Samir Sinha (Department of Medicine, University of Toronto; National Institute on Ageing, Ryerson University) @DrSamirSinha
Cameron Feil (National Institute on Ageing, Ryerson University) @Cameron_Feil
Natalie Iciaszczyk (National Institute on Ageing, Ryerson University)
In November, prior to the arrival of its first vaccines, Canada’s National Advisory Committee on Immunization (NACI) recommended that the first stage of immunizations be given to residents and staff in seniors’ homes, adults over 70, health-care workers, and adults in Indigenous communities (See Figure 1). NACI also emphasized this in its subsequent COVID-19 vaccination guidelines released in December 2020[1].
Figure 1: Summary of the Preliminary Canadian NACI Recommendations on Key Populations for Early COVID-19 Immunization
Under the Canada Health Act, jurisdictional responsibility for the provision of health care falls to the provinces and territories. Each has released their own corresponding vaccination rollout strategies based on their individual priorities, that now include vaccinating all LTC residents and staff by February 2021. Additionally, five provinces: Newfoundland, British Columbia, Nova Scotia, Prince Edward Island (PEI), and Ontario have also included family caregivers of LTC residents as part of the initial populations being prioritized for vaccination.
Of the 1,253,140 doses of the Pfizer-BioNTech and Moderna vaccines that the federal government delivered to each of Canada’s provinces and territories on an equal per capita basis, 86.75% of these doses had been reportedly administered as of February 8th, 2021. While each province had received sufficient vaccine doses by late December to deliver initial doses to their entire LTC populations, which total at least 211,000 individuals[2], differences in approaches to vaccine rollout strategies have resulted in large discrepancies in LTC residents, staff, and family caregivers vaccination across Canada. As of January 30, 2021 an estimated 129,923 (48.25%) residents of Canadian LTC Homes have been vaccinated [16].
As of January 5, 2021 fewer than 4,000 (5.5%) of Ontario’s 72,000 LTC residents had been given an initial dose of the Pfizer-BioNTech or Moderna vaccine, and over 26,000 (26%) of its more than 100,000 LTC staff. British Columbia, by comparison, had by January 4, 2021 given a first dose to over 4,700 (20%) of its LTC residents and 11,600 (50%) of its LTC staff[3].
Table 1 presents Canada’s current progress in vaccinating its LTC residents and staff. As of February 5, 2021, 48% of residents in care homes for seniors have been vaccinated in Canada [16]. Seven provinces and territories have completed vaccination of their designated LTC populations receiving publicly-funded LTC: Prince Edward Island (January 15th), Alberta (January 17th), Saskatchewan (January 21st), Yukon Territory (January 26th), British Columbia (January 29th), Manitoba (January 29th) and North West Territories (February 3rd) [17, 18]. have reportedly offered first-dose vaccinations to 100% of their LTC home populations [8,9,10].
Between January 29 and February 5, 2021 Ontario significantly increased their numbers of vaccinated LTC residents from 65% to 81% [19]. However, the Ontario government announced on February 2, 2021 that they will be unable to meet their target of 100% vaccination for LTC residents and staff by February 5th, and thus extended its target date to February 10, 2021 [19]. This occurred despite the fact that a recent study, found that completing vaccinations for LTC residents by January 31st rather than Ontario’s initial February 15th goal would help avert a significant number of new COVID-19 infections and deaths.
Finally, some provinces and territories, namely Nunavut, Newfoundland, and New Brunswick, have not publicly released detailed data or updates pertaining to their LTC vaccination programs. Furthermore, there have been few or no updates from Quebec, and thus the proportion of LTC residents vaccinated remains at 87%. Finally, Nova Scotia announced that it will begin vaccinating LTC residents and staff on February 22, 2021 [20].
