‘Fortress Australia’: Why calls to open up borders are meeting resistance

Of note and the challenge of reopening:

Australia has been one of the world’s Covid success stories, where infection rates are near zero and life mostly goes on as normal.

That’s in large part thanks to the early move to shut its borders – a policy that has consistently been supported by the public.

But after a year in the cocoon, there is growing unease in the country over the so-called “Fortress Australia” policy.

Recent announcements declaring that Australia won’t open up until mid-2022 – meaning a two year-plus isolation – have amplified concerns.

Critics argue the extension of closed borders will cause long-lasting damage to the economy, young people and separated families. It also tarnishes Australia’s character as open and free, they say.

Calls for a clear plan to pull Australia back into the world are growing, as the country wrestles with an uncomfortable tension – balancing the safety of closed borders against what is lost by living in isolation.

“A Fortress Australia with the drawbridge pulled up indefinitely is not where we want to be,” says former Race Discrimination Commissioner Dr Tim Soutphommasane.

“Australia is at its best when it’s open and confident – not fearful and insular.”

Locking the gate

In March 2020, the government closed the borders. It barred most foreigners from entering the country and put caps on total arrivals to combat Covid. Mandatory 14-day quarantine and snap lockdowns have also been used to control the virus spread.

The measures are extreme, and among the strictest in the world.

But they’ve worked. Australia regularly sees months without a single case in the community, and it has recorded fewer than 1,000 deaths in the pandemic.

Given that, the strict border controls have proven tremendously popular. Public polls regularly report 75-80% approval ratings for keeping the door shut.

Even higher numbers – around 90% – approve overall of the government’s pandemic handling, and trust in government has increased in contrast to views of voters in some Covid-ravaged nations.

Languishing behind

But the government now also faces mounting pressure over how it plans to handle the next phase of the pandemic.

Prime Minister Scott Morrison – who faces an election next year – has announced Australia won’t re-open borders until mid-2022. The exact timing and just how that will happen are unclear.

But the budget announcement was a shock extension to previous forecasts of an opening-up to occur slowly at the end of this year.

The main reason for the delay is vaccination.

Australia’s immunisation programme has been beset with delays, and lags well behind other developed nations such as the UK and US.

Critics say complacency over the low virus circulation delayed its kick-off. And now rising hesitancy – fuelled at least in part by Australia’s isolation – has also slowed the vaccine rollout.

Facing those failures, the government fell back on the border ban as a resort, critics say.

That’s dealing a heavy blow to sectors like tourism and higher education. Australia’s strong migration programme – relied on to address skills shortages and population growth – has also been cut almost completely.

Ernst and Young, an accounting firm, estimates that Australia’s economy is losing A$7.6bn (£4.18; $5.9bn) a month from the closed borders.

So a group of experts from the University of Sydney have called for an exit plan to be put in place. People need to know their options and prepare for the future, they say.

Their “roadmap to re-opening” focuses on prioritising vaccination, expanding quarantine and starting trials to bring in people for affected industries.

They point to successful examples like the New Zealand travel bubble, and the Australian Open tennis tournament.

“This is the case when measured in hard dollar terms, but also when measured against less tangible factors such as fuelling a negative and inwards-focused national psyche that threatens our global standing, as well as national unity and cohesion.”

‘Us and them’ mentality

Others have also voiced their concerns over how an extended retreat from the world could damage Australia’s character.

When Australia was parochial it had a White Australia policy (1900s-1970s), which restricted immigration from non-European nations. Multiculturalism has replaced that policy in recent decades, but the ideal is still fragile, experts warn.

Dr Liz Allen, a demographer at the Australian National University, contends that Covid has already made the nation more “protectionist and insular”.

Government policies have created an “us and them” division, she argues.

The hostile treatment of migrants is a clear example, she says. Australia’s conservative government of eight years has never advocated for immigration – the coalition won the 2019 election pledging to “slash” the migrant intake.

At the start of the pandemic, Mr Morrison told the nation’s two million migrants on temporary visas to “go home”.

Those visa holders – often doing the low-paid, essential jobs of cleaning and food delivery – were also ineligible for the government’s pandemic welfare support, leaving many facing destitution.

The border ban has also sown community division, seen in its most extreme form last month when Australia took the world-first step of threatening jail for citizens who returned home from Covid-ravaged India. The Indian-Australian community expressed outrage they were being treated like second-class citizens.

Multicultural roots

The issue of stranded Australians reflects Australia’s character as an intensely multicultural nation.

Nearly 30% of the population were born overseas, and another quarter have a parent who was. As a nation of migrants, so many Australians have deep personal ties to other parts of the world.

Prior to Covid, about one million Australians were estimated to be living and working overseas. A section of the population – often highly educated and skilled – was also very mobile.

But the closed-border policy doesn’t appear to recognise these global connections or the disproportionate impact on first and second-generation Australians, critics say.

In addition, the borders created a narrative where blame for a virus outbreak was often laid at the feet of returning individuals.

“We turned on ourselves, on our own people,” says Dr Allen.

Political leaders described the virus as “imported” by returning travellers, rather than escaping through failures in the hotel quarantine system. Such rhetoric egged on social media commentary blaming incoming Australians.

Just happy to be safe

But while there’s division aimed at Australians outside the country, within the borders people feel comfortable with their lot.

First and foremost, people say they feel relieved and grateful to be shielded from the virus.

“There’s a lot of sympathy and real feeling for people caught up outside, and for the people who can’t go to weddings and funerals overseas,” says Melissa Monteiro, head of a migrant resource community centre in western Sydney.

“But you know, everyone ends with ‘that’s just how it is’. People are firstly, just grateful to be in this country and to be safe.”

Race relations researcher Andrew Markus, an emeritus professor at the University of Monash, says most Australians also don’t view the closed borders as a cultural isolation, or a “shutting yourself off from the world”.

Instead it’s just seen as a necessary short-term health measure – an attitude adopted across the political and cultural spectrum, he says.

He notes too that polling throughout the pandemic showed Australians’ support for multiculturalism and globalisation remained strong – about 80% approval – despite concerns about social cohesion and a rise in hate crimes against Asian-Australians.

Dr Allen says that the strong support for the government’s Covid fight is understandable – particularly when it has worked.

But she also says that the Australian public has been presented with no other options. The prolonged border closure and city lockdowns on single infections have all been largely uncontested policies.

She says it’s time now for Australia to move past such policies which she feels are rooted in fear. The country continues to face calls to bring back its own citizens.

“I don’t think it’s bad that people are afraid of Covid – we should be afraid. But we require leadership going forwards that doesn’t leave people behind.”

Source: ‘Fortress Australia’: Why calls to open up borders are meeting resistance

Provinces are working with outdated vaccine tracking systems, hindering national data

Canada’s patchwork system at its worst:

As Canada prepares for a massive increase in vaccine doses from abroad, some provinces and territories are using outdated technology to record their vaccination data and not fully participating in a system Ottawa created to manage infectious disease outbreaks.

