“When the first and second doses became available, Ontario – and Canada in general – were jealous of how quickly the population was vaccinated,” said Dr. Fahad Razak, physician and member of the scientific advisory board of the province. However, while 91 percent of Ontario residents 12 years of age and older have received two doses of COVID-19 vaccine, only about 60 percent have received three. “A lot of the energy and innovation used to take the first and second doses, we could not reproduce this magic to the same degree for the third dose,” Razak said. “We need to make sure that the messages about moving to a period of less public health measures do not mean that the risk to an individual or the risk to humans has diminished over time if they continue to become infected.” Two doses are effective in preventing serious illness, but three doses can reduce the risk of infection even against the Omicron variant and are still important, Razak said. Infection means that people can not work, children can not go to school and carries the risk of prolonged complications known as long COVID. Infectious disease specialist Dr. Isaac Bogoch said Ontario is probably in better shape than the huge percentage of amplifiers would suggest. Two doses plus infection provide about the same protection as three doses, Bogoch said, and millions of Ontarians have been infected since the Omicron variant appeared late last year. However, there is still much room for improvement in memory coverage, especially among vulnerable people, and Ontario has not used enough behavior change experts to figure out how to communicate vaccination messages, Bogoch said. “When we stop and see 30,000 feet of what we are trying to do here, what we are trying to do is change people’s behavior,” he said. It is not enough to have, you know, me – a boring, middle-aged doctor – to go on TV and say ‘Get your vaccine’, or a senior politician or public health official to give a press conference and change policy at 3 at noon every day “. Another strategy that could help vaccinate more people is to make better use of family medicine, Razak said. “I think one of the most underused resources in the whole pandemic was family doctors,” he said. Making more of the vaccine strategy would help Ontario deliver any additional doses because there is no need to strengthen an external infrastructure, Razak said. “Of course, if there are time pressures … you can use this mass vaccination strategy. But every year and every time it should not be a mass vaccination strategy. It should be closer to the flu.” It is not yet known if additional booster doses come in each year, such as the flu vaccine, or if needed in a different schedule, but experts say more doses may be available. Regardless, the planning has to be done now, Bogoch said. “We can be proactive and have a plan so that we do not try to make flu vaccines in consultation with … COVID vaccines,” he said. “Even if we telegraph that we plan to do it, we just do not know what the policy will be. There are many efforts that can be made in advance to prepare for a possible vaccine release.” Dr. Paul Roumeliotis, a physician in charge of the Eastern Ontario Health Unit, said he was developing emergency plans to redeploy staff to mass vaccination clinics each time the fourth installments became more widely available. The National Advisory Committee on Immunization is expected to issue guidelines for the fourth installments in early April. Many public health units are closing their massive clinics in favor of emerging clinics and supra-local strategies. Toronto operates limited-time clinics at transit stations and libraries. As for the children aged five to 11, however, Roumeliotis said that the issue is not a matter of location, but parental fears. “It has nothing to do with accessibility because they can enter virtually any clinic at any time and be vaccinated,” said the doctor, who is also president of the Association of Local Public Institutions. About 56 percent of children in this age group have at least one dose and 33 percent have two. Roumeliotis’s health unit is trying to educate parents and answer any questions they may have through town halls, seminars with schools, social media updates and a video campaign, he said. Ontario will also receive its first shipment next week of Novavax, a more traditional, mRNA-free vaccine used by Pfizer and Moderna. Experts said it was unlikely to have a major effect on vaccination rates, as anyone who has not yet been vaccinated at this point is likely to remain so. A single-dose, mRNA-free vaccine from Johnson and Johnson has been available in Ontario since early December on request, and 3,134 doses of J&J have been available in the province since March 31. Ontario Chief Medical Officer Dr. Kieran Moore said earlier this year that he was excited about the arrival of Novavax and hoped it would reach people who do not want an mRNA vaccine. Moore finished his weekly updates last month and turned down several requests within three weeks from the Canadian press for an interview on the province’s future vaccination strategy. A spokeswoman for Health Minister Christine Eliot sent a statement about what the county has already done about the vaccine, including communications, a mobile vaccine clinic, school clinics and extending vaccine clinic opening hours to help approach communities with lower rates. This Canadian Press report was first published on April 3, 2022.
