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There’s a logic gap in the fight against COVID-19 in Canada, and it comes down to a single word: “fully.”

The federal government and its provincial counterparts still define someone who has had two doses of vaccine as “fully vaccinated.” And yet, there is a growing awareness that this is a misnomer – that a person is not fully protected against Omicron and its subvariants unless they have received a third shot, a.k.a. a booster.

On April 12, the National Advisory Committee on Immunization (NACI) strongly recommended that anyone aged 18 and up get a booster six months after their second dose. It did the same for immunocompromised adolescents.

This was based on evidence of the waning effectiveness of vaccines against Omicron over time, and on evidence that third doses can increase the effectiveness to 90 per cent.

NACI’s guidance comes in the midst of a spike in infections that began several weeks ago, after the widespread dropping of the last of public-health restrictions, including masks. Cases are high across the country, and hospitalizations have been rising – although accurate information on that last point is limited because so many provinces have stopped keeping daily records during the sixth wave of the pandemic.

What is known is that the unvaccinated, or those without boosters, are considerably more likely to be hospitalized or die from Omicron than those who’ve had a third shot.

The need for boosters is widely accepted by experts. “This is a minimum three-dose vaccine,” Katharine Smart, president of the Canadian Medical Association, recently told The Globe and Mail. It was a sentiment echoed by Brian Conway, president of the Vancouver Infectious Diseases Centre: “It is three shots to protect against Omicron.”

But there’s a gap between what the science is saying and the public is hearing – a gap Health Canada is aware of. “Doses of COVID-19 vaccines after the primary series are being described as booster doses,” it says in the most recent version of its immunization guide. “However, over time, the nomenclature of this additional dose could evolve as the optimal number of doses in a primary series is better understood.”

For now, however, millions of Canadians with two doses may be under the impression they are “fully” protected against COVID-19 – even though Health Canada knows that’s likely not true.

This semantic failure is no doubt contributing to the fact that the effort to get third shots into Canadians has all but stalled out.

Just 47.5 per cent of Canada’s population has had a third shot, according to federal data. The number has been stuck at that low level for weeks, thanks to a lack of urgency at all levels of government.

In Quebec, where 46 per cent of the eligible population hasn’t had a third dose – including 14 per cent of those over 60 – the province administered 1,326 boosters on Monday.

In Ontario, where about 40 per cent of the population hasn’t had a booster, the number of third shots administered averaged 3,927 a day over 10 days from April 10-19. That’s half the daily average number of shots in early March, and one-eighth the level of early February.

The good news is that most provinces have given third shots, and in some cases fourth shots, to those most vulnerable to COVID-19: older seniors, particularly those in long-term care.

And while COVID-19 hospitalizations have risen in recent weeks, they don’t appear to have shot up at the same rapid rate as new infections. That is in large part due to vaccines.

But the booster gap is worrisome – especially given Canada’s thin data on how many people have recently been infected, and who they are. Governments are navigating in the dark compared with previous waves.

They do know, however, that vaccines are the most effective weapon they have against COVID-19, and that adults need a third shot to be fully protected.

And yet they continue to classify Canadians with two shots as “fully vaccinated.” It’s a misleading message that could easily be corrected. Instead, governments are compounding it with a lackadaisical approach to delivering third doses.

Canada’s goal is living with COVID-19 – by taking steps to make it livable. Vaccination remains the key to ensuring that future waves of the virus result in the fewest possible hospitalizations and deaths.

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