The results of a Globe and Mail survey sent to every province and territory found a patchwork of systems for recording vaccine information that will be crucial in monitoring supply, adverse reactions and population immunity across the country, and for booking appointments. Some provinces reported that they had not enabled core pieces of the technology, called Panorama, that the federal government designed for campaigns like this one.

The SARS epidemic of 2003 highlighted the fact that Canada lacked a modern public-health database to manage all the information related to outbreaks of infectious diseases. Ottawa funded the creation of Panorama for all provinces and territories to use. The platform is actually a suite of technologies and databases for vaccine and infectious disease tracking. But more than a decade of delays and the increasing cost of participation led some provinces to opt out of some parts, revert to their previous systems, or adopt other technology platforms.

The end result is 13 different vaccine-tracking systems, many of which do not communicate with each other or Ottawa.

Shannon MacDonald, an adjunct professor at the University of Alberta faculty of nursing and a researcher with the Canadian Immunization Research Network, said the situation gives the federal government an incomplete picture of the national vaccine program.

“We can’t look at immunization coverage nationally,” Prof. MacDonald said. Some provinces and territories, she added, will struggle even to track their own programs.

Panorama has been in use for several years to track immunizations. The federal government obtained new technology in January to address some of the gaps, and that platform came online on Feb. 2.

Every province that responded to The Globe confirmed it has yet to plug in to the new system.

Representatives of some provinces said health officials still use paper or basic Excel spreadsheets to track vaccines and vaccinations.

The Globe survey found that Quebec, British Columbia, Yukon and Saskatchewan use Panorama, or some version of it, for various aspects of the COVID-19 vaccination campaign. Alberta, the Northwest Territories, Ontario and Manitoba have their own systems. Other provinces did not respond or did not indicate what technology they use.

In light of COVID-19, Ontario hired the accounting company Deloitte Canada to develop a new system. COVaxON, once it comes online, will manage “scheduling, client management, recording administered doses, site inventory management, receipt of vaccination” in a platform that is easy to use, Ministry of Health spokesman David Jensen wrote in response to the Globe survey.

Since December, Canada has received just over a million doses of two types of COVID-19 vaccines. In the next six weeks, four million are scheduled to arrive, and tens of millions more before the end of summer.

The shelf life and storage requirements of each vaccine must be closely monitored. Dale Hunter, a spokesperson for Saskatchewan’s Health Ministry, said the state of the province’s vaccine cold storage is “reported and tracked manually,” meaning the data are sent to the ministry via e-mail or fax. Panorama can be used to manage inventory, but several provinces and territories, including Saskatchewan, said they had not enabled that feature.

The Northwest Territories is using Excel spreadsheets and “specially trained logisticians” to ensure that “no dose is wasted,” Health Ministry spokesperson Andrea Nilson said.

Panorama includes a feature that allows health authorities to scan the barcodes on pallets and doses to keep track of the vaccines and who needs a second dose of which one. None of the provinces or territories that responded to the survey said they had enabled that feature, meaning health authorities enter the data manually.

In Ontario, government employees enter lot numbers into COVaxON when vaccine shipments arrive. Nurses and doctors who administer the vaccines can select the identifying serial numbers on their computers from a drop-down list. This helps clinics track doses both used and unused. Quebec does something similar, Health Ministry spokesperson Robert Maranda wrote.

Mr. Jensen wrote that Ontario’s system could be more efficient if the federal government provided lot numbers in advance.

Many provincial and territorial health systems are accessible on only a limited number of hospital and clinic computers, raising the question of whether they could be used more widely, such as in pop-up clinics or pharmacies.

The Globe asked provinces how they would deal with data entry for vaccinations in makeshift clinics or pharmacies. Manitoba, Alberta, Ontario and Quebec said their systems are designed to be accessible in all clinics and pharmacies. Saskatchewan reported that only public health facilities and some First Nations communities have access to Panorama. Data from pharmacies will be entered manually.

Prof. MacDonald said most provinces and territories have “good enough” systems to manage the vaccination programs. But she said that if any continue recording data with pen and paper, “we’re in a lot of trouble.”

There’s also the question of how provinces and territories will book vaccination appointments.

Alberta, British Columbia, and Saskatchewan are finalizing their booking systems. The Northwest Territories is leaving that issue to health authorities and hospitals. Booking systems for Quebec and Ontario are online.

Health authorities will need to monitor for adverse reactions and the possibility that some people who received the vaccine still contract COVID-19 – which could indicate a defective batch, a more potent variant, or that the patient is among the few for whom the vaccine is not effective.

Quebec’s system is designed to identify defective batches based on reports of adverse reactions and to notify those who received doses. Ontario is tracking adverse reactions with a system that has not been integrated into COVaxON. Saskatchewan and the Northwest Territories have not activated Panorama’s adverse-reaction module, and submit their reports manually.

The Public Health Agency of Canada is the main body responsible for monitoring adverse reactions. However, some provinces told The Globe they report to Ottawa on that manually or infrequently.

As the vaccinations continue, provinces will want to know what proportion of their population is immune at any given time. A 2016 study found the majority of provinces and territories lacked the ability to do a complete analysis of a mass vaccination campaign.

New Brunswick spokesman Shawn Berry said the province’s technology can “obtain near real-time immunization data for COVID-19 vaccinations.” Quebec said its system allows good population surveillance for infectious disease outbreaks, which includes vaccination data. While many provinces and territories that responded did not provide much detail, most told The Globe that, even if they can analyze their data, they do not automatically share the results with the federal government.

Most provinces and territories provided complete answers to the Globe survey, but British Columbia spokesman Devon Smith wrote that “confidentiality and safety” issues prevented the province from answering. Manitoba spokesman Brian Smiley said the province was unable to respond to most questions. Newfoundland and Labrador spokesperson Erin Shea indicated the province was still struggling with a recent outbreak of COVID-19 cases and could not fulfill the request. Nunavut, Nova Scotia and Prince Edward Island did not send responses.

Prof. MacDonald said the COVID-19 crisis should inspire provinces to modernize their health infrastructure. “God forbid it takes a pandemic for us to get moving on this,” she said. “But let’s make hay.”

Source: https://www.theglobeandmail.com/canada/article-provinces-working-with-outdated-vaccine-tracking-systems/

India’s Vaccine Rollout Stumbles as COVID-19 Cases Decline. That’s Bad News for the Rest of the World

Of note:

India’s COVID-19 vaccination scheme looked set for success.

For the “pharmacy of the world,” which produced 60% of the vaccines for global use before the pandemic, supply was never going to be a problem. The country already had the world’s largest immunization program, delivering 390 million doses annually to protect against diseases like tuberculosis and measles, and an existing infrastructure that would make COVID-19 vaccine distribution easier. Ahead of the launch, the government organized dry runs, put up billboards touting the vaccines and replaced phone ringing tones with a message urging people to get vaccinated.

