Why Ontario’s COVID vaccination program is confusing to navigate

Politicians and community workers explain how the fast-changing vaccination strategy impacts work on the ground


Do you live in Ontario? Do you live in one of the province’s newly designated COVID-19 “hot spots?” Are you between the ages of 18 and 49?

Well, good news: you might be eligible for a COVID-19 vaccine. Or you might not. It’s confusing, because the way it all works is chaotic: Ontario premier Doug Ford makes a big announcement, and the province’s public health units scramble to execute whatever that announcement entails. (The latest vaccine eligibility information is here.)

Sometimes the direction is clear, like when the province opened pharmacy vaccinations up to those 50 and over, lowering the floor from 55. And sometimes it’s less clear, like last week’s announcement that anyone in those hot spots over the age of 18 could register for a shot. For one thing, the province’s website was set to reject anyone under 50, and for another, some of the hot spots themselves were questionable.

On Monday, a CBC investigation revealed five postal codes designated as COVID hot spots were in fact running lower than average rates of infection, hospitalization and death; and four are in ridings held by PC MPPs, raising questions about the province’s priorities.

In the latest episode of the NOW What podcast, I talk to three people who are doing their best to roll with the province’s constantly changing pandemic response: Bhutila Karpoche, the NDP MPP for Parkdale-High Park; Maureen Gans, senior director of client services for the Parkdale Queen West Community Health Centre; and Joe Cressy, councillor for Ward 10 and chair of the Toronto Board Of Health.

“Part of the problem is that decisions are made pretty quickly, and sometimes for good reason,” says Gans. “But the people who need to be at the table aren’t always at the table. Even our hospital partners – who are actually sort of the hub for distributing vaccine for outreach activities, people who are running some of the clinics – they didn’t know about this. They didn’t know about this pivot until they heard it in the news with everyone else.”

Fluctuations in vaccine supply are another issue, complicating efforts to plan ahead with any certainty.

“We’ve got the mass vaccination clinics, we’ve got the shelter clinics, we’ve got the pop-up clinics, we’ve got the hospital clinics,” Gans says. “There are lots of clinics and not enough vaccine for everybody to run every day. So it’s a combination of last-minute decision-making – sometimes based on good evidence, sometimes maybe not – and just not enough supply. And then everybody scrambling to try to put it together.”

How will mobile vaccination clinics in hot spots work?

Last week, Ford said all people age 18 and up living in high-transmission areas – or hot spots – would now be eligible to receive the vaccine. However, people between 18 and 49 are not able to make appointments via provincial booking systems.

Instead, hospital clinics and Ontario Health Teams are working with local public health units, municipalities, community groups, religious institutions, employers and residential buildings in hot spot neighbourhoods in Toronto and Peel.

For example, a mosque near Humber River Hospital and North Western Toronto Ontario Health Team hosted a clinic on Monday where 219 residents age 40 years and older were vaccinated. On Tuesday, Unity Health Toronto will hold a mobile clinic at a Toronto Community Housing building to vaccinate 131 residents age 18 years and older.

On Tuesday, the province announced a large pop-up clinic will open at BAPS Shri Swaminarayan complex in North Etobicoke in partnership with BAPS Charities, William Osler Health System and Toronto Public Health. It will run for three weeks and appointment bookings will open on April 14 through the William Osler Health System booking system to people living nearby.

“The province announced last week that those over the age of 18 and under the age of 50 will be able to access mobile and pop-up clinics,” Cressy says. “Well, the subsequent question then becomes, ‘When is the clinic coming, where is it and how do I register for it?’

“What needs to happen here is twofold. One, at the city of Toronto we’re working with our health care partners, Ontario health teams, hospitals, to try to scale up mobile clinics. The faster we do that, the more we can bring vaccines directly to hard-hit neighborhoods, hard-hit communities, hard-hit workplaces, the better.”

But mobile clinics can only distribute so many shots, and Cressy stresses that mass vaccination sites are also operating – it’s just a question of making them accessible to people in designated hot spots.

“We need both options and we need them now – and frankly, that’s the type of clarity and consistency I think residents want. They just want to know,  ‘When do I book?’”

Vaccine hesitancy is a common issue

One postal code in Karpoche’s riding has been designated as a hot spot.

“But we have many other areas within my community that desperately need vaccines,” she says. “Essential workers who need vaccines, homebound seniors who need vaccines, others with comorbidities and other high-risk conditions, underlying health conditions. So many people desperately need vaccines, and yet we’re seeing them being left behind.”

Ford’s inconsistent messaging on the vaccines – saying he wasn’t willing to “roll the dice” on AstraZeneca on March 31, then holding a photo op at an Etobicoke pharmacy to take it himself on April 9 (where he pretended to “die” from the shot for the crowd) – also feeds into vaccine hesitancy in people who can’t tell the facts from misinformation running rampant on social media.

“It’s an issue,” Karpoche says of vaccine hesitancy. “We’ve seen it not just with COVID, but in general becoming a bigger issue in the last number of years because there’s so much disinformation out there.”

But what’s worse is being deemed eligible for a vaccine only to be unable to navigate the registration system. Even before the provincial system opened up to people age 50+ in hot spots, she says, “in Parkdale we were experiencing seniors who were eligible in the 50+ category but not able to get a vaccine appointment because of language barriers, internet access barriers, and also just complete confusion in terms of how to go about booking an appointment.”

Cressy agrees.

“Clear, consistent and easy to understand guidance on when and how you get vaccinated is key for a successful campaign,” he says. “The vast majority of Torontonians aren’t sitting on Twitter all day long looking for the latest day-by-day, minute-by-minute adjustment to the vaccine campaign. Most residents in our city aren’t on listservs trying to find the latest clinic that may be opening vaccine registration lists to new populations. The more information is muddled, the more information changes, the harder it is for people to follow.”

And this brings us back to community centres and other groups that will play an integral role in spreading word around mobile clinics in hot spots – and building trust.

“Local community health centres know the population they serve,” Karpoche says. “They have existing relationships with other community organizations that serve very specific groups. So, for example, we have settlement organizations in Parkdale because we have many racialized newcomer immigrant populations. And that partnership, that trust and that history, is there between the organizations. And so we are able to then partner together to try and address a very specific issue in terms of ensuring there is access to these particular groups that face all of these different barriers.

“But again, nothing can be done without the proper resources. And that’s where the province really needs to step in. You cannot leave out local health centres who have the knowledge, who have the expertise and the trust from the community. You can’t leave them hanging dry.”

Listen to the full conversation on the latest episode of the NOW What podcast, available on Apple Podcasts or Spotify or playable directly below :

NOW What is a twice-weekly podcast that explores the ways Torontonians are coping with life in the time of coronavirus. New episodes are available Tuesdays and Fridays.

@normwilner

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