About 83% of Ottawa residents have been vaccinated

About one-quarter of the remaining unvaccinated portion of the population is likely to adamantly refuse. The remainder are still sitting on the fence.

Ottawa Citizen 6 minute read August 2, 2021

When it come to getting vaccinated, Marion Jones, a retired registered nurse, vows that she won’t be swayed by incentives or bow to compulsion.

“There’s a lot of pressure and shaming and blaming,” Jones said. “I am not playing the carrot and stick game with the government. I am making a decision that’s important to me. And I don’t care what other people think.”

About 80 per cent of Ontario’s eligible population has received at least one vaccine.

“We are in the last leg of the race,” Dr. Kieran Moore, the province’s chief medical officer of health, said Tuesday. But the slowing vaccination rate has him concerned.

The “last mile” of the vaccine race will be one that will be won by inches. About one-quarter of the remaining unvaccinated portion of the population, like Jones, is likely to adamantly refuse. The remainder are still sitting on the fence.

It’s this “moveable middle” that public health officials will have to pull out all the stops to persuade.

“If you could get above 90 per cent, the world would feel different,” said epidemiologist Dr. Doug Manuel, a senior scientist with The Ottawa Hospital Research Institute.

But vaccine hesitancy is, at its core, a matter of trust. Those who refuse or hesitate to be vaccinated don’t trust medical authorities, government or pharmaceutical companies, said Max Lê, a project officer with Ottawa Public Health’s communications team who wrote his master’s thesis on vaccine hesitancy.

It calls for a multi-pronged approach and both sensitivity and thick skin.

“It’s a challenge. But it’s something we’re prepared to do,” Lê said.

In Ottawa, 83 per cent of the eligible population has received at least one dose of vaccine, with 70 per cent immunized with both doses.

On the more persuade-able side of the unvaccinated spectrum are those who are not vaccinated because of convenience or logistics: clinics are too far away, or clinic hours conflicting with working hours, for example. Solutions include holding vaccination clinics for employers, Lê said.

Then there are demographic challenges, such as the 20- to 40-year-olds who have lagged behind other vaccine-eligible groups.

Among young people, there is a feeling of invulnerability, Lê said. “A frequent argument is that they knew someone who had COVID and it ‘wasn’t that bad.’”

The electronic music festival Escapade, which announced it will only admit vaccinated ticket holders in 2021, partnered with OPH to offer a July 24 popup clinic featuring DJs and prizes. The clinic had 700 appointments available. It attracted 135 people.

Vaccine hesitancy is nothing new and it’s normal, Lê said. Nurses who answer the phones at OPH have been trained, as have school support nurses, in motivational interviewing and diffusing tense situations. OPH workers are taught to engage with people as much as possible and to ask open-ended questions, such as, ‘What do you think about that?” and to listen more than they speak.

No belittling, shaming, dismissing, or judging someone for being vaccine hesitant or having questions about vaccines.

“It takes time,” Lê said. “You have to be patient. You have to have a follow-up plan when you talk to people. Trust takes time to build.”

It is also crucial that people know they have the right to refuse, he said.

“You have to validate people’s right to say, ‘No.’ It shows empathy. It’s really powerful.”

Marginalized communities often have good reason to suspect authority because of past trauma. OPH has teams of polyglot community development workers who visit priority neighbourhoods.

‘When you communicate with someone who looks and sounds like you, it establishes trust,” Lê said. “We’re trying not to be big government.”

Maombi Mwambutsa, a member of the team, speaks French, English and five languages spoken in West Africa. She’s also happy to answer personal questions about her own vaccine experience.

The newness of the vaccine and trust in government are common themes with vaccine-hesitant people, she said. Newcomers are often still connected to their home countries via social media. Some people don’t access or are skeptical about the mainstream media.

“A lot of people comes from countries where there is war and they don’t trust the government,” said Mwambutsa, who sometimes spends 10 to 20 minutes talking to a single person.

“If someone doesn’t want to talk to me, I never take it personally. It’s about timing. And no judgment.”

OPH workers often face the argument that pressure to be vaccinated will lead to greater assaults on civil liberties. Some of the vaccine-hesitant reject the idea that being vaccinated is a civic duty.

Kelvin Mulligan, 72, says he feels pressured to get vaccinated, but will resist, even though it has created friction in his family.

“I knew it would be presented as, ‘Do your duty, be responsible, be a good citizen,’” Mulligan said. “It’s pretty seductive. But the more intense it gets, the more I feel there’s more to it. They’re making it sound so desperate. Free donuts, lottery draws. Once you smell coercion, it just reinforces your impulse (to refuse).”

Ilian Nikolov, 38, also absolutely refuses to be vaccinated, citing concerns about the speed at which the vaccines were developed, tested and approved. He also questions the effectiveness of COVID-19 vaccines and argues that debate has been stifled and personal freedoms are at stake.

“I come from Eastern Europe. My family escaped that to come to a free country, to choose what you want to do. These choices are being taken away from us,” he said.

Health Canada says researchers have been studying and working with mRNA vaccines for quite some time and these vaccines can be developed faster because they’re made in labs using materials that are easily available. Large-scale clinical trials are carried out to show that the vaccine is safe and effective, the federal health agency said.

Janessa Griffith, a Toronto researcher in health information management, has used Twitter to learn about what makes people hesitant.

The study, published in April in the Journal of Medical Internet Research, screened 3,915 tweets from public Twitter profiles in Canada after vaccines were first introduced in December. Overall, 605 tweets were about hesitancy.

The most common themes were concerns about safety, suspicion about political or economic forces behind the pandemic or vaccine development, a lack of knowledge about the vaccine and anti-vaccine messages from authority figures and celebrities.

There are nuances behind hesitancy and they have to be understood, Griffith said.

“Someone might get their annual flu shots, for example, but they’re hesitant about mRNA technology. If we know what people are hesitant about, then we can tailor our strategies. If people feel judged, then there is no way forward.”

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Manuel sees the last mile lasting into this fall and beyond. Perhaps it may never end and COVID-19 will become endemic, flaring up in pockets of the population.

“Getting to the last mile would be like winning the war. The benefits would be huge,” he said. “Right now, we will not be able to meet the goal unless we do more.”

Public health officials know that they have to spend more money and time on the last last mile, but it’s worth it, Manuel said.

“Every percentage point higher is way more important than the first person being vaccinated.”