And yet, one month into its vaccination campaign, India is struggling to get even its health workers to line up for shots. In early January, India announced a goal to inoculate 300 million people by August. Just 8.4 million received a vaccine in the first month, less than a quarter of the number needed to stay on pace for the government’s goal. So far, vaccinations are only available for frontline health workers, and in some places police officers and soldiers.

And even that initial interest might be waning. India’s vaccine scheme relies on a mobile phone app that schedules vaccination appointments. On the first day doses were administered, Jan. 16, some 191,000 people showed up. But four weeks later, when those people were summoned for the second dose, only only 4% returned.

A. Valsala, a community health worker in the southern city of Kollam who spent months fighting COVID-19 door-to-door, skipped her appointment to get her first dose of the vaccine after a hectic day on Feb. 12. “I don’t feel the need to rush because the worst is over,” she says. “So there is a sense that it is okay to wait and watch since there are concerns about how these vaccines were developed so fast.”

A. Valsala’s comments point to a troubling trend—one reflected in TIME’s interviews with health workers across India. A combination of waning COVID-19 cases nationwide, questions over the efficacy of one of the two vaccines currently authorized for use in the country and complacency are resulting in growing hesitancy to get vaccinated.

“There is a reduced perception of threat with regard to the virus,” says Dr. Chandrakant Lahariya, a New Delhi-based epidemiologist. “Had the same vaccines been available during the peak of the pandemic in September and October, the uptake would have been different.”

A troubling sign for the rest of the world

Public health experts are now concerned that the sluggish start could impact the subsequent phases of the vaccination drive, especially when the vaccination scheme is widened next month to include older people and those with preexisting conditions.

“In India, people have an inherent trust in doctors,” says Dr. Smisha Agarwal, Research Director at the Johns Hopkins Global mHealth Initiative. “So when [doctors] don’t turn up to get vaccines, it reaffirms any doubts that the general public might have.”

In an effort to accelerate the vaccination drive, the government started walk-in vaccinations as opposed to allowing only those scheduled for the day to get the shots. It also set up new vaccination centers across the country.

For now, India might be an outlier: a country with a surfeit of vaccines with few takers. But its experience shows that, while the first challenge is stocking up on vaccine supplies, convincing people to take them can be its own huge task. It might be a portent for the rest of the world as the number of COVID-19 cases decline globally and vaccines become more widely available, warns Dr. Paul Griffin, an infectious diseases specialist at the University of Queensland in Brisbane.

It’s easy to be complacent about getting a vaccine when cases are declining,Griffin says, “but now, when the trajectory looks favorable, is the right time to step back and realize that this will be our reality for a long time if we don’t speed up the vaccinations at this moment.”

How India fell behind on vaccinations

Despite being well-positioned, India’s vaccination drive got off to a rough start. The hasty approval of the country’s homegrown vaccine, Covaxin, with little data available while Phase 3 trials were still underway (those remain ongoing) drew criticism from health workers and scientists. The mainstay of India’s vaccination scheme is Covishield, the Indian variant of the vaccine developed by University of Oxford and AstraZeneca, which has been approved by regulators in the U.K., the E.U. and elsewhere. However, Covaxin is the only vaccine on offer in some vaccination centers in urban areas and health workers don’t get to choose which jab they receive.

“Covaxin might be efficacious but what guides me is data,” says Dr. Nirmalya Mohapatra at the Dr. Ram Manohar Lohia Hospital in New Delhi, where only Covaxin is available. “We also want vaccines faster because we have seen deaths because of this disease but that doesn’t mean we should cut corners with the data.” Mohapatra has refused to take Covaxin until more data is available.

But even for Covishield, there aren’t as many takers as expected. In the western city of Nagpur, fewer than 36% of those scheduled to take the vaccine turned up Feb. 11, as per a Times of India report. In the north, the city of Chandigarh is planning to set up counselling centres to dispel fearsabout the vaccines. In a hospital in the southern city of Thrissur, Dr. Pradeep Gopalakrishnan was the last one to get the vaccine on the morning of Feb. 8. “No one came in after me, so around 69 doses set aside for the day remained unused,” he says.

Experts say the lack of enthusiasm could also be attributed to a decline in cases. India’s daily case average has dropped to less than 12,000—down from more than 90,000 in September. At the peak of the pandemic, health care systems were overwhelmed, with shortages of hospital beds and oxygen cylinders being reported across the country. India’s official COVID-19 tally, now at nearly 11 million, surged to No. 2 in the world, behind the U.S (where it remains to this day).

In a Feb. 4 press conference, the Indian Council of Medical Research said that more than 20% of subjects over age 18 from across the country tested in late December and early January had antibodies for the coronavirus that causes COVID-19, meaning they likely had the disease and recovered. Similar studies in Mumbai and Delhi showed even higher levels of antibodies—up to 56%, according to Delhi’s health minister. Several health workers interviewed by TIME said they contracted COVID-19, and were less concerned about getting the vaccine immediately because they believe they have immunity.

But health experts warn India is far from herd immunity. And many worry that people not taking vaccines seriously might not bode well for India, given that other countries’ later waves of COVID-19 were even more severe than those early in the pandemic. Already, Maharashtra, the worst-hit state in the country, has seen a COVID-19 spike in recent days, with daily casesabove 5,000 on Feb. 18 for the first in two and a half months

‘The worst is not over yet’

On a global level too, the tendency to let the guard down might hamper efforts to bring the pandemic under control. Experts say vaccination is necessary not only to get long-term immunity but to also reduce the potential for new mutations, which are largely behind recent surges in cases in the U.K and Brazil.

“High vaccination coverage rate reduces the potential for new variants,” says Griffin of the University of Queensland. “The more cases we have in circulation, the more chances there are of generating mutations that confer some kind of benefit to the virus.”

Even in countries like the U.S. and the U.K., where vaccination started during a surge in cases, there is a risk that people lose enthusiasm once cases decline. Experts emphasize the need for better communication with the public to ensure that vaccination drives don’t slow down with COVID-19 case counts.

“There isn’t any time to wait because the worst is not over yet,” says Agarwal of Johns Hopkins. “Despite the fatigue, ramping up the vaccination is the only and best weapon we have against what might otherwise be a very long winter.”

Source: India’s Vaccine Rollout Stumbles as COVID-19 Cases Decline. That’s Bad News for the Rest of the World

Across The South, COVID-19 Vaccine Sites Missing From Black And Hispanic Neighborhoods

Not surprising. Hope someone will do a similar analysis for Canada (once we have a full supply of vaccines):

Georgia Washington, 79, can’t drive. Whenever she needs to go somewhere, she asks her daughter or her friends to pick her up.

She has lived in the northern part of Baton Rouge, a predominantly Black area of Louisiana’s capital, since 1973. There aren’t many resources there, including medical facilities. So when Washington fell ill with COVID-19 last March, she had to get a ride 20 minutes south to get medical attention.

