COVID-19 Vaccine Uptake in Southeastern Ontario, Canada: Monitoring and Addressing Health Inequities

Abstract

Context: Implementation of a population-based COVID-19 vaccine strategy, with a tailored approach to reduce inequities in 2-dose coverage, by a mid-sized local public health agency in southeastern Ontario, Canada. Program: Coverage maps and crude and age-standardized coverage rates by material and social deprivation, urban/rural status, and sex were calculated biweekly and reviewed by local public health planners. In collaboration with community partners, the results guided targeted strategies to enhance uptake for marginalized populations. Evaluation: The largest gaps in vaccine coverage were for those living in more materially deprived areas and rural residents—coverage was lower by 10.9% (95% confidence interval: −11.8 to −10.0) and 9.3% (95% confidence interval: −10.4 to −8.1) for these groups compared with living in less deprived areas and urban residents, respectively. The gaps for all health equity indicators decreased statistically significantly over time. Targeted strategies included expanding clinic operating hours and availability of walk-in appointments, mobile clinics targeted to marginalized populations, leveraging primary care partners to provide pop-up clinics in rural and materially and socially deprived areas, and collaborating with multiple partners to coordinate communication efforts, especially in rural areas. Discussion: The scale and scope of monitoring and improving local vaccine uptake are unprecedented. Regular review of health equity indicators provided critical situational awareness for decision makers, allowing partners to align and tailor strategies locally and in collaboration with one another. Health care providers and pharmacies/pharmacists are key partners who require innovative support to increase uptake in marginalized groups. Continued engagement of other community partners such as schools, municipalities, and local service groups is also crucial. A “hyper local” approach is needed along with commitment from partners in all sectors and at all levels to reduce barriers to vaccination that lie further upstream for marginalized groups.

Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study

“…Some unvaccinated PWUD additionally reported feeling that they were healthy enough to withstand the virus without the vaccine, which can be contributed to a lack of education or knowledge about the effectiveness of the vaccine and the risks of contracting the virus. Research among other populations that face marginalization such as racialized and Indigenous peoples [ 44 , 45 ], individuals from low-income households [ 46 ], those living in rural areas [ 47 ], and those experiencing housing insecurity [ 48 ] further corroborate our results. This data suggests that distrust of governments and public health agencies and knowledge barriers can contribute to disparities in vaccine uptake.…”

Accessibility of Ontario pharmacies offering COVID-19 vaccination by rurality, community material deprivation, and ethnic concentration : A repeated cross-sectional geospatial analysis

“…This may partially explain the lower vaccination coverage in these areas. (14,43,44) While vaccine hesitancy may be more prevalent in rural areas,(45) our results showed that the impact of geographically accessible vaccination services cannot be underestimated. Adequate and universal distribution of vaccination-offering pharmacies is essential to ensure that vaccination campaigns can successfully reach all residents including rural dwelling individuals.…”

Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience

“…Marginalized communities in Ontario are more likely to be severely affected by COVID-19 and are less likely to be fully vaccinated against COVID-19. 27 By August 2021, 72% of Canadians had a single COVID-19 vaccine dose while 61% had received both vaccine doses. 28 COVID-19 vaccination protects against poor disease outcomes, hospitalization, the risk of requiring critical care admission.…”