As public health units across Ontario ramp up efforts to fully vaccinate all eligible residents against COVID-19, many regions have a long way to go to meet provincial thresholds for exiting Step 3 and returning to some semblance of normal life.
All public health units have vaccinated over 50 per cent of their populations 12 years old and over, according to the Ministry of Health’s most recent figures. But while the overall provincial average is nearing 64 per cent for the eligible populations who have been fully vaccinated, several of the province’s 34 health units are substantially below that.
“It is absolutely concerning,” said Ashleigh Tuite, an infectious disease epidemiologist, at the Dalla Lana School of Public Health, noting the province-wide numbers mask some of the variability between regions, and even neighbourhoods with lower rates.
These “pockets” of unvaccinated people are where the virus, especially the contagious Delta variant, can get a foothold.
“It’s going to find these unvaccinated people,” she said, even in regions with higher vaccine rates but where children under 12 are not vaccinated.
Ontario entered Step 3 of the government’s “Roadmap to Reopen” on July 16, allowing indoor dining, movie theatres and gyms to welcome back patrons — with capacity limits — for the first time in months. Business owners are relieved to open their doors again, but getting out of this stage might not be so easy.
To further relax public health restrictions, stringent requirements will have to be met: Ontario will have to stay in Step 3 for at least 21 days during which time 80 per cent of residents aged 12 and over will have to have received at least one dose of the vaccine; 75 per cent of those 12 and older will have to be fully vaccinated; and all public health units must have at least 70 per cent of their eligible populations fully vaccinated.
As well, other key public health indicators, such as hospitalizations and ICU capacity, must remain stable.
But according to the latest provincial data, only health unit, Leeds, Grenville and Lanark, has reached the crucial threshold of 70 per cent of over-12s fully vaccinated. The vast majority are still in the 60s.
But even then, the 70-per-cent threshold may no longer be enough to keep the virus at bay given the growth of the more transmissible Delta variant, said Colin Furness, an infection control epidemiologist at the University of Toronto.
Noting that the reopening road map is now months old — and drafted before Delta gained such a foothold — he said Ontario should consider moving the goalposts to reflect knowledge about the variant gleaned from recent experiences in the U.K. and U.S. Both countries have seen recent Delta-driven spikes in infections. Last week, Britain recorded more than 50,000 daily cases for the first time in six months, while in the U.S., officials say the variant is the cause of more than 80 per cent of new cases.
This is “abundantly clear” where low vaccine coverage in states such as Alabama, Mississippi, and Louisiana have fuelled outbreaks in clusters of unvaccinated people, Tuite noted.
“The proportion that you need vaccinated to reach herd immunity depends on two things: it depends on how contagious the disease is, and how effective the vaccine is,” said Furness. “The vaccines are great and their ability to provide protection is only slightly diminished by the variant, but the transmissibility is way higher now.”
Dr. Paul Roumeliotis, medical officer of health for the Eastern Ontario Health Unit, where 59 per cent of the population over 12 has been fully vaccinated, according to the Ministry of Health, said what the world is experiencing now is “a pandemic of the unvaccinated.”
“The more vaccinated we have the less we will have a chance of getting a resurgence and a fourth wave with Delta,” he said.
As of press time, the highest double-vaccination rates for people 12 and over in Ontario are in Leeds, Grenville and Lanark, with 71 per cent; Thunder Bay with 69 per cent; and Grey Bruce with 68. The lowest are Southwestern, with 56 per cent, Simcoe Muskoka with 58 per cent, while the Eastern Ontario Health Unit and Hastings Prince Edward are tied with 59 per cent.
When providing this data to the Star, the ministry noted that there may be slight discrepancies between the provincial and local health unit numbers, due to the date the data was pulled, as well as the way it’s coded and categorized.
“There are a lot of things that we’re trying to do to increase” vaccination numbers, Roumeliotis told reporters at a recent press conference, including contacting residents to move up August appointments, and talking to St. Lawrence College about on-site clinics.
