What’s behind Ontario’s abrupt shift to immunizing everyone in COVID-19 hotspots

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What’s behind Ontario’s abrupt shift to immunizing everyone in COVID-19 hotspots


Premier Doug Ford’s government has frequently tweaked its COVID-19 strategies, but none of the changes have seemed as abrupt as this week’s announcement that everyone in Ontario’s worst-affected neighborhoods aged 18 years and over can be vaccinated.
The province had previously reported that there would be a supplemental vaccination campaign directed to the places most affected by the pandemic. But all of the documentation released by the Department of Health up to this week showed those efforts would focus on older age groups.

On Tuesday morning, senior government officials in charge of immunization deployment gave a detailed briefing on the April-June schedule. He declared the start of targeted vaccinations in hotspots, but only for people aged 50 and over.

Just 24 hours later, Ford announced that all adults in these hot spots would be eligible to get the vaccine immediately.

“As we speak, mobile immunization teams are organizing to get vaccines to where they will have the most impact,” Ford said Wednesday at his press conference announcing the new stay-at-home order. Ontario.

The implication in Ford’s words “as we speak” was that the move had come about at lightning speed – which is not typical of the provincial government apparatus.

So what really happened?

Neighborhoods in and around Toronto that had the highest proportion of racialized workers throughout the pandemic bore a disproportionate burden of COVID-19. Yet Ontario’s vaccination campaign failed to reach those same neighborhoods. The change in strategy notably came just days after a change in leadership within the province’s vaccine working group.

Orlando Mosca, 71, receives his first dose of Moderna COVID-19 vaccine at St. Fidelis Parish Church in Toronto on April 7. Nurses from Humber River Hospital run clinics in the church as part of a community immunization program. the elderly to their place of worship. (Evan Mitsui / CBC)

Always planned

The province’s own COVID-19 scientific advisory table has called for weeks for a concerted vaccination campaign in the worst-affected areas. Such a campaign “would directly address the inequitable impact of COVID-19 on disadvantaged populations in Ontario,” said a presentation released by the Science Table in February.

The province had always planned to pour more vaccines into high-risk areas, said Dr Isaac Bogoch, infectious disease specialist, member of the provincial immunization task force and one of the co-authors of this briefing. the Scientific Table.

That still leaves a question open to the Ford government: if a full-fledged press in the worst-hit neighborhoods was still the plan, why was it missing from Tuesday’s detailed immunization schedule, but suddenly present at the press conference in Ford Wednesday?

“Variants and COVID are evolving at record speed and we need to be nimble to adapt and respond to them,” Health Minister Christine Elliott said on Friday.

“That’s why you sometimes see these changes in the plans that we just have to make because of the way COVID is evolving. “

WATCH | Who can get the COVID-19 vaccine in designated high-risk areas of Ontario:

Ontario’s COVID-19 vaccination plan is evolving rapidly, and many people struggle with who is eligible – and where they can get vaccinated. Angelina King has the latest update on Phase 2 of the province’s immunization plan. 14h30

Change of direction

Ontario paid retired General Rick Hillier $ 20,000 per month to lead the vaccine distribution task force. He left his post at the end of March.

One of the last efforts of Hillier’s tenure was the rollout of vaccines to over 300 pharmacies in Toronto, Kingston and Windsor. It turned out that vaccines weren’t allocated to pharmacies in most northwest and northeast parts of Toronto, the neighborhoods most affected by COVID-19.

Retired General Rick Hillier completed his term as chair of the Ontario COVID-19 Vaccine Distribution Task Force at the end of March. (Frank Gunn / The Canadian Press)

For weeks after Hillier’s planned departure was made public, senior government officials said he would not be replaced. Officials said Hillier had accomplished the mission of setting up vaccine distribution channels, the system was working well, and the two deputy ministers of the immunization task force would take care of things from now on.

The government then quietly reversed course and appointed a replacement for Hillier. Contrary to the fanfare surrounding Hillier’s arrival last fall, or his departure, the government has not even issued a press release on the new chairman of the vaccine distribution task force.

This is Dr. Homer Tien, CEO of the province’s air ambulance service, Ornge. Tien has a long history as a trauma surgeon and a three-decade career as a medical officer in the Canadian Armed Forces, reaching the rank of colonel, with a role of chief of military medical and surgical specialties.