A critical reason for the fragmented rollout across Canada’s LTC settings has been how its provinces/territories had originally set up their vaccine distribution programs. The northern territories and more rural and remote settings of Canada’s provinces are relying on the use of the more easily transportable Moderna vaccine which only began to be delivered to the provinces and territories at the end of December to vaccinate their LTC residents. Some initial concerns about the ability to transport the Pfizer-BioNTech vaccine into LTC settings meant that some provinces like Ontario decided to prioritize its use via hospital distribution centres where able bodied LTC staff and family caregivers could receive their vaccine while waiting to use the Moderna vaccine for its LTC residents.
Pfizer, however, provided broadened transportation guidelines to the Public Health Agency of Canada on December 18 on how to safely transport its vaccine into LTC settings. As a result, Quebec established half of its initial vaccination centres in its LTC settings to facilitate resident vaccinations with the Pfizer-BioNTech and BC quickly adjusted its rollout strategy to begin moving its larger supply of this vaccine into LTC homes by December 23, to get its LTC residents vaccinated. On the other hand, Ontario which initially decided against bringing its Pfizer-BioNTech vaccines directly into LTC settings began to do so as of January 5th as it began to face widespread criticism around its slow vaccination rollout in its LTC settings[4]. In Ontario, there has been concern around how it initially prioritized certain frontline and non-LTC frontline health care workers over LTC residents and staff that worsened its ability to vaccinate LTC residents efficiently especially as subsequent vaccine shortages emerged; whilst in Manitoba, concerns had been reported regarding its in initial approach to support the vaccination of LTC home-dwelling individuals.
Moreover, even in provinces where vaccination efforts in its LTC settings have appeared to be comprehensive, many residents and staff have in reality been left out. For example, in Alberta, while 100% of 27,000 residents in publicly funded LTC facilities have been vaccinated, 10,000 residents of exclusively private ‘undesignated’ LTC and retirement homes were not included in its initial or first stage of the vaccine rollout because the death toll in these settings has been deemed to be ‘less heavy’ compared to those of publicly funded LTC settings. Regardless, all LTC settings have collectively represented 66% of Alberta’s death toll, where 73% of LTC settings have experienced at least one COVID-19 outbreak, the most of any other province in Canada[5]. There have been no further updates on the status of the 10,000 unvaccinated residents of privately funded LTC and retirement homes in Alberta.
Another issue which is coming to light is that, while over 90% of LTC residents appear to be accepting a COVID-19 vaccine, varying levels of vaccine hesitancy are seeing highly variable uptake ranging from 20-70% and less than 50% overall uptake of the COVID-19 vaccine by staff in these settings due to a variety of unaddressed issues and concerns.[6]
Finally, it was revealed on January 28, 2021 that the Ontario government had been inadvertently providing data on the number of doses administered to achieve full vaccination when reporting on the number of Ontarians who have been vaccinated with both doses of either the Pfizer-BioNTech or Moderna vaccine. As a result, reporting on the number of people fully vaccinated in Canada’s most populous province in January has been double the true number. While the government claimed that the number of fully vaccinated people exceeded 96,000 earlier in the week of January 25th, the total number of people who have received both doses was in reality only 55,286 as of January 28th.[14] The province’s inability to properly monitor its vaccination rollout not only raised questions about what else the Ontario government has been inaccurately reporting over the course of the pandemic, but also undermined efforts to track vaccination coverage at the national level.