Washington doesn’t want to fall sick again, so she was eager to get vaccinated, which is in line with federal health recommendations. But she faced the same challenge she did last year: finding a local provider, this time for a vaccine. She tried for weeks, checking at pharmacies in the area. And she was put on a waiting list.

Georgia Washington has lived in Southern Heights, a predominantly Black neighborhood in the northern part of Baton Rouge, La., since 1973. After falling ill with COVID-19 last year, Washington was eager to get vaccinated, which is in line with federal health recommendations. But Washington again had difficulty finding a local provider, this time to get a vaccine.

“I’ve got lots of patience,” Washington said. “I just want to get it over with.”

Communities of color have been disproportionately harmed by the COVID-19 pandemic. Now they’re at risk of being left behind in the vaccine rollout.

Using data from several states that have published their own maps and lists of where vaccination sites are located, NPR identified disparities in the locations of vaccination sites in major cities across the Southern U.S. — with most sites placed in whiter neighborhoods.

NPR found this disparity by looking at Census Bureau statistics of non-Hispanic white residents and mapping where the vaccine sites were. NPR identified counties where vaccine sites tended to be in census tracts — roughly equivalent to neighborhoods — that had a higher percentage of white residents, compared with the census-tract average in that county. Reporters attempted to confirm the findings with health officials in nine counties across six states where the differences were most dramatic: Travis and Bastrop counties, Texas; East Baton Rouge Parish, La.; Hinds County, Miss.; Mobile County, Ala.; Chatham County, Ga.; DeKalb County, Ga.; Fulton County, Ga.; and Richland County, South Carolina.

The reasons are both unique to each place and common across the region: The health care locations that are logical places to distribute a vaccine tend to be located in the more affluent and whiter parts of town where medical infrastructure already exists. That presents a challenge for public health officials who are relying on what’s already in place to mount a quick vaccination campaign.

It’s a problem that exists not just in the South but across the country. A team of researchers at the West Health Policy Center and the University of Pittsburgh found nearly two dozen urban counties where Black residents would need to travel farther than white residents to a potential vaccination site — unless health officials act to narrow the disparities.

“We’re hopeful there will be new facilities that are stood up,” says Dr. Utibe Essien, an assistant professor of medicine at the University of Pittsburgh who studies health disparities and worked on the research team. “But what we saw play out with COVID testing was there were new facilities that came up, but they relied on existing infrastructure.”

“This is structural and foundational to the racial disparities in our country.”

Troubles getting vaccinated in Black neighborhoods

In the part of Baton Rouge where Georgia Washington lives, there is just one Walgreens where COVID-19 vaccines can be found.

Ever since an interstate was built through Baton Rouge in the 1960s, the population in the northern part of the city has struggled with housing, food insecurity, poverty and crime. These inequities have always fueled disparities in health care in Baton Rouge. The vaccine rollout is just the latest example.

“When you go to north Baton Rouge, there are very few [health care] choices. And then how many of those are participating in the vaccine program?” said Tasha Clark-Amar, CEO of the East Baton Rouge Council on Aging.

Clark-Amar runs about two dozen senior centers around the city, and her organization stepped up to fill the pharmacy gap by obtaining and providing vaccines. Clark-Amar’s group organized a pop-up clinic in mid-January, giving out around 1,000 doses that it secured from the grocery chain Albertsons. But another time, a community health clinic planned to give Clark-Amar around 150 doses for seniors — except the clinic couldn’t deliver on that promise and she had to cancel the pop-up event at the last minute.

“I was livid. I was so angry and frustrated,” she said. “Thirty-five of the people we had registered are between the ages of 80 and 99. Now you tell me, how am I supposed to pick?”

Clark-Amar has been able to schedule other pop-up events. In fact, that’s how Washington was finally able to get a vaccine. She went to one of the council’s pop-up events at a local community center in late January.

Clark-Amar says this patchwork of resources is part of life in many underresourced Black communities.

In the next state over, people are facing similar challenges. In Hinds County, Miss., where the state capital of Jackson sits, there’s only one major drive-through site, which is where the state is sending the vast majority of doses. The state added the site in late January, weeks after it had already put two drive-throughs in the wealthier, whiter suburbs just outside the city.

“It took us a little bit of time to get it logistically set up to make sure we had a Hinds County site,” Mississippi’s state epidemiologist, Dr. Paul Byers, acknowledged at a recent news conference. “But we were always planning to do that. And we are glad that we have that now.”

There’s still a problem for the residents of Hinds County, nearly three-quarters of whom are Black: The vaccination site is north of downtown Jackson in a neighborhood that is 89% white and already has more medical facilities. It’s close to a 30-minute drive from the more rural parts of the county, where many Black residents live.

In Alabama, the state has consistently ranked near the bottom in vaccine distribution since the rollout began.

But in terms of where the vaccine is available, NPR’s analysis found a disparity in one of the state’s largest counties. In Mobile County, 18 vaccination sites are listed on the Alabama Department of Public Health webpage. Fourteen are located in the whiter half of neighborhoods in the county.

Rendi Murphree, director of the Bureau of Disease Surveillance and Environmental Services at the Mobile County Health Department, said it has been hard for the county to get any vaccines at all. She also said distribution is based on which sites have the capacity to store vaccines at very low temperatures.

Joe Womack, a native of a historically Black neighborhood known locally as Africatown, said Black communities in the northern part of Mobile have always dealt with poverty, pollution and health disparities.

“It’s been a struggle ever since the ’70s,” said Womack, president of the Africatown community group C.H.E.S.S.

Beyond the South

Because of the need for a quick rollout, vaccination sites are largely dependent on the health care infrastructure already in place. Places such as pharmacies, clinics and hospitals make convenient sites for vaccines to be administered.

But the locations of those facilities can be inconvenient for millions of Americans. Those are the findings from a team of researchers at the nonpartisan West Health Policy Center and the University of Pittsburgh who analyzed the distance that Americans live from these types of places.

In 23 of the nation’s urban counties, the researchers found, Black residents were less likely than white residents to be within a mile of a site that could potentially distribute vaccines. In just these counties, they estimated 2.4 million Black residents were farther than a mile.

“We worry this is going to exacerbate disparities in outcomes even more now,” says Inmaculada Hernandez, an assistant professor of pharmacy and therapeutics at the University of Pittsburgh who analyzed the data. “The limitations of existing infrastructure in counties are very different.”

And it’s not just in urban areas. In more than 250 other U.S. counties, the researchers found, Black residents were less likely than white residents to live within 10 miles driving distance of a site. Hernandez estimates the true number of places with this disparity to be higher, since the researchers only estimated based on a sample of county residents. Georgia and Virginia top the list of states with the most counties that have this disparity.

The Georgia Department of Public Health declined to comment on the University of Pittsburgh study. The Virginia Department of Health pointed to plans to deploy the National Guard to assist with vaccinations, as well as mass vaccination sites it set up at places like a convention center, a raceway complex and a vacated department store.