Dr Homer Tien, CEO of the Ornge Province Air Ambulance Service and a senior trauma surgeon, was named the Ontario COVID-19 Vaccination Task Force Leader earlier this month, replacing the General retired Rick Hillier. (Submitted by Ornge)

He went on to become Medical Director of the Tory Regional Trauma Center at Sunnybrook Health Sciences Center in Toronto, then Chief Medical Officer of Ornge before becoming its CEO in 2019.

Dr Peter Jüni, head of the COVID-19 scientific advisory table, gives Tien significant credit for moving all adults to vaccination in the most affected communities.

“The first conversation the two of us had was directly related to this,” Jüni said in an interview on Thursday. ” He [Tien] wanted to know more about our strategy that we defined in February and whether it would indeed be wise to strengthen this strategy. ”

The Science Table performed further analysis of data showing that a concerted effort to vaccinate all adults in high-risk neighborhoods would result in “a dramatic increase in control of the pandemic,” Jüni said.

“Tuesday afternoon, we had the scientific table where we presented the results of our analysis. Dr Tien was at this meeting and the results were very convincing. “

CBC requested an interview with Tien, but it was turned down by a spokesperson for Solicitor General Sylvia Jones, whose department is responsible for the vaccine task force.

Public health caught off guard

The decision to put more emphasis on vaccinations in places most affected by COVID-19 enjoys broad support from experts.

“You should really pour your water where the fire burns the most to help quell the pandemic,” Bogoch said in an interview this week with CBC News. He said the change was made possible by the recent increase in vaccine supplies.

The move came as startling data revealed much lower vaccination rates in neighborhoods most affected by COVID-19 compared to richer areas where the virus has had little impact.

Sources from the provincial Department of Health and local public health units told CBC News that all adults in hotspots would be eligible for vaccinations caught them off guard.

Vaccination plans for young adults in the worst-affected areas were not in any official Health Ministry document released until Wednesday.

This COVID-19 vaccination clinic at Downsview Arena is operated by Humber River Hospital in conjunction with the City of Toronto. (Paul Smith / CBC)

For adults living in communities in COVID-19 hotspots, “vaccination should start with the oldest people and decrease in age until they reach 50,” says the province’s guidance document on priority populations for the current phase of the vaccination campaign, dated March 23. .

The 22-page vaccination plan given to journalists on Tuesday does not mention the vaccination of all adults regardless of their age in hard-hit neighborhoods.

“Adults aged 50 and over in 13 BSP“ hotspot ”communities [public health units] are prioritized under Phase 2 of Ontario’s vaccine distribution plan, ”the document read.

All of this might suggest that the change in focus and the change in leadership of the Vaccine Working Group is no coincidence.

Ontario has administered more than 100,000 doses of the vaccine per day for three consecutive days this week. More than 2.6 million people have received at least one vaccine, or about 22% of the province’s adult population. (Nathan Denette / The Canadian Press)

113 high-risk postal codes

People aged 50 and over in all areas designated as high risk – 113 postcode areas stretching from Windsor to Ottawa – can now make appointments for vaccination through the booking portal of the Ontario.

It is not yet clear how people under the age of 50 will be able to register for vaccinations in the hardest-hit areas. A post on Ontario’s COVID-19 Vaccination webpage reads: “If you are between the ages of 18 and 49 and live in a designated hot spot, find your public health unit and check their website to get details about immunization in your area.

It is also unclear when the vaccination campaign will extend to all young adults in all designated areas. For now, the vaccination campaign for people under 50 is starting in Toronto and Peel, due to high transmission rates.

Mobile teams and pop-up clinics will be established to administer vaccines to people aged 18 and over in high-risk areas of Toronto and Peel, as supply permits, the government said in a statement. .

The government’s plan allocates 920,000 additional doses of vaccine to the most affected areas. It is far from certain that this is sufficient to cover most of the adult population in the target areas.

CBC News asked the Department of Health on Friday for an estimate of the adult population in the 113 designated zip codes, but officials said they could not provide a response until Monday.

However, using data from the 2016 census, the CBC calculated that more than 4.2 million Ontarians live in the regions. While about 80% are adults, vaccinating 75% of the adult population with a single dose would require about 2.5 million doses.

Ontario has administered more than 100,000 doses of the vaccine per day for three consecutive days this week. More than 2.6 million people have received at least one vaccine, or about 22% of the province’s adult population.

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