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COVID-19 vaccine mandates are coming — whether Canadians want them or not –



This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

Like it or not, COVID-19 vaccine mandates are coming to Canada. 

Whether they’re government-ordered for certain jobs and activities, or implemented in a piecemeal way by the private sector, Canadians can expect to see more aspects of society require proof of vaccination in the weeks and months ahead. 

And with a fourth wave underway in much of the country ahead of schools restarting and borders reopening to some fully vaccinated travellers next month, experts say now is the time to put vaccine mandates in place before another potential surge.

Michelle Quick, 33, gets her second dose of the Pfizer-BioNTech COVID-19 vaccine at a one-day pop-up clinic in the Eaton Centre shopping mall in Toronto on July 27. (Evan Mitsui/CBC)

“They’re coming — one way or the other,” said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.

“Do you want to do it while we are calm in the water? Or do you want to do it when the storm is raging around us?” 

Pedestrians in Toronto carry and don masks on Aug. 12. Health officials are citing rising COVID-19 case counts as a sign Ontario is in a fourth wave of infection. (Evan Mitsui/CBC)

Provinces ‘choosing their own adventure’

Instead of a co-ordinated approach across the country, a patchwork system of vaccine certification is emerging throughout Canada as some provinces outright oppose the concept while others fully embrace it. 

Quebec took the bold first step of announcing this week that vaccine passports for non-essential services, like bars, restaurants, gyms and festivals, would be mandated on Sept. 1 in an effort to avoid reintroducing lockdown measures.

British Columbia announced Thursday that anyone working in long-term care and assisted-living facilities in the province will be required to be vaccinated by Oct. 12, and Manitoba has launched a new proof-of-immunization mobile app for fully vaccinated residents.

But Alberta has repeatedly said it will not bring in vaccine passports and Premier Jason Kenney has outright dismissed the notion of mandatory vaccinations, even amending the province’s Public Health Act to remove a 100-year-old power allowing the government to force people to be vaccinated.

Ontario Premier Doug Ford also firmly rejected the possibility of vaccine passports last month, even for health-care workers, saying the province is “not going to have a split society.”

The federal government made its position known Friday ahead of an election call, announcing it will soon require all public servants to be vaccinated, as well as passengers on commercial planes, cruise ships and interprovincial trains in Canada.

But while Ottawa has taken a hard line on vaccine mandates and committed to creating proof-of-vaccination documentation for international travel by early fall, it stopped short of implementing a domestic vaccine passport system across Canada.

“Unfortunately, the provincial and territorial scene is likely to remain a patchwork for ideological reasons,” said Dr. David Naylor, who led the federal inquiry into Canada’s response to the 2003 SARS epidemic and now co-chairs the federal government’s COVID-19 immunity task force.

“And I don’t think the federal government can force vaccine certificates on subnational jurisdictions.” 

Ottawa working out details of vaccine passport

2 days ago

The federal government says it is working on the details of a COVID-19 vaccine passport that can be used for international travel, which it hopes will be available by the fall. 1:36

Naylor says he hopes the federal government can work with provinces and territories to adapt the newly announced vaccine document for international travel into a national vaccine passport for use in all provinces and territories in the future. 

“The provinces would probably wave that idea off,” he said. “But in a rational universe, we’d have one standardized Canadian document for domestic and international use.”

Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s COVID-19 vaccine task force, says it’s become clear that Canada will not take a national approach to vaccine certification because the federal government doesn’t have the authority to direct provinces and territories to come on board.

“We’re going to have vastly different strategies, with Alberta at one end of the spectrum, and Quebec at the other end of the spectrum — and probably many provinces in between,” he said. 

“But from a policy standpoint, it’s clear that the provinces are choosing their own adventure.” 

Instead of a co-ordinated approach across the country, a patchwork system of vaccine certification is emerging throughout Canada as each province and territory takes its own path. (Evan Mitsui/CBC)

Mandating vaccines ‘not the be all and end all’

The question remains as to how effective vaccine mandates will be in controlling the spread of COVID-19 among the unvaccinated during the fourth wave, and whether testing is sufficient enough to keep community transmission low. 

“You can definitely see how mixing vaccinated and unvaccinated people in high-risk environments could ripple out into unvaccinated populations — particularly ones that are high risk,” said Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton and an associate professor at McMaster University. 

“It makes sense if you get to a certain community incidence, where the odds of someone walking into that place with COVID-19 are starting to get higher and higher by the day, it could start a chain effect.” 

Chagla says Quebec’s approach of only mandating vaccines for non-essential services prevents ostracizing those who aren’t vaccinated — due to choice, eligibility or accessibility — while encouraging more people to get vaccinated so they can engage in more activities.

He doesn’t think vaccine passports are the “be all and end all” in the push to get people vaccinated. “But it certainly is a downstream effect that you do bring people on board and … make them minimize the risk even more going forward,” he said.

