Front Burner - The last 22%: Vaccine access and hesitancy

Episode Date: July 13, 2021

Nearly 78 per cent of eligible people in Canada have at least one shot of a COVID-19 vaccine. What’s stopping the rest? Today, Dr. Naheed Dosani and Dr. Jia Hu discuss.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Jamie Poisson. As COVID-19 vaccines became available in Canada, so many of us rushed out to roll up our sleeves. More than 25 million of us have gotten at least one shot, about 78% of the eligible population. at least one shot, about 78% of the eligible population. But now some health experts are starting to wonder about that remaining 22-ish percent. Why haven't they got their first dose

yet? It's a critical question as more transmissible variants continue to emerge. Today I'm joined by two doctors to tackle it. Dr. Nahid Dasani is back. He's the health equity lead at Kensington Health in Toronto and the medical director of the COVID-19 isolation housing program in the region of Peel. And Dr. Jahoo, he's a public health physician in Calgary and one of the founders of 9 to 0, a coalition of experts working to build confidence in vaccines. in vaccines. Dr. Hu, Dr. Dasani, hello to you both. Thank you so much for being here. Hello. Happy to be here. Thanks for having us on. It's so great to have you both. And I know you guys actually both went to residency together in Toronto. So you actually know each other very well.

So true. It's great to be together with you, Jeff. Likewise. Yeah, on the airwaves. So Dr. Hu, maybe we'll start with you. When you look at the vaccination rate here in Canada, so about 78% of eligible people with at least one dose now, that's a pretty positive statistic, right? The U.S. is only around 67%. Yeah, no, it's really quite high. I think we're either first or second in the world right now for, you know, first dose uptake. And I never would have dreamed to be this high. So, you know, it is a very good number. I mean, it'd be nice to be higher, but we are much better than the U.S., much better than many other countries.

Very true. nice to be higher, but we are much better than the US, much better than many other countries. Very true. And I'm hoping today we can talk about, you know, how we might get higher and why that's important. Dr. Dasani, I wonder if you're starting, though, to feel concerned about that figure, maybe starting to slow a bit. Yeah, you know, I think we have a lot we need to celebrate about getting to that number. But we have to start to come to the realization that the effort we put in to get to that number, we might have to work double or triply as hard to get that last mile that last, you know, 25% going to get people really vaccinated, we, you know, recognize that there are some people who either are not legible for vaccines or have an

allergy or a health condition. And then there's maybe, you know, this group that is this smaller group, but a group of, you know, potentially anti-vaxxers who will never really change their position on this topic. But there's a whole proportion of people who have not been vaccinated due to structural issues and the ability to get access around, you know, transportation, paid time off work, childcare, language issues, technology issues. And we really need to, you know, transportation, paid time off work, childcare, language issues, technology issues. And we really need to, you know, dig deep to really meet these people where they're at to support them so that we can really bring the number of people who need to be vaccinated to bring that number up to where it needs to be. I know this might sound like kind

of an obvious question, but why is it important that that percentage keeps going up and like ideally to where? Yeah, I mean, I think the issue here is absolutely a lot of the things we've been talking about throughout the pandemic, including the concept of herd immunity. But in the era of variants, we have to recognize that if people do not get vaccinated, they can become variant factories, they can produce new variants that are more transmissible, that are more dangerous, and potentially more resistant to vaccines. So when we talk about vaccination, we're not just saying to people, listen, this is about your health, this is about also taking the responsibility of vaccination on so we can improve the health of our entire

community. That's why vaccination is so important at this point and even more important than ever. Yeah, of course. I mean, I think that with the variants, the higher the rate we get, the better we are, right? We begin to see right now in Europe and Israel a sort of resurgence in the number of cases. In Israel, coronavirus cases have surged by 50% in the last week. The Delta variant has driven infections to levels not seen in Israel since April, mainly among unvaccinated people. We actually are opening at a time where we actually had a higher vaccine uptake rate

than nearly anywhere in the world, which is good. We mostly have the population immunised with these mRNA vaccines, which are quite protective against even the Delta variant, which is good. But, you know, I think that if we really, really want to put this to bed, which I think would be great for everybody, getting even higher than, you know, 75, 80, you know, if we get to 90, that'd be really good and a bit of a dream, but that would be sort of a nice target to reach. And so I guess let's get into some of the hurdles to reaching a target like that. And Dr.

