Canada’s COVID-19 vaccine coverage flatlining as fall nears: ‘The stakes are high’

As fall approaches, experts are urging Canadian governments to create new COVID-19 vaccine campaigns to try to boost the country’s stagnant inoculation rate to avoid overwhelming an already strained health-care system.

About 82 per cent of the entire population is fully vaccinated, with roughly half receiving a third dose and just 11 per cent getting a fourth shot, the latest federal data reported on July 17 shows. Aside from fourth doses, which became available this summer, vaccination coverage hasn’t moved significantly in months.

After enjoying a largely restriction-free summer, Canadians are heading into the fall, when health officials worry COVID-19 will circulate with other respiratory infections like influenza. Therefore, it’s important governments get their vaccination messaging right to help ease pressure on a health-care system plagued by staff shortages and emergency room closures, experts say.

“Every year, even before COVID, we’ve experienced surges of patients coming into hospitals getting sick, a lot of them driven by respiratory viruses that tend to crop up in the fall and in the winter months,” said Dr. Susy Hota, an infectious diseases specialist with the University Health Network in Toronto.

“The stakes are high because we’ve got fewer public health measures in place, and we’ve got all kinds of respiratory viruses likely to circulate this fall because of that.”

As COVID-19 immunity — be it from vaccination or infection — wanes over time, some provinces, like Quebec, are preparing to launch new campaigns to try and boost coverage.

According to Ottawa’s July 17 data, only 52 per cent of Quebecers had received a third vaccine dose, and roughly 15 per cent had received a fourth. As of Aug. 16, anyone 75 years and older can book an appointment under its fall plan. Eligibility opens to anyone 18 or older starting Aug. 29.

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Government officials have said low booster uptake is due to the fact that millions of Quebecers have caught COVID-19 and consider themselves adequately protected. Meanwhile, health experts also point to pandemic fatigue and government communication playing a role in booster coverage.

In Saskatchewan, where third-dose coverage was 42 per cent and fourth-dose coverage was 11 per cent as of Ottawa’s July 17 data, the government plans to continue to run a general vaccination campaign as a broad portion of the population needs to get up to date with their shots, a government spokesperson told Global News in an email.

In addition to targeted campaigns for vulnerable populations, Saskatchewan’s marketing to date has featured a range of spokespeople from medical health officers and surgeons, parents, influencers and community leaders to reach various demographics, the spokesperson added.

“COVID-19 transmission continues in the province of Saskatchewan and we anticipate increasing cases as people return to workspaces and children return to classrooms this fall,” they said.

“Booster doses can prevent the most severe COVID-19 outcomes and help preserve health-care system capacity this fall and winter.”

Manitoba did not indicate any specific plans for a fall booster campaign when asked by Global News. But a spokesperson from the province said in an email that as of Aug. 17 in Manitoba, third-dose uptake for eligible residents 12 years of age and older is 51.6 per cent and 13.3 per cent for fourth doses. Manitobans have many options to access vaccines, including through their primary care provider, local pharmacy and regional public health clinics, they added.

Global News reached out to all the provinces and territories about their fall vaccine campaigns heading into the fall but did not hear back from the rest by deadline.

Low booster uptake to date has a lot to with pandemic “exhaustion,” said Jason Harley, an associate professor in the department of surgery at McGill University, who added they believe many people have shifted to a “post-COVID mentality” that leads them to ignore public health advice.

The challenge as the fall nears is to convince people to protect themselves and listen to guidelines, which requires connecting to people through clear, easy-to-follow public health messaging, Harley told The Canadian Press recently.

Canada’s National Advisory Committee on Immunization (NACI) has advised Canadians to get a booster shot, regardless of the number of booster doses previously received, in the fall — a time when an increase in cases is possible as people begin to spend more time indoors, where COVID-19 can spread more easily than outdoors.

COVID-19 booster shots can be offered six months after a previous vaccine dose or infection. A shorter interval of at least three months may be warranted depending on a number of factors, including heightened epidemiologic risk, NACI said in its June 29 interim guidance report on planning considerations for a fall booster program.

The appetite to get a COVID-19 booster for the majority of Canadians is there, an Ipsos poll conducted exclusively for Global News last month found, but the urgency to do so isn’t.

Booster uptake is high in older age groups — such as those 70 years and older — but drops off in younger age groups, federal data shows. Third-shot uptake was high at the beginning of the year when Omicron emerged, but flatlined as the spring set in.

It’s unclear what immunity levels are like in Canada right now, but what the data suggests is there could be a lot of people who are vulnerable coming into the fall, Hota said.

“It is reassuring that at least in the upper age bracket, we tend to be doing better with the additional doses … but it doesn’t eliminate the risk from the others as well (as) there are still younger and healthier people who’ve had severe illness,” she added.

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While vulnerable populations have been prioritized, public trust is critical in getting high booster uptake, said Dr. Matthew Miller, an associate professor of biochemistry and biomedical sciences at McMaster University.

Governments need to be honest in what the current vaccines are capable of doing well, and that is preventing severe illness rather than outright COVID-19 infection, he added. By doing so, it would also help alleviate the burden on the health-care system with Canadians opting to stay up to date on their vaccines.

“Our health-care workers have been stretched to the limit going on close to three years now,” he said.

“That has knock-on effects for people who are awaiting other medical procedures, which in many cases have been delayed or there are huge wait-list backlogs because of cancellations throughout the pandemic that we’re required to maintain capacity to look after people with COVID.”

Governments will have another opportunity to highlight vaccine effectiveness if Health Canada approves Pfizer and Moderna’s bivalent vaccines targeting the original COVID-19 variant and the Omicron BA.1 sublineage, Miller said. Those vaccines are still under review, a Health Canada spokesperson told Global News earlier this week.

While experts have urged Canadians to get the first COVID-19 vaccine available to them, having an updated shot available may increase intake overall, he added.

“The hope is that in addition to continuing to provide really good protection against severe disease, these updated vaccines will hopefully be more effective in preventing infection and reducing transmission as well, something that the current vaccines have struggled more with as the virus has evolved,” Miller said.

It’s also time for the terms “third and fourth dose” to be dropped, Hota said.

“People are getting tired of hearing the numbers of doses that we need,” she said, adding the counting of COVID-19 waves should also stop as it can be “overwhelming.”

“We need to get away from those numbers and think about how long has it been since you’ve had your last dose as we move forward in this pandemic because it will be important to keep on top of what the data is telling us, (which) is going to protect you from severe illness.”

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At the end of the day, it’s important to remember COVID-19 vaccination is not just about immunity, but about protection, Hota added.

“We want to make sure people are protected as best as possible from severe illness, from COVID-19,” she said.

“That’s maybe the way that we need to word it.”

— with files from The Canadian Press