Hardest-hit areas have lowest rates of fourth dose

Uptake in hot spots in Toronto, Peel trails neighbourhoods with higher income, data shows

The challenges associated with access to and trust of the COVID-19 vaccine in the GTA’s most vulnerable communities are playing out once again, with the Toronto neighbourhoods hardest hit by the virus over the past two-and-a-half years seeing among the lowest fourth-dose uptake rates in Ontario.

It’s been four months since Ontario opened fourth doses to those 60 and older and almost a month since fourth-dose eligibility was expanded to all adults, yet uptake remains stubbornly low in areas where many of our most vulnerable residents — immigrants, the working poor and essential workers — live, compared with areas with higher incomes and less racial diversity.

New postal code data from ICES, formerly the Institute for Clinical Evaluative Sciences, lays this trend bare with deemed hot spots in Peel and Toronto making up more than half of the 20 postal codes in the province with the lowest fourth-dose vaccination rates so far.

Postal codes in rural or less developed areas of Waterloo, Halton, Durham and York Regions are also among the areas with the lowest fourth-dose rates in the province.

“I think it’s a result of both confusion around messaging and structural inequities around access,” said Michelle Dagnino, executive director of the Jane/Finch Community and Family Centre.

“So what we’ve heard, anecdotally, is that a lot of people got COVID back in the spring, and there’s sort of a lack of clarity as to how long

that immunity lasts, if there’s any immunity, when should you be getting your fourth dose after having had COVID,” Dagnino said.

Challenges around access have manifested in a limited number of clinics and pharmacies offering fourth shots in vulnerable areas, as well as a cumbersome booking system, she noted, adding that the work done by the city of Toronto through the vaccine outreach ambassadors is “so important, because it really is about reaching out to people in the community and in a variety of languages. Because the impacts of getting COVID are just so disproportionate in northwest Toronto.”

To be sure, the ICES data shows that, as of July 31, the overall fourthdose uptake in the GTA across all age groups is not as high as third-, second- or first-dose uptake. Fourth-dose eligibility for all adults has only been open for a month, after all, and many people are away on summer vacation or experiencing COVID fatigue. According to Public Health Ontario, only 1.8 million Ontarians, representing 12.5 per cent of the province’s population, had received a fourth dose as of Aug. 1.

In opening fourth-dose eligibility in mid-July to anyone over age 18, Ontario chief medical officer of health Dr. Kieran Moore noted that most people with three doses are well-protected against the virus and that young people who have no underlying health conditions may wish to postpone another dose until the fall, when Omicron-specific

‘‘

We did a lot of work to get the first and second dose really high. After that, a lot have said, ‘Hey, I’ve done it. I’m not sure I want to go any further until more information comes out.’

vaccines could become available.

“It’s not a ‘should,’ it’s absolutely a ‘may,’ depending on your personal circumstances,” Moore said at the time. “Ontarians, if they have questions, may speak to their healthcare provider about whether getting a second booster dose is right for them.”

Angela Carter, executive director of the Roots Community Services in Brampton, noted that many of her constituents find messaging from officials around whether to take a fourth dose lacks consistency. “There’s no mandate to take it,” she said.

“How many people are really going to go and take it if they don’t see the need, and especially if they were hesitant to take it in the first place? If you look at Peel, you’ll see that the first and second doses are pretty high. We did a lot of work to get the first and second dose really high. After that, a lot have said, ‘Hey, I’ve done it. I’m not sure I want to go any further until more information comes out.’ ”

When it comes to the lowest fourth-dose uptake in the GTA, three Brampton forward sortation areas (the first three characters in postal codes) at the north end of the city are at the top of the list: L6P, where just 2.4 per cent of eligible residents have received a fourth dose; L7A, where the fourth-dose vaccination rate sits at 2.7 per cent; and L6R, where 3.5 per cent of eligible residents have gotten a fourth shot. L7A, which is located west of Hurontario and north of Bovaird Drive West, had some of the highest test positivity rates for COVID in Brampton during the second wave.

In the city of Toronto, the M3N forward sortation area, which includes the Black Creek and Jane and Finch neighbourhoods, has the lowest fourth-dose rate, with just 4.3 per cent. This area has seen consistent challenges throughout the pandemic concerning both access to vaccinations and testing as well as vaccine uptake.

This is followed by M9V, which includes the neighbourhoods of Thistletown, Smithfield and Mt. Olive north of Rexdale, with just 4.5 per cent of eligible residents having received a fourth dose to date.

In an email to the Star, Toronto Public Health said it continues to address barriers through an “equity-focused, hyper-local mobile strategy, providing accessible and convenient vaccination opportunities to residents in places where they live, work and play.”

It said residents can get their shots at any of the five City of Toronto immunization clinics, more than 525 pharmacies, primary-care offices and pop-up and mobile clinics, including at schools.

Immunization opportunities are also being offered at community venues and events (eg. shopping malls and libraries), most recently at summer festivals and events, and mobile clinics in the community, including offering hyper-local COVID-19 vaccination opportunities in Toronto’s northwest neighbourhoods.

Farwa Ladha, national co-ordinator of the Canadian Muslim COVID-19 Task Force, said she believes the lower uptake is due to several factors, including a decrease in government and public health messaging with respect to vaccinations, boosters and communitybased clinics; summer pandemic fatigue; and a desire by some to wait until the fall to get their Omicronspecific vaccine.

As for what can be done about it, Ladha said she doesn’t think that what worked when vaccines were first being rolled out in January of last year will work again. Instead, she is advocating for a more holistic health-care approach, involving primary-care providers and ensuring that the millions of Canadians who don’t have a family doctor get one.

“Many people, not just here in Toronto but across the province, across the country, are behind literally and figuratively over the pandemic, with respect to their general care,” she said. “We have to take the approach of engaging all of these people and advising them to go see their family doctor and make sure they haven’t missed out on their health checkups. That’s where these conversations around vaccinations, not just for COVID-19, but other routine vaccinations as well (will be).”

ANGELA CARTER EXECUTIVE DIRECTOR OF THE ROOTS COMMUNITY SERVICES IN BRAMPTON