Dasani also already talked about accessibility issues. And I wonder, Dr. Dasani, if you could just tell me a little bit more, maybe you can elaborate on what you were talking about earlier and tell me about who you see still facing those kind of barriers around just simply accessing the vaccine. Yeah, you know, I think a lot about what we've done. And we've done a great job coast to coast. Kudos to colleagues who have really developed interventions and models that have been, you know, pop-up clinics and, you know, mass clinics and arenas. And we've done a great job at that. I think to really push this last mile, we're going to really have to think about how we can really get to where people are

even in a more fine-tuned way. And that might mean going door to door, house to house, apartment building to apartment building, neighborhood to neighborhood. Why is it a wild thought that we're not doing that? And we actually have some jurisdictions in Canada that are starting to do that and use data to target particular kinds of buildings and spaces and places. We also have to start to think about

the kinds of populations that are often excluded by healthcare or who lack trust in healthcare. People who are non-status in our communities, migrant workers, people who experience homelessness, people who use drugs, you know, we really need to recognize the experience of what it's like for these folks who don't have that trust in healthcare, may not be willing to give their name or demographic information. And that might be the actual reason they haven't been vaccinated. And then finally, there actual reason they haven't been vaccinated. And then finally, there are still lots and lots of people who are working and just don't have the resources

or ability or haven't had the ability to get vaccinated for paid time off for vaccination or vaccination side effects, for example. People who are working in multiple roles or can't get childcare or transportation, for example. I think these are some of the structural factors we really need to think through. Dr. Hu, do you see those structural factors in Alberta as well, which I should note has one of the lowest vaccination rates in the country? Yeah, definitely. I mean, I think we sort of

see these structural factors across the country, they sort of exist to different degrees, different populations. You know, I think in Ontario, Nahid mentioned sort of these undocumented temporary migrant workers, and lots of these, I think we had pretty big outbreaks at our meat plants in the same way. I think in Alberta, what we see a lot of is people like Dr. Desani has done a pretty good job, I think, of actually increasing uptake amongst what I call urban vulnerables. In Alberta, if you look at where people aren't getting vaccinated, it really does seem to be the rural areas. And so if I go outside of Edmonton, Calgary, maybe Red Deer, you know, just chatting with the Tabor Town Council, where, you know, their vaccine uptake

rate across all ages is about 36%. And I think that access structural stuff, you know, how worried people are about COVID in general, and what you might think of as traditional hesitancy, or what I would say is like a lack of trust in the vaccine, which is often linked to a lack of trust in government, public health, etc. Yeah, I really appreciate Dr. Hu talking about trust, because I think there's another piece to this, that, you know, we really relied up until this point on our public health units and government in various institutions putting out messaging around COVID-19. And then people just consuming that mass messaging, and it worked, it got us to where we are. In the last mile, this last 25%, that may not be as effective. So I'm really excited here in Ontario, because, you know, rolling out this week and next week, family doctors are going to have access to reports to really know whether their patients have been vaccinated, whether they've gotten one or both or none. And that will allow them to be thrust into this position where they can have this one on one counseling opportunity, providing that tailored education, that custom discussion that people really need.

And there's a lot of people out there like that. I also think about the role of social media and social media influencers in Canada to help build that trust back in institutions and back into the COVID-19 vaccine strategy. I was pleased to hear an Ontario government officials talking about it last week. I don't know if there's actually resources being put to this because it's definitely an art, but it's a science. We need to be on Instagram. We need to be on TikTok. We need to be using trusted sources of information, accounts that people trust from various demographics and walks of life to build connections for people. I think those are two important things to consider around trust.

