“The devil is in the details” is an expression perfectly suited to Canada’s vaccination strategy, for what looks good on a national map tends to appear less positive the more one drills down to regional and local areas. Countrywide, more than 88 per cent of eligible residents have received at least one dose, according to the federal government’s data. But crunch that vaccination rate for the entire population, including currently ineligible children, and that one-dose number drops to 78 per cent. That means more than one in five Canadians aren’t vaccinated.
Dive further into the data and one trend pops: there are pockets of unvaccinated, both small and disconcertingly large. And those are the areas that continue to be hit hard by Delta, even as the overall number of new cases in Canada falls.
Roughly half of that unvaxxed cohort are children who are still too young for the vaccines. In Ontario, the under-20 age group has the most active cases of COVID-19, 935 in total, while those 30-39 are in second place with just 531 cases and the previously-hard-hit 80-plus cohort has just 100 active cases.
Until kids under 12 become vaccine-eligible, the focus should be on persuading older, still-unvaccinated Canadians to get immunized, says Kevin Wilson, a Halifax-based epidemiologist who has been crunching data on the pandemic since early 2020. As of the end of October, that unvaxxed-but-eligible cohort stood at 5.5 million people, according to the Public Health Agency of Canada.
“The flip side of ‘vaccines work’ is that if you don’t use them, they don’t work,” he says bluntly. And especially as public-health measures, which have been doing heavy lifting by protecting people, are removed, those pockets are the epicentres of current outbreaks.
Though the federal data was last updated at the end of October, the regional disparities are clear. Generally, vaccination levels fall as one travels west from Atlantic Canada. So while 86 per cent of the entire population in Newfoundland and Labrador has received at least one dose, that share falls to 81 per cent in New Brunswick, then to 77 per cent in Ontario and then to 72 and 73 per cent in Saskatchewan and Alberta, respectively, before rebounding to 79 per cent in British Columbia.
Within provinces, there are even sharper disparities. In Alberta, which breaks rates down by local geographic areas, 92 per cent of eligible residents in the Sherwood Park area outside Edmonton have gotten at least one dose, compared to 64 per cent in St. Paul, just 175 km away. By contrast, the 34 public-health units of Ontario have relatively similar vaccination rates. Ontario government data for eligible residents ranges from a low of 84 per cent in Renfrew and Lambton counties having one dose to 98 per cent in Leeds, Grenville and Lanark District.
“Health-care capacity is very much a local resource,” Wilson says. “It would almost be better if the unvaccinated were thinly distributed around any given province. That way any local hospital isn’t going to get overwhelmed.” Instead, the unvaccinated are clustered very heavily in certain communities, interacting with each other, he says. When COVID-19 hits one of those pockets, the local hospital gets slammed with patients.
In late September, Edson, Alta. was in the news, amid reports that many in the small community weren’t taking the virus seriously. There was even an unconfirmed report of a “get-COVID” party. At the time, Edson’s vaccination rate was roughly 50 per cent of eligible residents, compared to a provincewide rate of 73 per cent. A week later, the number of local residents needing hospitalization due to COVID-19 rose, and Alberta Health Services suspended obstetric services at the local hospital, forcing expectant mothers to go to other facilities, including Hinton, 90 km away.
Even Atlantic Canada has pockets of higher levels of unvaccinated populations. One area is around Edmundston, in northwestern New Brunswick, which Wilson calls the “problem-child region” of the province because it has had repeated outbreaks during the pandemic, and has per capita rates of cases and deaths that are noticeably higher than other regions. Though the government doesn’t reveal regional breakdowns in vaccination rates on its website, CBC News got hold of a map from mid-October that showed that the area surrounding Edmundston had some of the lowest rates in the province: only 65-70 per cent of eligible population there were vaccinated, compared to more than 80 per cent for the province as a whole. (Vaccination rates are higher within the city of Edmundston, itself.)
If rural residents believe their wide-open areas are safer than densely-packed cities when it comes to getting COVID-19, Kevin Wilson has bad news for them. He tested that idea by crunching data, comparing Nova Scotia, which has experienced a far less severe pandemic than most of Canada, to the least densely populated health regions in the country. His calculations showed that those rural areas had more than five times the number of cases and deaths as Nova Scotia, on a per capita basis. Even when excluding the hard-hit Far North region of Saskatchewan and comparing the remaining 10 most rural health regions against the city of Halifax, he found that the rural cohort still had around three times the number of cases and 1.5 times the number of deaths as Nova Scotia’s capital. (What’s more, he notes, the majority of Halifax’s deaths were at the very beginning of the pandemic, when its long-term care homes were hit badly.)
At the same time, vaccination rates in cities are often higher than those in rural areas. In Toronto, every neighbourhood reports at least 67 per cent of eligible residents with at least one dose of vaccine, while the overall rate for the city is 87.7 per cent. And though the city suffered earlier in the pandemic, its rate of new cases is currently well below less-vaccinated, more rural areas in the province.
As provinces lift public health measures, persuading the unvaxxed in those areas of low immunization to get the doses is key to keeping the pandemic at bay, Wilson believes. Immunity will come from a vaccine or the disease itself. Trouble is, he says, going to get vaccinated can for many rural residents mean a day-long journey to a spot offering shots, compared to someone in a city who just has to walk around a corner.
“It should be as easy as possible in those pocket areas,” he says. That could include loading an industrial mini fridge full of doses into a van to drive it to wherever there is a group of people who need vaccines. “Do whatever you need to do,” he says, “to make those pockets less obvious on a map.”