“A long history of racism”

The effects of this gap, coupled with historical trust issues between Black Americans and health care providers, are already reflected in the nationwide data showing who’s getting vaccinated. According to a Centers for Disease Control and Prevention analysis published this week — which included race data on half of those who were vaccinated in the first month of the vaccination campaign — Blacks are lagging behind in vaccination rates, even when accounting for the demographics of health care workers and others who were in top priority groups.

Thomas LaVeist, a dean and health care equity researcher at Tulane University in New Orleans, says medical deserts go back into the early evolution of health care.

“But I do think that the South is perhaps more of a problem than some other parts of the country,” says LaVeist, who is also co-chair of the Louisiana COVID-19 Health Equity Task Force. “Part of that is a long history of racism, Jim Crow and, in some cases, intentional actions that were taken to ensure that some communities did not have access to health care and other resources, while others did.”

And it’s not just Black neighborhoods having trouble getting access. In Texas, with its large population of recent immigrants, the problem of location and convenience is interwoven with a lack of trust.

Texas health officials recently designated several vaccination “hubs” around the state after advocates and local officials raised concerns about the state’s initial plan to rely heavily on chain grocery stores and pharmacies to distribute the vaccine. The hubs will make their own decisions about where to distribute the vaccines they are allocated.

But as the Texas Tribune reported, when Dallas County tried to take it a step further by prioritizing ZIP codes where mostly Blacks and Hispanics live, state officials threatened to withhold doses.

The way that hubs allocate their vaccines is an especially important issue in smaller counties like Bastrop County, east of Austin.

The state’s list of providers in the county shows they are almost all clustered around State Highway 71 — mostly in the city of Bastrop — which is far from the rural county’s outskirts, where many Latinos live.

Edie Clark, a leader with a local faith-based nonprofit, said her group is worried for neighborhoods like Stony Point, which is a small immigrant community in the county.

Clark said members of the Stony Point community are still reeling from events a few years ago when the Sheriff’s Department turned over roughly a dozen residents to Immigration and Customs Enforcement for deportation. Many of those arrested were pulled over for minor traffic violations, like a broken taillight.

“They have a lot of distrust and fear of giving their information out without knowing it’s not going to be used against them,” she said.

Clark said it’s tough to imagine that a lot of people in Stony Point will drive to get vaccinated in the city of Bastrop when they won’t even drive there to get groceries. The U.S. Department of Homeland Security announced this week that immigration agencies will not make immigration enforcement arrests at vaccination sites.

Fast or fair

Reaching long-neglected communities takes time — and in the race to get vaccines to as many people as possible, time is in short supply.

Still, when the CDC outlined four ethical principles for the allocation of vaccines, two of them included equitable and fair distribution. CDC spokesperson Kristen Nordlund said, “Vaccine allocation strategies should aim to both reduce existing disparities and to not create new disparities.”

But the pressure to get the vaccine out quickly means not everyone follows those principles. In South Carolina, the board of the state’s Department of Health and Environmental Control shunned a proposal last week that would have factored age and “social vulnerability” metrics into its vaccine allocations. It opted instead to distribute solely by county population, citing a need for speed.

“I think when you look at speed, certainly, it’s probably a lot easier and faster and quicker to do those calculations when it’s just based on per capita,” said Nick Davidson, the South Carolina health department’s senior deputy for public health.

In Georgia, the high demand for COVID-19 vaccinations has left little opportunity for providers to build up new infrastructure to supplement what already exists or to work with members of historically marginalized communities on any hesitations they might have about getting vaccinated.

That’s why the Good Samaritan Health Center in Atlanta has been saving a handful of its vaccination appointments for people who might want to meet with a health care provider at the clinic to ask questions before rolling up their sleeves.

“And at the end of most of those conversations, the person says, ‘You know what? That was what I really needed. And now I’m ready to be vaccinated,’ ” said Breanna Lathrop, the clinic’s chief operating officer.

Even for those eager to get the vaccine, it’s hard to find in certain parts of the city. Only one of Atlanta’s five large-scale county vaccination sites falls in the Black neighborhoods south of Interstate 20 — and that outlier sits in a shopping mall directly adjacent to the interstate on the outskirts of the city. Many of the smaller vaccination sites that are in those Black neighborhoods are grocery store pharmacies, which receive a much lower number of doses than what can be found at hospitals and the county sites.

A few hours away in Savannah, Ga., NPR’s analysis shows just one of Chatham County’s half-dozen vaccination sites is located in a majority-Black neighborhood. That didn’t surprise Nichele Hoskins. She’s assistant director of a local YMCA-led coalition called Healthy Savannah and works to flatten out health disparities among people of color.

“In order to get people vaccinated, you’re going to have to have that kind of trust,” Hoskins said, noting it can seem a tedious process. “If you’ve ever done retail, it’s going to take a little bit of hand-selling.”

The Coastal Health District in Savannah, of course, can’t take each patient by the hand. The health director, Dr. Lawton Davis, says it’s tough to formalize a plan targeting Black residents, who make up about 42% of Chatham County’s population. So far, the Coastal Health District has reached out to two Black churches and a community health center in a predominantly Black neighborhood to arrange mobile vaccination clinics. It’s also using an existing hurricane evacuation registry of people with disabilities and health issues to help identify neglected neighborhoods around Savannah.

“There simply is not enough vaccine to go around,” Davis says. “I don’t have a formal document that says this is, you know, step A, B, C and D, but we have had reasonably in-depth discussions and we have, shall we say, a game plan on how we think this will go.”

There are other options in a public health game plan.

“Alternative facilities come to mind,” Jeni Hebert-Beirne, who leads the Collaboratory for Health Justice at the University of Illinois at Chicago’s School of Public Health, wrote in an email to NPR. “Public libraries (an important source of free wifi), community centers/park districts, faith-based organizations, barber/beauty shops. These are places that people regularly convene/gather and places where people are more likely to feel they belong.”

Shivani Patel, a researcher tracking COVID-19 health equity issues at Emory University in Atlanta, is quick to acknowledge that the problem is too large for a state’s public health system to solve on its own. Like many across the country, Georgia’s public health system has seen funding cuts in recent years that have reduced its capacity to respond to the pandemic.

Washington is also promising new support for states: A million more doses weekly are on their way to pharmacies, and the White House’s COVID-19 czar said, “[Pharmacy] sites are selected based on their ability to reach some of the populations most at risk.” The new sites are expected to start receiving the doses next week.

“Every day is potentially more lives lost,” Patel said. “This is extremely urgent.”

WWNO’s Shalina Chatlani is a health care reporter for NPR’s Gulf States Newsroom; she reported from Baton Rouge, Louisiana. KUT reporter Ashley Lopez reported from Bastrop, Texas. WABE reporter Sam Whitehead reported from Atlanta.

Methodology: NPR gathered addresses of permanent vaccination sites from state websites. NPR verified these sites by contacting county and state health officials in the nine counties mentioned in this report. Officials were offered the opportunity to review the findings and point to additional testing sites. What counts as a vaccination site varies by state. NPR geocoded vaccination site locations using the Google Geocoding API joined with Census Bureau shapefiles to determine what census tracts they were within. For each county, the analysis included only census tracts within the county’s official boundaries. The Census Bureau provided demographic data per census tract. The main demographic measure referenced in this story was the percentage of the population that identifies as “white alone,” not Hispanic or Latino. For percent white, NPR calculated the number of sites for tracts above and below the median county’s percentage of white residents. Medians referenced are medians of census tracts and are not population totals, and may therefore differ slightly from population totals.

Source: Across The South, COVID-19 Vaccine Sites Missing From Black And Hispanic Neighborhoods

Vaccines For Data: Israel’s Pfizer Deal Drives Quick Rollout — And Privacy Worries

A key factor behind Israel’s success in vaccination:

How has tiny Israel beat out bigger countries on COVID-19 vaccinations, securing a steady stream of vials and inoculating a larger share of its citizenry than any other nation?

Israel paid a premium, locked in an early supply of Pfizer-BioNTech vaccines and struck a unique deal: vaccines for data.

The nation of some 9 million promised Pfizer a swift vaccine rollout, along with data from Israel’s centralized trove of medical statistics to study “whether herd immunity is achieved after reaching a certain percentage of vaccination coverage in Israel,” according to their agreement.

“We said to Pfizer … that the moment they give us the vaccine, we’ll be able to vaccinate at the speed they’ve never heard of,” Israel’s health minister Yuli Edelstein tells NPR.

Israel’s small size and technologically advanced public health system offer an attractive model for Pfizer to demonstrate the impact of the vaccine on an entire population. Pfizer has not signed a similar agreement with any other country, company spokesperson Jerica Pitts says.

The vaccines-for-data trade-off has sparked impassioned debate in Israel among data privacy experts, biotech researchers and the country’s own medical ethics board, weighing the potential benefits of mining the population for vaccine insights against the potential abuse of millions of personal medical records.

“We need to understand that [Israel’s agreement with Pfizer] is going to be one of the, I would say, widest medical experiments on humans at the 21st century,” says the Israel Democracy Institute’s Tehilla Shwartz Altshuler, a data privacy advocate and a leading voice questioning the Pfizer data deal.

Some Israeli commentators have accused Shwartz Altshuler of seeking to spoil a successful national campaign that the government has branded with the hashtag “VacciNation.” She and many other Israeli experts tend to concur that quick access to the vaccine is Israel’s most important priority.

Israel is already reporting promising initial results of the vaccination campaign. The Health Ministry said Thursday that out of a group of 715,425 Israelis fully vaccinated, only 317 — 0.04% — got infected with the virus at least one week after their second shot, and 16 were hospitalized with serious symptoms.

Israeli HMOs have reported a decrease in infection rates among those vaccinated with one shot of the Pfizer vaccine, and a drop in the country’s serious COVID-19 infections for older age categories a couple of weeks after Israel started its national vaccination drive.

“I think that it’s really very special that Israel’s been recognized by Pfizer as a country that the whole world can learn from,” says Diane Levin-Zamir, director of health education at Israel’s largest HMO, Clalit Health Services. “There’s good research coming out and we’re being very transparent about the data.”

Vaccines and politics

Most Israelis are celebrating their record-setting vaccination drive. “To be the first place in the world, it’s a good feeling,” says Yoni Boigenman, an Israeli getting a first shot of the Pfizer-BioNTech vaccine at Jerusalem’s main sports stadium, which has been converted into a hive of needles and nurses 14 hours every day.

Close to a third of the population has received at least one shot of the Pfizer-BioNTech COVID-19 vaccine and about 17% received both shots, far beyond any other country. Israel aims to be the first to vaccinate most of its citizenry against COVID-19 before elections are held March 23.

The vaccine drive is central to Prime Minister Benjamin Netanyahu’s reelection campaign. The first Israeli to receive a shot, Netanyahu mounted his syringe in a glass box, the needle angled upward like a rocket ship, with a plaque riffing off the words of U.S. astronaut Neil Armstrong: “One small shot for a man, a giant step for everyone’s health.”

Israel has waved away human rights groups’ assertions that the country is obliged to provide vaccines to Palestinians in the Israeli-occupied West Bank and the Gaza Strip; Israel says the Palestinian Authority holds that responsibility.

Still, Israel has decided to send 5,000 COVID-19 vaccines to Palestinian medical workers in the West Bank, with an initial shipment this week, Defense Minister Benny Gantz’s office tells NPR. Palestinian officials signed late deals with vaccine manufacturers and still await shipments to begin vaccinating the public.

Some Israeli medical experts warn that widespread immunity cannot be achieved so long as millions of Palestinians are not vaccinated. Palestinian officials say they do not expect to vaccinate the majority of their population until at least the end of the year.

“It’s a gold mine”

Nearly every Israeli citizen and resident belongs to one of four public HMOs, a health care system rooted in the national trade union of Israel’s early years. Every Israeli’s full medical history – from physician visits to hospitalizations – is accessible to any health provider at the click of a mouse, a repository of digital records going back 30 years.

“It’s a gold mine,” says Ziv Ofek, who helped launch Israel’s public health database, which he asserts is unparalleled by any other country.

Unrelated to the Pfizer study in Israel, Ofek’s medical data company, MDClone, is helping assemble a separate Israeli coronavirus patient database, with privacy protections. Israeli researchers are already tapping it for insights, such as findings that suggest a higher likelihood of dying from COVID-19 among those with fatty liver disease.

The data offers potential for vaccine research, too.

“Is there any progression of other diseases? … Does it impact your hypertension?” Ofek says. “All you need to do is just to be able to load the fact that you’ve been vaccinated, and then you can run new studies.”

Privacy concerns

The Israeli Health Ministry initially kept the terms of the Pfizer agreement confidential, but on Jan. 17 published part of the English-language contract, dated Jan. 6, to reassure the public about data use. Instead, the fine print has raised further questions.

Israel’s medical data experts want to know exactly what Israel is giving Pfizer, and whether the data being studied amounts to a clinical trial without the express consent of the millions of Israelis rushing to get vaccinated.

In interviews, Israeli officials insist they are only giving Pfizer anonymous statistics already provided to the public, such as the number of weekly cases and hospitalizations.

Pfizer said in a statement that it “will not receive any identifiable individual health information. The [Israeli Ministry of Health] will only share aggregated epidemiological data.”

But the contract says Israel will give Pfizer unspecified “subgroup analyses and vaccine effectiveness analyses, as agreed by the Parties,” leaving open the possibility that more personalized categories of data could be delivered.

“Can you have a real research based on … statistical numbers? This is not research,” Ofek says. Israeli health officials “claim they don’t give patient-level data, only statistics. There’s a big question whether it’s the whole truth, part of the truth or no truth at all.”

Privacy and medical data experts say buckets of data scrubbed of patients’ personal details can still be traced back to identify people if the sample is small enough, revealing sensitive medical details such as who is HIV-positive. If Israel transfers such private data to Pfizer, there are concerns it could get hacked and disseminated by third parties.

