The first batch of both the Pfizer and Moderna COVID-19 vaccines are here, being distributed to priority groups like nursing homes, healthcare workers, as well as remote Indigenous communities. As additional shipments arrive, a comprehensive communication and vaccine distribution program will be a necessity.  

Over the coming months, Canada will have to quickly immunize its 37.7 million citizens, all within an environment of incomplete information, vaccine hesitancy and differential access to health and social supports. To do that, we must act upon the truths about equity, diversity, decision-making and health system logistics that the pandemic laid bare.

To succeed, Canada’s immunization strategy will have to lean on influential community leaders, family doctors and public health.

Communities consisting of predominantly immigrant, ethnic or other marginalized citizens have been hardest hit by the pandemic. This is no surprise. These groups do not have the same access to health and social supports like income stability, job stability, housing stability, stable childcare/eldercare. 

Canada is one of the most diverse countries in the world, with immigrants comprising 20-50% of many cities. I grew up in Thorncliffe Park, a densely populated neighbourhood in east Toronto. 89% of the population lives in high-rise apartment rentals. The majority are well-educated, visible minorities who immigrated to Canada. Household incomes average $50,000/ year. Crowded buses, crowded homes, crowded parks were the norm as were cultural practices based on the primacy of relationships with extended family, religious and social leaders. I grew up surrounded by other voices, other cultures, other religions, other ways of living and learning.

Having since studied and worked in different communities, from the remote northern Cree community of Moose Factory to the ocean-side Maritime city of Halifax to the multi-cultural hustle of Scarborough to the spacious, spare beauty of Calgary and so on, I appreciate the uniqueness of each. To me, Canada is more than hockey and maple syrup. 

Why does Canada’s diversity matter to a vaccination program?

Vaccine hesitancy is a significant issue with only 57.5% of Canadians very likely to get a COVID-19 vaccine. Factors associated with hesitancy include younger age, lower education level and immigration. In fact, immigrants represent one-third of healthcare workers in Canada, with the number rising to 79% in cities like Toronto. So not surprisingly, even among healthcare workers, 45% expressed hesitancy. Concerns centred on vaccine efficacy, safety and the speed of vaccine development.

Clear, reliable information about the vaccine should be relayed via multiple channels, using multi-lingual, culturally appropriate and highly-accessible strategies to support decision-making.

84% of Canadians trust their physician’s advice, so family doctors can influence vaccine hesitancy. However, health information is still sought from social networks, extended families and religious leaders, as well as internet searches including social media before contact is made with physicians — especially among immigrants. Despite this, centralized communication systems usually do not use influencers closest to citizens, including community organizations and religious leaders, to design and disseminate key information.

Previous experiences with government and healthcare impacts how highly citizens rank information from Canada’s medical officers of health. In 2019, most Canadian immigrants travelled from India, China, Philippines, Nigeria, Pakistan, the US, Syria, Eritrea, South Korea and Iran. Many governments in Asia and Africa struggle with transparency and trust. Health care in these regions are often available only to the privileged few. Immigration aside, even Canadian-born Indigenous, Black and other people of colour have suffered institutionalized racism . All this impacts what and who is trusted. 

A strategy using the expertise and reach of religious leaders, community influencers and family doctors will be more persuasive and relevant, and will improve vaccine uptake.

A similar decentralized strategy navigating the logistics of vaccine distribution is necessary. Local networks between family physicians and public health should be allowed the authority and funding to co-design locally relevant vaccine distribution programs. 

After all, family doctors are more geographically accessible than hospitals for many citizens. Even during lockdowns in hard-hit provinces like Ontario, 96% of family physician offices continued to provide care.

Limited supplies of the vaccines require infrastructure to identify and track priority populations, necessitating access to a person’s medical and social history. Family doctors routinely record this information because community-based family medicine by nature is comprehensive, continuous, first-contact and person-centered. 

Decades of experience have refined the approach family doctors use for vaccinations, even those requiring multi-dose regimens for infants, children and adults. Family physician offices are experts in identifying those in need, administering vaccines, managing side effects, tracking immunizations and calling patients back for booster doses. Both the Pfizer and Moderna vaccines require two doses to reach maximal efficacy. Evidence shows that, outside school settings, tracking vaccine administration, telephone call-backs and relationships with family doctors improve the uptake of multi-dose vaccination programs.

The COVID-19 vaccines hold the promise of moving beyond a pandemic reality. To reach that reality will require not only learning from the lessons of the past, but acting on them in innovative, community-based ways.

(Originally published in Healthy Debate on January 6, 2021.)