Jaime Fletcher, program manager of the COVID-19 immunization task force for Southwestern Public Health, which covers rural areas and towns outside of London, said that as a smaller health unit, Southwestern was “later starting than some of the bigger metropolises.” It took the unit some time to procure an ultralow freezer for storing vaccines early in the rollout, for example.
But Fletcher said staff are “thrilled” with the turnout at recent clinics, and believe the momentum is going in the right direction, with big improvements in vaccination rates for youth week over week.
They unit is now shifting towards a less formal, more targeted approach to reach communities where the rates are lower, especially rural areas. This includes mobile clinics, and early discussions about workplace and post-secondary on-site vaccinations.
The health unit also encompasses one of the neighbourhoods with the lowest vaccination rates in the province, according to data from non-profit research group ICES, formerly known as the Institute for Clinical Evaluative Sciences.
In the N5H postal code, home to the town of Aylmer, where a controversial pastor has been preaching against COVID lockdowns and masks, only about 27 per cent of the total population has been fully vaccinated. Fletcher said the health unit has had “several mobile clinics” in the area, which was declared a hot spot by the province for increased vaccines back in May, and has seen “great uptake.”
There are 93 postal codes across the province in which rates of fully vaccinated residents remain in the 30s. Ten are found in the Middlesex-London Health Unit, which has an overall rate of fully vaccinated residents over 12 years of age of 61 per cent, according to the province.
Maureen MacCormick, director of healthy living for the unit, said it is shifting to a more nimble approach, targeting areas where uptake is low, and where hesitancy, cultural and transportation barriers may be playing a role.
This includes neighbourhood pop-up clinics with translators on hand, and even music — one recent site featured a classical cellist in the waiting area — as well as “myth busting” misinformation through Instagram Live Q and As.
In August, Middlesex-London is planning temporary vaccine sites at local events, and even on Richmond Row, a popular downtown stretch of bars and restaurants, where it is hoped 20- and 30-somethings might swing by for a shot.
While progress has been encouraging, MacCormick said it may be a “challenge” to boost the vaccination rate to 70 per cent in the next couple of weeks.
Dr. Charles Gardner, medical officer of health for the Simcoe Muskoka District Health Unit, acknowledged his region has one of the lowest rates of full vaccination, but pointed out that throughout the province’s immunization campaign, Simcoe Muskoka has received a below-average allocation of vaccine because of the region’s success in containing the virus.
“Typically, throughout the pandemic our rates of disease have been about half the rate of the province and about a quarter of the rate of the Greater Toronto Area health units, and we’ve only had one designated hot spot during the second wave,” Gardner told reporters during a briefing this week. “The volume of vaccine we’ve been receiving has been lower to allow those other health units to get vaccines.”
Simcoe Muskoka is a popular destination for vacations and cottagers, which has put increased pressure on the health unit to meet vaccine demands from non-residents, Gardner noted. In fact, he said the region is a net provider of vaccines for people from out of district, particularly in areas that border larger municipalities, such as Bradford West Gwillimbury. To ensure locals still have opportunities to book vaccinations, Gardner said the health unit has set up its own booking system exclusive to Simcoe Muskoka residents.
The health unit has also conducted local pop-up clinics to increase vaccination in communities that are lagging, and plans to launch a campaign next week to target those who may have difficulty accessing vaccinations or who are hesitant. In particular, the region is focusing on increasing turnout for young people 12 to 17 and has recruited youth social media ambassadors to encourage other teenagers to get vaccinated.
Gardner noted that rates are lagging in men up to 39 years old. “We really need them to be covered for their own protection, the creation of safe school environments and secondary education environments and work environments going into the fall,” he said.
For Furness, a safer measure by which to gauge when we can reopen more goes beyond “eligible population.”
“COVID doesn’t care who’s eligible,” he said. “If we’re actually looking at what is the threshold for us to be safe, we can’t use the eligible population benchmark.”
He said another milestone should be the vaccination of children under 12, provided results from ongoing studies on safety, effectiveness and dosage come through in the fall, as expected.
“We can’t ignore children. We just can’t.”
