the virus. In Rhode Island, for example, Black and Latino people aged 35-44 (who are much more likely to work in essential front-line jobs and live in crowded housing conditions) have three times the hospitalization rate of white people in their 70s and 80s. Where we live and where we work inform how much risk we face.
We will not end this pandemic until those who have been hardest hit have equitable access to life-saving vaccines. It is not too late for the rest of the country to follow Ontario in adjusting its vaccination strategy, but we must act fast – lives are on the line.
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