You know, this is something that we've talked a lot on the show about this, this issue of trust around vaccine hesitancy. And, you know, where do you guys think it comes from? Yeah, no, of course. I mean, like when it comes to building trust, right? Like, I mean, maybe I'll use some of the meat plants as an example, right? There's very, very large outbreaks about 14 months ago. And I think that, you know, why do people lack trust in the vaccines I think like some groups have been you know traditionally uh marginalized or hurt by governments and so they don't trust them some of the you know on the rural side I think they're just general lower trust in government but I think to sort of build trust you know and this started happening well before vaccine was available um you know we would support people essentially with whatever needs they had and sometimes that was you know income support something that was food support and you know, we would support people essentially with whatever needs they had.

And sometimes that was, you know, income support, something that was food support and, you know, working through people and groups that work with the communities already and have relations very helpful. And so I think that really the key is to, when it comes to trust these, you know, one, I think working with people who have trusted relationships, and two, meeting people where they are with whatever needs they have at times, as opposed to sort of imposing some sort of view upon them. I'm trying to think about what that could look like in, in, like rural Alberta. And I know I bring this up in part because, you know, recently,

we spoke with a doctor in southern Manitobaoba who's treating a number of unvaccinated patients with COVID. And, you know, he talked to us about how some of them just didn't even believe that COVID existed. I've had patients who, even on their deathbeds, have denied that they have COVID. They don't want to hear it. I've had patients who have left our emergency room very angry at being given that diagnosis. Patients who refuse to be tested because they don't believe that this is real.

And so what could that look like in that part of the country, sort of more rural areas? Yeah, and you know, I think I'm learning more about the sort of rural areas myself as we sort of kick off some of the rural projects. But, you know, when we've chatted with sort of some of our sort of community leaders, you know, I think the different sort of churches and other faith communities that exist tend to be influential. You have things like 4-H clubs and Rotary clubs, communities that exist tend to be influential. You have things like 4-H clubs and rotary clubs, you know, organizations in Alberta, like companies like Nutrien or UFA, I think some of the big employers, but I, you know, no matter sort of where you are, there does tend to be, you know,

organizations that, you know, are part of the community that sort of have the trust of the community. One thing I did sort of want to index on is that, you know, I think that there is a very small number of people that really don't think COVID is real. You know, this is like, sort of like that microchip 5G crowd. But I think as with, you know, the sort of urban vulnerable population,

if I sort of spin back the clock and we've been sort of tracking sentiment for more than a year, you know, there's quite a lot of hesitancy. But I think through sort of spin back the clock and we've been sort of tracking sentiment for more than a year, you know, let's say there's quite a lot of hesitancy, but I think through sort of that trust building and sort of collective work that many people have done, it's pretty high. And I like, I think that we can sort of do better than the, than we are in the rural areas.

Very few people are what I would say, like truly conspiratorially anti-vaxxer. You know, I do wonder if, if like another piece of this, and I would open this question up to either of you. Like, do you think that some people are also just thinking that this is kind of under control now? So why would they bother to get vaccinated? For sure. There are people out there who are feeling well, everyone else is vaccinated, so I don't need to get vaccinated or are seeing case counts and death counts come down. And that is unfortunate because, you know, really, we're only going to get through this together through herd immunity. And then the discussion, you know, really has to change. And it has, you know, a lot of us are now talking about the idea of unvaccinated people becoming reservoirs for these more dangerous variants. So I think it requires a pivot in how we're educating people, which goes back to like the messaging, and how we, you know, we message things through media and social media. But I also want to just touch on the fact that

there is a tendency when people aren't getting vaccinated, and we've all seen it online, to just really just bash people, attack them, call them all sorts of names. And I can understand from one perspective where that comes from, but I don't know that that's really improving vaccine uptake when we attack and insult people. I think we have to remember that this pandemic has been hard on people from all walks of life. People have lost their jobs. Businesses have been impacted. People's livelihood and purposes have been impacted. There's been a lot of emotional pain through this. I think we need to respond with empathy and compassion. And as hard as that might be for people, I think that's the way to get there. And certainly that is backed up by all sorts of research around this. In the Dragon's Den, a simple pitch can lead to a life-changing connection.

Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. and industry connections. That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. Besides what we've talked about in terms of increasing access and building trust and employing empathy. Are there any like carrots and or sticks that you think may end up being useful in terms of getting those on the fence vaccinated maybe?

So like, I know, for example, Dr. Who, Alberto is offering lottery money, which sounds kind of fun. And it's announced three prizes of $1 million a piece. And these are going to be handed out over the next few months. After all, we've had to spend billions of dollars in our healthcare system and through supporting people through the past 16 tough months. Yeah, I mean, I think that I'm a fan of whatever, right?

Like in a lot of reasons for some people, I know a lot of organizations have given out incentives like money or gift cards. I think another sort of type of incentive or disincentive not to be vaccinated that's occurring is what I call sort of proofs of vaccination. One of my jobs is the Calgary Stampede medical director and basically have a sort of proof vaccination negative testing program. But certainly for international travel, I think to go to a lot of countries in the in the not too distant future if you want to avoid a fortnight quarantine you will need to be immunized those things they don't work for everybody but they work some people it's fine by me uh we really just need to like do whatever it takes and for different folks that'll

be different things yeah yeah i so i really do recognize the importance of using every carrot we can to get people vaccinated. Lotteries are certainly interesting, but even just presenting, you know, passports or proof of vaccination to go to restaurants, for example, or concerts or for travel, this is a huge potential carrot for people that will encourage them to get vaccinated. But we cannot forget that this may be more challenging for structurally vulnerable groups, like, for example, people who experience homelessness or don't have access to technology that in the bid to kind of use every carrot, we've further ostracized already marginalized groups. And so we must be cognizant of that and create safeguards for people who, you know, deal with deficiencies in the social determinants of health in our communities as well. I do worry about that, too. Before we go today, I wonder if either of you would would want to make a final pitch here, either to someone who might not be vaccinated yet or someone who's worried about someone in their

lives who's not vaccinated yet? And Dr. Hu, maybe we'll start with you. Yeah, to Nicky's point, like yelling at people or telling people that they're wrong or is totally pointless and bad. But you know, we've come a long way since a year and a half ago, when this started, we have more experience with the efficacy and the safety of these vaccines than we did, you know, half a year ago. And I you know, I know that many people who haven't been vaccinated, have legitimate concerns and legitimate questions. But I would just say that we know that it is highly effective, highly safe. It's the only way I think we can really continue life in a normal way in the future. And if you have any sort of additional

questions, I think, you know, contacting somebody like your family doctor, if you have one, would be really helpful. But let's try not to relive 2020 ever again. And please get vaccinated. That's a very good pitch to me. I do not want to relive 2020 again. Dr. Desani, final word to you. Yeah, I really love that. You said it really well. What I'll say is care about your neighbor, care about those who are vulnerable in your communities, care about those who have been hardest hit by this virus and will continue to be. And if you care, you will wear a mask, you will get vaccinated. Don't be a variant factory. If you need to talk to someone, reach out to your primary care provider to have that one-on-one conversation. Please get vaccinated.

We'll only get through this if we are doing this together. Our collective intent through empathy and compassion and care for each other is the way out of this pandemic. Okay. Guys, thank you for this. I know you both have a ton going on. So thank you for taking the time. Thanks for having us. Thanks so much. Nice chatting again, Nahid. You too, Chad. Gotta run. Okay, that is all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner.

And to play us out, a vaccine outreach anthem from Juvenile, who released this version of his 1999 hit last week. They done real like you need to vax that thing up. Feeling freaky all night, you need to vax that thing up. Girl, you look good, want your vax that thing up. You's a handsome young brother, want your vax that thing up. They done real like you need to vax that thing up. Feeling freaky all night, you need to vax that thing up. I know you can't stand it, no holding hands check. But when we get the shot, we gonna be romancing. Girl, you could be the queen after quarantine.

We could meet up at the spot and we could do the thing. Internet date check. I'm your mate check. Download the app, Charlie. You ain't got to wait, check. I love it when your homie is trying to move.