With the recently announced slow-downs of Canada’s Pfizer-BioNTech vaccine shipments from Europe, and no new deliveries during the week of January 25th, and much reduced deliveries expected in subsequent weeks, all of Canada’s provinces and territories have had to revise their vaccine rollout-strategies including now considering delaying the administration of the second doses of its vaccines. Provinces like Ontario have indicated that they will not do this to their LTC resident populations and will also further prioritize any remaining vaccine towards prioritizing the vaccination of its LTC residents first to meet its goal of administering a first dose to all of its LTC residents by February 10th. While most of Canada’s largest provinces have already accomplished this by the week of January 25th, a recent modelling study released by the Ontario Government’s Science Table helped to underscore the value of vaccinating all LTC residents as soon as possible. In their study, they noted that if Ontario had prioritized getting all of its LTC residents vaccinated by January 31, 2021 vs February 15, 2021 would help to avert at least 600 new COVID-19 infections and 115 deaths by March 31, 2021[7]. As a result of this study, the Ontario Government announced on January 25th that it would speed up its target to administer an initial vaccine dose to all of its LTC home residents by 10 days with a new target completion date of February 5, 2021. The ongoing delays in receiving more vaccines, however, led the Ontario government to announce on February 2, 2021 that it would be unable to meet their target of 100% vaccination for LTC residents and staff by February 5th, and thus extended its target date to February 10, 2021 [19].
Numerous reports highlight vaccine hesitancy among staff in LTC settings stemming from concerns about vaccine safety and efficacy [21,22]. A separate survey in British Columbia found that just over half (57%) of LTC staff wanted to get the COVID-19 vaccination [23]. Additional problems such as employers asking LTC workers to take unpaid leave to vaccine may be contributing to low vaccination rates [22]. Overall, a comprehensive information campaign targeting front-line workers could have proactively addressed questions about the benefits and risks of the vaccine and combated misinformation, ultimately reducing hesitancy among a group that has faced some of the highest risks during the pandemic. Thus far early reports show that British Columbia that has more actively addressed these issues has vaccinated 89% of their LTC staff while Ontario has only vaccinated 70% of its LTC staff to date. [21].
Across Canada, vaccination of LTC residents, staff and family caregivers, where prioritized, is expected to continue to be the main priority across Canadian jurisdictions like Ontario heading into the week of February 8, 2021 that have yet to complete its LTC vaccination program.
SUGGESTED CITATION
Sinha S, Feil C and Iciaszczyk N. The rollout of the COVID-19 vaccines in care homes in Canada as of 9th February 2021. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE.
REFERENCES
[1] National Advisory Committee on Immunization (NACI) December 12, 2020. Recommendations on the use of COVID-19 vaccine(s). Accessed Jan 30th at: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/december-12-2020.html
[2] Statistic Canada. Type of Collective Dwelling (16), Age (20) and Sex (3) for the Population in Collective Dwellings of Canada, Provinces and Territories, 2016 Census. Accessed Jan 24th at: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/dt-td/Rp-eng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=0&GK=0&GRP=0&PID=109537&PRID=0&PTYPE=109445&S=0&SHOWALL=0&SUB=0&Temporal=2016&THEME=116&VID=0&VNAMEE=&VNAMEF=&wbdisable=true
[3] Global News Canada. ‘A senicide’: Strategic missteps, logistical hurdles plague Ontario’s early vaccine rollout. January 23, 2001. Accessible at: https://globalnews.ca/news/7588530/ontario-coronavirus-vaccine-rollout-inside-look/
[4] Global News Canada. ‘A senicide’: Strategic missteps, logistical hurdles plague Ontario’s early vaccine rollout. January 23, 2001. Accessible at: https://globalnews.ca/news/7588530/ontario-coronavirus-vaccine-rollout-inside-look/
[5] Globe and Mail. ‘Thousands of Albertans in private seniors’ facilities still awaiting vaccines, not atop priority lists’ January 21, 2001. Accesible at: https://www.theglobeandmail.com/canada/alberta/article-thousands-of-albertans-in-private-seniors-facilities-are-still/
[6] Toronto Star. ‘Uptake for the COVID-19 vaccine has been high among Toronto’s long-term-care home residents. For staff, not so much’. January 16, 2021. Accessible at: https://www.thestar.com/news/gta/2021/01/16/uptake-for-the-covid-19-vaccine-has-been-high-among-torontos-long-term-care-home-residents-for-staff-not-so-much.html
[7] Nathan M. Stall et al. on behalf of the Ontario COVID-19 Science Advisory Table. ‘The Impact of the Speed of Vaccine Rollout on COVID-19 Cases and Deaths in Ontario Long-Term Care Homes’. January 21, 2021. Accessible at: https://doi.org/10.47326/ocsat.2021.02.08.1.0
[8] “All LTC Residents, Staff in BC Offered COVID-19 Vaccination”
https://www.citynews1130.com/2021/01/29/ltc-vaccine-covid-19-bc/
[9] Yukon, COVID-19 Update.