“Your insurance company will know all your medical history. Your employer will know it. The political campaigner who would like to convince you to vote for someone would know everything about your medical history, not to say about people who would like to marry your children,” warns Shwartz Altshuler, describing what she calls a small concern.

The contract also allows Pfizer or Israel to “provide input, make factual corrections” and delay publication of their studies of the vaccine’s effectiveness, which some Israeli medical data and privacy experts say could allow either party – each with vested commercial and political interests in the vaccine’s success – to hide or delay publication of failures. A Pfizer spokesperson did not respond to NPR’s query on this matter.

The head of Israel’s medical ethics review board, Dr. Eitan Friedman, says the review board has requested further clarification on the agreement. The government has not officially responded to the board’s request to review the agreement, he says.

If Pfizer and Israel are studying response to the vaccine by subgroups of Israelis’ demographic profiles and medical conditions, it should qualify as a clinical study requiring his board’s approval, says Friedman.

“There needs to be total transparency. No one party can override the real data. We need to know the truth,” he says.

The data study and fast vaccine rollout have fed some suspicions. Skepticism among the vaccine is prevalent among Palestinian citizens and residents of Israel.

“I heard so many rumors about this. Some say … they want to see the experience on the people here, if it’s a good vaccine or not. That’s why I’m a little confused about it,” says Nuha Sharif, a Palestinian resident of Jerusalem who nevertheless came to the Jerusalem sports arena to get her shot.

She has Israeli health insurance and received the vaccination for free, unlike Palestinians in the West Bank and Gaza who are still waiting for vaccine manufacturers to deliver vials to the Palestinian territories.

Some Israelis getting shots at the arena say they are not worried about their data.

“If it can help the world to get out of it, I don’t care,” Noam Ben Dror says. “I don’t think it’s a big secret, my personal data.”

Source: Vaccines For Data: Israel’s Pfizer Deal Drives Quick Rollout — And Privacy Worries

Engage the ethnic press to combat vaccine hesitancy

Star has been featuring a number of similar op-eds, this being the latest:

In recent days, doctors across Canada have been calling for “culturally competent” campaigns to fight vaccine hesitancy. But we need much more than that.

In long-term-care homes, there have been reports of personal support workers (PSWs) refusing to be vaccinated — despite the fact they work in high-risk environments. Many essential workers, including PSWs, are from highly racialized populations.

Some of the worst COVID-19 hot spots across the country have been in population centres with high counts of new Canadians and immigrants.

Knowing that, you might imagine that governments would be placing public health announcements in as many ethnic publications as possible. Unfortunately, that has not been the case.

The Government of Canada only advertises in 11 languages aside from English and French. There are far too many outlets who aren’t receiving any government ads to share with their readership. As some doctors have reported from firsthand experience, the outreach to ethnic outlets has been, in some cases, non-existent.

When the pandemic hit, ethnic media was particularly affected. Most advertisers for ethnic newspapers, radio shows and TV shows are small businesses, hosts of events and conventions — all sectors hit particularly hard from the get-go.

Though some government assistance reached some members of the ethnic press, for far too many, the collapse of advertising was too much to bear. Many outlets weren’t eligible for any government assistance.

What that has meant is that outlets have closed, gone purely digital, cut their publication schedules, laid off staff, cut circulation or some combination thereof.

Day-to-day, this has meant less access to reliable and accurate news for new Canadians and immigrants. Non-English-speaking seniors, who relied on their printed ethnic newspaper to stay informed, have seen their access to news yanked away or reduced.

Even worse is that even if they are still getting a paper, it doesn’t necessarily contain accurate information from government sources — information that is going to be critical as we continue the fight against COVID-19 and misinformation about the vaccine.

While misinformation has spread, ethnic reporters have been laid off. We have tracked this — layoffs now reach as high as 80 per cent. Fewer staff means less news for the outlets who have managed to survive.

There is no magic bullet to fix vaccine hesitancy, but engaging the ethnic press will help in communities that need it. It’s not just about dollars — we need the government to send public health experts onto ethnic shows, press releases to be translated into as many languages as possible and regular government-led briefings for ethnic media.

And yes, we need to keep ethnic publications afloat and help them return to their pre-pandemic publishing schedules.

Canada’s Chinese language press isn’t just combating misinformation from Canada, it’s combating misinformation from around the world. The same goes for outlets publishing in Polish, Spanish and every other language under the sun.

The best way to fight fake news is with the truth. Ethnic journalists are ready to work to spread it in as many languages as possible.

Source: https://www.thestar.com/opinion/contributors/2021/02/01/engage-the-ethnic-press-to-combat-vaccine-hesitancy.html

Quebec to wait up to 90 days to give second dose of COVID-19 vaccines

The province that has the highest infection and death rates, comparable to some of the worst hit G7 countries, is taking this risky approach. This will generate some good comparative data regarding following the Pharma companies advice and not doing so. But as someone who follows the instructions on my meds, question the wisdom: 

Quebec will wait up to 90 days before giving a COVID-19 vaccine booster to people who have received a first shot, Health Minister Christian Dube said Thursday.

That delay goes far beyond the recommendations of vaccine manufacturers Pfizer and Moderna, which propose intervals of 21 and 28 days respectively, and is more than double the 42-day maximum proposed by Canada’s national vaccine advisory committee.

Dube told a news conference that the decision was made in order to vaccinate as many vulnerable people as possible and to reduce the pressure on the health system.

“In our context, this is the best strategy, because we have to contend with (having) very few vaccines, and we’re in a race against the clock,” Dube said at a news conference.

Dube said the province had discussed the decision with both vaccine manufacturers and federal public health officials. He said the latter acknowledged that the 42-day recommended maximum can be extended depending on the disease’s progression in a particular province.

He said the high rate of community transmission, hospitalizations and deaths in Quebec justified the change.

“In Quebec we don’t have the same situation as in New Brunswick or British Columbia,” he said.

Richard Masse, a senior public health adviser, said the change would allow up to 500,000 seniors who are most at risk of complications — including those in private residences and those aged 80 and up — to receive their vaccine several weeks earlier than originally thought.

He said the justification to extend the interval was based on the “experience of working with many vaccines through time,” which shows that vaccine immunity does not suddenly drop off within a month or two.

However, he said the province was carefully monitoring the efficacy of the shot and would immediately give second doses if it saw evidence of decreased immunity in certain groups, such as the elderly.

Both Masse and Dube said the province would work to shorten the interval between first and second doses once the province begins to receive larger quantities of vaccine.

Meanwhile, the province was reporting some regions of the province have few or no doses of COVID-19 vaccine remaining as the vaccination effort outpaces the speed of delivery.

Quebec says as of Thursday morning, the Gaspe region, Iles-de-la-Madeleine, Nord-du-Quebec and the James Bay Cree Nation territories are out or almost out of vaccine; the province expects new deliveries Friday or Saturday.

