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A health care worker from Humber River Hospital administers a second dose of the Pfizer COVID-19 vaccination to Sylvana Creglia inside Caboto Terrace on April 1, 2021, in Toronto.

Cole Burston/Getty Images

Because of Canada’s rickety vaccine rollout, it was important for national morale (and for saving political face) that governments got as many first doses of the two-shot vaccines into people as quickly as possible.

Now that we’re sort of hitting our stride – 6.3 million doses have been administered to date, with more than 2 million more vaccines arriving this week – we need to refine our approach.

Quantity matters, but so does using vaccines as effectively as possible. That means not only getting shots into arms, but into the right arms at the right time.

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Prioritizing the vaccination of elders in institutional care and front-line health workers, as most provinces did, was the right move. Of the more than 23,000 pandemic deaths Canada has recorded to date, more than 16,000 have occurred in institutional settings like nursing homes, a number that is likely an under-estimate, according to new research.

The carnage has stopped abruptly thanks to vaccination. Yet for the most part, residents of long-term care homes have received only one dose so far.

Is that good enough?

Canada has adopted a controversial policy of extending the time lag between the first and second dose to 16 weeks, or 112 days. This is very different from the recommendations of vaccine makers: 21 days for Pfizer, 28 days for Moderna and 84 days for AstraZeneca.

The science is evolving, so there are no easy answers. Stretching the time between doses makes sense on a population level; if we can get twice as many people vaccinated and still confer 80-per-cent protection with a single dose, that is clearly sound policy.

Of the 6.3 million Canadians vaccinated to date, fewer than 705,000 have been fully vaccinated with both shots; that’s 11 per cent.

In the U.S., which has vaccinated far more people per capita, almost 60 per cent are fully immunized. But Americans are having the opposite debate of the one here in Canada. There is a push below the border to delay second shots, rather than, as we’re now talking about here, reversing course and giving them closer together.

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The great unknown is how far can you safely stretch the lag between shots without people’s immunity waning.

Just as important is how crudely these dose-sparing strategies should be applied. There is emerging evidence that the wait cannot be too long, especially for the most vulnerable, such as frail elders, and others with immune deficiencies, like cancer patients.

In other words, many people can afford to wait, but some cannot.

This is a reminder that, as vaccination campaigns evolve, policies need to become more nuanced and sophisticated.

At the outset, our vaccination priorities were principally age-specific, starting with centenarians and working our way down in five- or 10-year increments.

Now, instead of offering the jab to healthy 50- and 60-year-olds, we need to vaccinate members of high-risk groups, such as essential workers in food-processing plants and warehouses, teachers and people in specific neighborhoods where cases are soaring.

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There are some great pilot projects (oh, how Canada loves its pilot projects!) showing that bringing vaccines to neighborhoods where blue-collar workers live is an effective mitigation strategy.

As the number of vaccines available grows substantially, we also need to be more aggressive and innovative in how we deliver them. Teams of vaccinators need to be dispatched to factories. Mobile teams need to get to housebound elders.

Clearly, we need to work on improving uptake among health care workers too, especially those who toil in long-term care houses and home care. But simply threatening to fire unvaccinated workers is not a viable solution, given dire shortages of personnel. The best way to overcome hesitancy is with sensible policies like paid sick days, so people have time to recover from any side effects, and peer-to-peer education.

The sight of empty clinics is infuriating, but also speaks to poor organization and communication, not lack of public interest.

Clinic hours and locations need to be improved. That means staging clinics in mosques and temples, not just convention centres. It means offering shots to elders early in the morning, not at suppertime.

Finally, what we really need is an injection of passion into the vaccine campaign.

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Canada has received 8.6 million vaccine doses to date; only 6.3 million of them have gone into arms.

Why, as variants are starting to run rampant, are one in every four doses of vaccine Canada has received sitting in freezers?

The same question needs to be asked today as when the vaccination campaign began in December of last year: Where is the sense of urgency?

We didn’t have it at Christmas, and we still didn’t have it at Easter. If continue with this languorousness, the pandemic will still be with us on Canada Day, on Labour Day – and beyond.

Health columnist André Picard answers reader questions about COVID-19 variants, how effective the various vaccines are and the impact of on-again, off-again lockdowns. The Globe and Mail

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