https://yukon.ca/en/news/january-20-2021-covid-19-update
[10] Saskatchewan COVID-19 Update January 21, 2021 https://www.saskatchewan.ca/government/news-and-media/2021/january/21/covid19pdate-for-january-21-29781-vaccines-delivered-227-new-cases-816-new-recoveries-13-new-death
[11] Ontario Plans to Accelerate Vaccination of Residents of Long-Term Care
[12] Manitoba Vaccine Briefing January 27th 2021 https://manitoba.ca/asset_library/en/covidvaccine/vaccine-briefing-01272021.pdf
[13] Quebec Coronavirus Rollout Inside Look
[14] “Ontario COVID-19 vaccinations only half of what reported because of government data error”: https://toronto.ctvnews.ca/ontario-covid-19-vaccinations-only-half-of-what-was-reported-because-of-government-data-error-1.5285935
[15] COVID-19 Vaccination Tracker: Available at: https://covid19tracker.ca/vaccinationtracker.html
[16] COVID-19 Vaccination in Canada https://health-infobase.canada.ca/covid-19/vaccination-coverage/#a3
[17] Government of Northwest Territories COVID-19 Vaccine https://www.google.com/url?q=https://www.gov.nt.ca/en/newsroom/government-northwest-territories-successes-covid-19-vaccine-deliveries&sa=D&source=editors&ust=1612560823791000&usg=AOvVaw0KeUFlwLoqprcyIs309b_p
[18] Government of Manitoba https://news.gov.mb.ca/news/index.html?item=50458&posted=2021-01-29
[19] CBC .“Ontario Says it will miss target of 1st dose of COVID-19 Vaccine”. https://www.cbc.ca/news/canada/toronto/covid-19-ontario-february-2-2021-vaccine-update-1.5897440
[20] Government of Nova Scotia. https://novascotia.ca/news/release/?id=20210203009
[21] The Globe and Mail. “Why Many Long-Term Care Workers Initially Passed on the COVID-19”. https://www.theglobeandmail.com/canada/article-why-many-long-term-care-workers-initially-passed-on-the-covid-19/
[22] CBC. “Some Health Care Workers Still Hesitant to Get the COVID-19 Vaccine”. https://www.cbc.ca/radio/whitecoat/some-health-care-workers-still-hesitant-to-get-covid-19-vaccine-1.5872004
[23] Safe Care Brish Columbia. COVID-10 Vaccine Survey. https://www.safecarebc.ca/2020/12/18/covid-19-vaccine-survey-preliminary-results/
TABLE 1.0 Data Sources:
Total # of LTC and Retirement Homes and % of Homes Affected by COVID-19 Outbreaks: NIA LTC COVID-19 Tracker Accessible at: https://ltc-covid19-tracker.ca/
Provincial/Territorial Vaccination Rates:
British Columbia:
https://www.citynews1130.com/2021/01/14/vancouver-coastal-lct-covid-19-vaccine/
New Brunswick
https://www2.gnb.ca/content/gnb/en/corporate/promo/covid-19/vaccine.html
Ontario:
Quebec:
Saskatchewan:
Manitoba:
https://news.gov.mb.ca/news/index.html?item=50458&posted=2021-01-29
PEI:
https://www.princeedwardisland.ca/en/news/two-new-positive-cases-covid-19-pei-vaccine-update
Yukon:
https://yukon.ca/en/news/january-20-2021-covid-19-update
Nunavut: