As Alberta’s COVID-19 vaccine campaign reached a milestone Friday, breaking a record for the number of doses given in a single day, some of the province’s doctors say the most vulnerable of the population are being left behind.
New data has shown that, particularly in Calgary and Edmonton, areas with high COVID-19 infection rates have dramatically lower vaccination rates compared to the surrounding area — something experts say is because of vaccine inaccessibility rather than vaccine hesitancy.
Dr. Gabriel Fabreau, physician at the Peter Lougheed Centre in Calgary and assistant professor at the University of Calgary, said he agrees with the way Alberta prioritized those at highest risk of severe outcomes early on.
However, with the introduction of COVID-19 variants, Fabreau said the barriers that put people at higher risk contracting COVID-19 — working shift work, living in cramped or multi-generational housing, not having easy access to transit or technology, or being a newcomer — are the same barriers keeping them from getting their vaccine.
“Not knowing how to navigate… what I’ve been calling the vaccine Hunger Games, which is calling five pharmacies and booking online and then taking the first appointment that you can and then getting there within X-number (of hours),” he said.
“That’s not a thing when you are a single mother with three kids working three jobs. That doesn’t happen.”
Fabreau, who was part of the team that brought vaccines to meat-packing plants in Alberta, said that model is one that should be established across the province: flexible, barrier-free, walk-in vaccination options to reach those who can’t navigate the current one-size-fits-all immunization program.
He cited Ontario’s Peel Region, which vaccinated thousands of people who couldn’t wait in daytime line-ups at an overnight walk-in clinic on the weekend.
Febreau also said health officials need to work with the communities most affected by vaccine inaccessibility to ensure clinics are opening where residents can easily get to them.
“The best way to get over vaccine hesitancy is to show up and show people you care about them and build trust,” he said. “And so the best way to do that is listen to people.”
He said of the 24 unvaccinated patients he saw with COVID-19 during his shift on Sunday, “not a single one of them didn’t want to get the vaccine,” but logistics had gotten in their way.
Vaccinations in emergency rooms
Another option being advocated for in Alberta is equipping emergency rooms to be able to administer vaccines to marginalized people who come through their doors.
Dr. Chuck Wurster, an emergency room physician at the Strathcona Regional Hospital in Sherwood Park, said in the last few weeks, he’s seen many patients who haven’t been immunized against COVID-19 because of “perceived or real barriers” to getting their shot.
“The centralized system that we have for vaccinations right now would probably not capture them,” Wurster said.
“There’s a lot of people that I’ve seen that, if we had access to vaccine, I could have vaccinated them. And I fear that they may not get vaccinated any other way.”
Wurster is part of a working group advocating for vaccines to be administered in the province’s emergency departments, as many of the patients winding up there are ones who have “fallen through the cracks” for a variety of reasons like lower incomes, language barriers, or lack of access to adequate transportation or technology.
The group is looking at the logistics of how those shots would be administered, and working out details of avoiding wasting any doses. In consultation with Alberta Health Services, the group is currently looking for hospitals to trial immunizing ER patients.
Wurster has been actively tweeting about how much of a “game-changer” bringing vaccines to emergency departments would be in reaching more of the population.
He said the current make an appointment, go to your appointment model isn’t possible or easy for everyone.
“That’s not necessarily the way that you can vaccinate the population because one size doesn’t fit all our numbers right now,” he said.
“I think that our trend for our vaccine numbers, now that we’ve caught up to the United States, will probably start to plateau out because there are lots of people that don’t have the privilege of being able to vaccinate themselves by going to an appointment and taking time out of their busy day or knowing how to use a computer.”
Farbeau also said flexible vaccination sites at high-risk workplaces would also help to close the vaccination gap in Alberta, and pointed to the fact that the meat-plant clinics had more than 80 per cent vaccination uptake among a population that was 85 to 90 per cent racialized workers with multiple barriers to conventional immunization.
Alberta Health said it was “developing a strategy to help specific groups and areas access the vaccine,” now that anyone over 12 in the province is eligible for a shot.
“This may include using temporary clinics and other tools to target areas where there is currently low coverage and where people may have challenges accessing currently available options,” McMillan said.
“We have already used temporary clinics to vaccinate individuals at shelters, meat-packing plants and work camps.”
The doctors aren’t the first to call for pop-up vaccination clinics in Alberta. Earlier this week, several Calgary politicians called on the province to set up immunization sites after a new interactive map from the province showed discrepancies in vaccine uptake in the east and northeast parts of the city.
Newcomers and those dealing with homelessness are also welcome to book appointments at Calgary’s ever-growing Indigenous vaccination clinic, which is now offering shots to a wider portion of the population.
Alberta Health said it understands the “racial, ethnic and socio-economic barriers that can impact some Albertans’ likelihood of exposure to COVID-19, experience of disease, and ability to access health services, including testing and treatment for COVID-19.”
“There are many different factors that can contribute to the current vaccination percentage in any given community,” McMillan said.
“This includes the proportion of the population that was eligible in Phase 1 and 2 of the province’s vaccine rollout, vaccine hesitancy, and other barriers impacting people’s ability to access the vaccine.”
So far, the priority has been bringing vaccine doses to as many Albertans as possible through pharmacies and some doctors’ offices, McMillan said, as well as translating materials to 13 languages and launching a provincial ad campaign aimed at curbing vaccine hesitancy.