A few weeks ago Bardha Oka was, as usual, worried about her residents.
Oka is the property manager at Central King Seniors Residence in Weston. It’s not a retirement home, but more than three-quarters of its 147 residents are 80 or older, so most were eligible to be vaccinated in Phase One of the province’s COVID-19 vaccine rollout.
Few had gotten the shot, however, for a number of reasons.
Most of them don’t use the internet and aren’t able to book an appointment on their own. Many have significant mobility issues and none of the vaccination sites are nearby. Some can’t afford transportation. Others worry about waiting in long lines.
“They have been left behind,” Oka says. “Not intentionally,” she adds. “But still.”
Oka was worried because Weston is among the hardest-hit parts of the city in terms of COVID-19 infections, and given the age of her residents, they were at particularly high risk.
She knew the most effective way to get her residents vaccinated was if the vaccine came to them. So she sent requests to every level of government, making her case in detailed emails.
Eventually she heard back from her MPP, Faisal Hassan, who, in collaboration with Humber River Hospital, arranged for a pop-up clinic at the building last week.
“It was beautiful,” Oka said. One hundred and fourteen residents were vaccinated in just three hours. (Four residents declined the vaccine, while 29 had already been vaccinated.)
“I can’t stress it enough how important it was for it to come to us,” Oka said. “If you want them to have the vaccine, this is the way to do it.”
Public health officials should be trying to replicate that success in as many places as possible, experts say, particularly in light of recent statistics showing that neighbourhoods facing the highest risk for COVID-19 had the lowest vaccination rates.
Data released Thursday in a presentation by the province’s COVID-19 Science Advisory Table showed that of those 80 and older, only 50 per cent had been vaccinated in the neighbourhoods with the highest rates of COVID-19, compared to 70 per cent in neighbourhoods with the lowest rates of infection. “That’s a disastrous gap,” said Dr. Nathan Stall, a geriatrician and epidemiologist at Sinai Health in Toronto.
Meanwhile, calls are growing for a more targeted approach to the province’s vaccination strategy, such as reallocating doses to the hardest-hit communities and focusing more directly on those most at risk, including essential workers.
Last month the province updated its vaccine distribution plan to focus on both age and neighbourhood risk, and some hospitals have started vaccinating people as young as 50 from certain postal codes.
But health experts say more needs to be done to address disparities in vaccination rates and remove barriers for those who are most vulnerable.
“Equity is being left behind,” Stall said, adding that he believes officials knew what the “equity blind spots” were going to be and have made some efforts to address them in the official vaccine strategy. “But we’re still seeing all these barriers to vaccination that have unfortunately yielded these results.”
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Last week Stall co-authored a brief for the science advisory table recommending mobile, in-home vaccination for homebound seniors, of which there are more than 75,000 in Ontario.
The majority of homebound people live in the highest-risk neighbourhoods, Stall said.
The brief highlights the fact that as of last week, more than a quarter of all Ontarians 75 and older had neither received their first vaccine dose nor booked an appointment.
“I think it’s reasonable what the province is doing to continue lowering the age because having empty chairs is also disastrous, but we have to make sure that we circle back to these people we’ve overlooked.”
The science table also recently produced a study on “Naturally Occurring Retirement Communities,” which are residential buildings — like Oka’s — where at least 30 per cent of residents are 65 or older. There are nearly 500 such buildings in Toronto and more than half are in high-risk neighbourhoods.
Targeting these buildings with pop-up clinics would be both “an efficient and equitable approach” to protecting those at highest risk for COVID-19, the authors wrote.
Dr. Naheed Dosani, a health justice activist and professor at the University of Toronto, said that while equity is supposed to be a guiding principle for the province’s vaccine rollout, it hasn’t played out in reality.
He cited the decision to rely “heavily” on pharmacies, rather than family doctors, to administer vaccines; the lack of paid time off to be vaccinated; and what he deemed insufficient vaccine supply for the hardest-hit communities.
“At this stage of the pandemic and the ways that COVID-19 variants are affecting low-income, racialized people and essential workers, it’s crucial that there is a plan to reallocate vaccine supply to hot spots so that we’re supplying the vaccine based on need,” he said in an interview.
In a written response to questions for this story, a spokesperson for Ontario’s Ministry of Health didn’t directly answer a question about whether the province was considering reallocating vaccine doses to address the disparity in vaccination rates between higher- and lower-risk communities.
“The province aims to achieve a balanced and equitable distribution of vaccines to health units,” the spokesperson wrote. “ … As we continue to receive supply from the federal government, public health units will receive additional vaccine doses (up to 920,000) as part of Phase Two to target historic and ongoing hot spots with high rates of death, hospitalization and transmission.”
The spokesperson said individual public health units have been “directed” to work with community partners to remove barriers to accessing the vaccine and improve uptake in hard-hit communities, including via mobile and community clinics.
Hassan, the New Democrat MPP for York South-Weston, said his community and others like it have been “neglected” throughout the pandemic. Before last week’s announcement by the province that it was expanding the number of pharmacies offering the vaccine, Hassan had described his riding as a “vaccine desert” for the lack of local pharmacies with a supply of vaccines.
He said there isn’t a single permanent vaccination site in the area, just as there wasn’t a permanent COVID-19 testing site for the first six months of the pandemic.
The riding is home to many low-income, front-line workers, he said, and it was declared a high-risk area early in the pandemic. “Still, when they’re making decisions this is what is happening to our community. This needs to be fixed.”
Brendan Kennedy is a Toronto-based social justice reporter for the Star. Follow him on Twitter: @BKennedyStar
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