Four other regions had almost used up all their doses but received new supplies Tuesday.

The province reported 2,132 new cases of COVID-19 Thursday and 64 more deaths attributed to the novel coronavirus, including 15 that occurred in the previous 24 hours.

One death previously attributed to COVID-19 was removed from the total after it was determined to be unrelated. Quebec has reported a total of 236,827 infections and 8,878 deaths linked to the virus.

Jean Morin, a spokesman for the Gaspe region’s health authority, said the vaccination campaign was going “exceedingly well” despite the fact nearly all the doses have been used.

Morin said there are logistical challenges to vaccinating people in the vast and thinly populated region, including having to transport people to clinics to receive their shots.

He says he expects the highest-priority groups in the region will be vaccinated by the end of January.

Source: Quebec to wait up to 90 days to give second dose of COVID-19 vaccines

What good are COVID-19 vaccines if people are afraid? We need to build trust with racialized communities, specifically PSWs facing vaccine hesitancy

Good practical suggestions;

Never in history have we gone from identifying a pathogen to creating and disseminating a safe and effective vaccine in under a year, however, we have not done a good job of explaining how we have been able to utilize scientific innovation without compromising on safety. Terms such as ‘Operation Warp Speed’ have not helped with hesitancy. Decades of mistrust towards pharmaceutical companies have also exacerbated this.

So, we must discuss vaccine hesitancy. What is it? It describes people who are not flat out against vaccinations, but who are anxious and afraid of vaccines, or sometimes one specific vaccine. Over the past few years, it’s a term that has gained traction even before the COVID-19 pandemic. These are individuals who may be continuously bombarded with fear-based and conflicting misinformation on vaccines.

In a Nov. 2020 poll from Ipsos and Radio-Canada surveying 3,000 Canadians on whether they were willing to take the COVID-19 vaccine when available, a large per cent reported they would get the vaccine, but less than 40 per cent said they would be willing to get it immediately.

This speaks to ongoing underlying hesitancy that must be addressed. Importantly, hesitancy involves not just refusal of vaccines, but delay despite availability.

Given that our health care workers are part of our communities, we can extrapolate that hesitancy may also be prevalent among those employed in vulnerable sectors such as our long-term care (LTC) homes. Several factors may impact their decision making, from concerns and fears around safety and effectiveness of the vaccines, to social, cultural and political influences, as well as logistical barriers that decrease access. Moreover, we must acknowledge that personal support workers (PSWs) in Ontario LTC homes largely belong to racialized communities that may harbour mistrust in the health care system, impacting vaccine uptake. Therefore it is not surprising that in many LTCs, anecdotally, around a third have refused or delayed vaccination. A poll undertaken at Windsor Regional Hospital found that more than 20 per cent of staff from seniors’ facilities are refusing or delaying vaccination.

As part of the scientific community, it is our job as the vaccines roll out to discern these workers’ concerns, fears and to acknowledge their mistrust or skepticism in a compassionate manner. Filling knowledge gaps and busting myths will only go so far. Black and Indigenous communities have had long-standing histories of abuse within our system and if we are to reach these communities, which are disproportionately affected by COVID19, we need to involve community leaders to engage and encourage widespread vaccination.

There is a long legacy of racism and discrimination resulting in significant mistrust in health care by BIPOC communities. And with good reason. If you feel you or your life is not valued, then how can you trust them? This is where tailored trauma-informed messaging is critical. Telling a racialized minority that Health Canada has reviewed the efficacy and safety of the vaccine and considers it safe is almost meaningless to a community that has mistrust across several systems of government whether it be educational, judicial or health care.

Currently, visible minorities are overrepresented among PSWs, making up 42 per cent in Ontario based on a CRNCC/PSNO survey, of which 18 per cent self-identify as Black and 5 per cent as Indigenous. Looking at the broader group of nurse aides, orderlies and patient service associates in Toronto, almost 79 per cent are immigrants. So it really should come as no surprise that this group has been hesitant to be the first in line to get vaccinated. However, little is being done to alleviate their fears and concerns.

We must prioritize collection of data. If we don’t see the problem, we cannot fix it. We have minimal data in Canada on vaccine hesitancy in general, and also no data on vaccine hesitancy in BIPOC communities. We know that the number of people refusing the vaccine is not insignificant, but we are not collecting this data.

What is driving their concerns? We know that PSWs are often racialized women; in fact, women account for the majority of nurse aides, orderlies and client service associates. Many are in their child-bearing years and are concerned about impact on fertility. There has been reluctance because the National Advisory Committee on Immunization guidelines as well as the Ontario Ministry of Health did not recommend the COVID-19 vaccine in those who are pregnant, breastfeeding or trying-to-conceive. While our obstetricians and gynecologists are rightfully advocating for this group to be able to receive the vaccine, as historically trials have excluded this population, changing messages without adequate discussions may not instill confidence.

We need to increase education, but encourage this information to also come from someone they trust. That could be their primary care providers, a partner community health organization or leaders they work closely with at their LTC homes. We need to be proactive and increase access to culturally sensitive, multi-language trauma informed educational materials.

We also need to break down barriers to vaccine distribution. Much light has been shed on PSWs needing to work multiple jobs as their positions are often part-time without benefits. Vaccine administration cannot just be during the day. Accessibility to on-site vaccinations in our LTCs homes is necessary. Paid sick time in the event of side effects should be mandated.

Lastly, we cannot be dismissive of fears. We must be empathetic, and provide factual information in an easy to understand manner, without any sensationalism or jargon. We must be respectful and compassionate. There is so much work yet to be done to ensure a successful uptake of the COVID-19 vaccine. Because after all, what good is a highly efficacious vaccine if people are too afraid to take it?

Sabina Vohra-Miller is the co-founder of the Toronto-based Vohra Miller Foundation, which aims to make health care equitable and accessible for all. Follow her at @SabiVM.

Dr. Anjali Bhayana is a family physician and staff hospitalist in geriatric rehabilitation at UHN TRI. Follow her at @AnjBhayana.

Source: What good are COVID-19 vaccines if people are afraid? We need to build trust with racialized communities, specifically PSWs facing vaccine hesitancy

HASSAN: Pakistan’s particular second wave challenge

Given Pakistan one of our top five immigration source countries,  of interest, with similarities with some of the fringes in Western countries:

Pakistan’s management of the pandemic was initially lauded even by the World Health Organization. Not so, the second wave.

The latest outbreaks have wrought havoc across the world, and Pakistan is no exception. COVID-19 appears to be spreading rapidly in many parts of the country. The rest of the world is beginning to see the hope of ending the pandemic in the development of various vaccines.

But Pakistan poses a special challenge toward fighting the pandemic within its borders. According to Younis Dar, Pakistan’s situation is “far more dangerous” as a significant number of Pakistanis refuse to embrace the idea of inoculation because of rampant suspicion against the vaccines.

Source: HASSAN: Pakistan’s particular second wave challenge