TORONTO: Health officials in the Canadian province of Ontario thought large, central clinics would be the most efficient way to get staff at long-term care homes vaccinated quickly, protecting elderly residents most at risk of severe COVID-19 and death.
As it became clear that some staff could or would not travel to hospitals in large cities like Toronto, wary of the healthcare system or of the vaccines, officials have turned to new strategies, like bringing the shots directly to care homes. There, vaccine teams can speak informally with staff to address their concerns.
Improving the vaccination rate among staff at long-term care (LTC) homes is critical to limiting further deaths and outbreaks in these facilities, where experts recently forecast another 1,520 residents could die by Feb. 14, under worst-case conditions.
As the first wave of the pandemic ravaged Canadian long-term care homes last year, some support staff were left to fend for themselves, lacking even basic protective gear.
“We’ve called them heroes, but we haven’t really treated them like that,” said Amit Arya, a palliative care doctor who treats patients at many LTC homes.
More than 3,000 LTC residents – 58% of Ontario’s overall COVID-19 deaths – and 10 workers have perished from the virus in the province. Outbreaks left some homes so short-staffed they struggled to provide basic care like feeding, according to testimony to a provincial commission.
“They’re fearful and they’re angry, and they’re feeling sacrificed,” Arya said of LTC staff.
Vaccine hesitancy among care home workers also underscores the risk of relying too heavily on large, centralized vaccination centers in other hard-hit communities.
“It won’t work for every population,” said Brian Hodges, chief medical officer at University Health Network (UHN), which has mobile teams vaccinating care home residents and staff.
While nearly all elderly residents offered a COVID-19 shot have been eager to get it at homes visited by UHN in Toronto, among staff, who could bring the virus into these homes, between 25% and 85% of staff have been vaccinated, Hodges said.
‘A LOT OF PEOPLE HAVE CONCERNS’
Vaccine hesitancy is not limited to care home workers. Only about half of Canadians say they are willing to be inoculated as soon as possible, according to a recent poll from Angus Reid. About 30% plan to be vaccinated “eventually” with the rest unsure or unwilling. In the United States, the number of people willing to be vaccinated has ticked up above 60% according to recent Gallup polls.
With their more personal approach, UHN has learned to set up staff vaccination clinics in a prominent location, usually the lobby. Staff hover, without joining the line for shots, and the UHN team circulates to chat.
“We answer their questions, and they see their peers being vaccinated, and then they line up,” Hodges said.
Workers also face practical barriers. Some do not have an easy way to reach central vaccination sites or “cannot afford to take any amount of time to leave work and get a vaccine,” said Sharleen Stewart, president of Services Employees International Union Healthcare.
Many LTC workers are immigrants or people of color, communities that have been hit particularly hard by COVID-19, and that may also be more distrustful of vaccines.
Statistics Canada found in a spring survey that 52% of immigrants were very likely to get vaccinated, compared with 59.4% of people born in Canada.
In the United States, a Reuters/Ipsos poll found Black people significantly less likely to agree to be vaccinated after decades of unequal healthcare access and treatment, under-representation in clinical trials and a history of being used as unwitting subjects in medical experiments.
Krishana Sankar, a program manager at COVID-19 Resources Canada – an alliance of scientists and experts – said misinformation is spreading between family and friends on messaging apps. Her organization is running daily Zoom calls during which LTC staff can ask experts about vaccines.
Some join for advice on how to talk to hesitant colleagues, while others bring their own questions about safety and efficacy of vaccines developed in record time.
“A lot of people have concerns around the vaccines,” she said. “Once we started answering questions around that, a lot of people seemed far more at ease.”
(Additional reporting by Anna Mehler Paperny and Moira Warburton in Toronto; Editing by Denny Thomas and Bill Berkrot)
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