“The verification of vaccines is going to be really important, especially as we’re struggling with this in the next little while — maybe the next six months — where we’re going to see a little bit of discomfort with more transmission.” 

People walk by a COVID-19 vaccination sign in Montreal on Aug. 8. Quebec became the first province in Canada this week to introduce a wide-ranging vaccine passport system, to begin on Sept. 1. (Graham Hughes/The Canadian Press)

Dr. Lisa Barrett, an infectious diseases physician and immunologist at Dalhousie University in Halifax, says that while she’s fully in favour of vaccine passports, there are other options for keeping Canadians safe in high-risk settings for COVID-19 transmission. 

“We want to protect public places and people attending them by not having infectious folks around. You can do that with double vaccine — or by showing a negative test for the minority not vaccinated for various reasons,” she said. 

“It’s obviously better on a personal front to be vaccinated, but it preserves some choice while people are getting there.” 

Barrett says while she prefers vaccination for controlling COVID-19 levels, she hates the idea of exclusion until all other options have been exhausted; she points to the ample supply of rapid antigen tests in Canada to help bridge the gap.

Bogoch agrees that while vaccine mandates are an effective strategy at increasing our vaccination levels across the country, unvaccinated Canadians are a diverse population with many different reasons for foregoing a shot — and that needs to be approached with care.

“Some people still have remaining questions and issues and anxiety that hasn’t been addressed. We obviously have to take those questions and issues and anxieties seriously, and address that in an empathetic manner,” he said. 

“I think it’s also fair to say that some people regardless of what we say — regardless of science, reason, logic — some people are just never going to get vaccinated.”

‘Window of opportunity’ to prevent brutal 4th wave

Canada has emerged as one of the most vaccinated countries in the world, with more than 60 per cent of the Canadian population fully vaccinated after a relatively slow start to the rollout. 

But with 40 per cent of the population with lower protection from COVID-19, with only one shot or none at all, there are still millions of susceptible Canadians — especially in the face of the more contagious and potentially more deadly delta variant. 

Unvaccinated adults driving COVID-19 case increase in Canada

4 days ago

There is growing concern about a fourth wave of COVID-19 as cases start to climb again across much of Canada, with the increase being overwhelmingly driven by unvaccinated people in western provinces. 1:54

“Given the fact that we’re about to open everything up, it seems likely that those 40 per cent are going to get infected at some point, which means that we’re going to have a lot of stress on our society,” Deonandan said. 

“There’s a window of opportunity to prevent a lot of societal suffering and frankly, the selling point should be to businesses — do you want to stay open? Do you want your employees to have jobs? This is what we do to make sure that happens, because we see a storm coming.”

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Canadian literary figures double down on free speech following Salman Rushdie attack – CTV News



Canadian writers, publishers and literary figures doubled down on the right to freedom of thought and expression on Saturday, one day after an attack on award-winning author Salman Rushdie that left him hospitalized and on a ventilator.

Rushdie, whose 1988 novel “The Satanic Verses” drew death threats from Iran’s leaders in the 1980s, was stabbed in the neck and abdomen Friday by a man who rushed the stage as the author was about to give a lecture in western New York.

Louise Dennys, executive vice-president and publisher of Penguin Random House Canada, has published and edited Rushdie’s writing for over 30 years. She condemned the attack on her longtime friend and colleague as “cowardly” and “reprehensible in every way.”

“He is without doubt one of the greatest proponents of freedom of thought and speech and debate and discussion in the world today,” Dennys said in a telephone interview. “I have hopes of his recovery. He’s a great warrior and fighter, and I hope he is fighting back.”

Rushdie, a native of India who has since lived in Britain and the U.S., is known for his surreal and satirical prose style. “The Satanic Verses” was regarded by many Muslims as blasphemous for its dream sequence based on the life of the Prophet Muhammad, among other objections. The book had already been banned and burned in India, Pakistan and elsewhere before Iran’s Grand Ayatollah Ruhollah Khomeini issued a 1989 fatwa, or edict, calling for Rushdie’s death.

Investigators were working to determine whether the attacker, born a decade after the publication of “The Satanic Verses,” acted alone. Police said the motive for Friday’s attack was unclear.

After the publication of “The Satanic Verses,” often-violent protests erupted across the Muslim world against Rushdie. At least 45 people were killed in riots over the book, including 12 people in Rushdie’s hometown of Mumbai. In 1991, a Japanese translator of the book was stabbed to death and an Italian translator survived a knife attack. In 1993, the book’s Norwegian publisher was shot three times and survived.

The death threats prompted Rushdie to go into hiding under a British government protection program, though he cautiously resumed public appearances after nine years of seclusion, maintaining his outspoken criticism of religious extremism overall.

“We all depend on the storytelling, power and imagination of writers. He came out of hiding because he realized he wanted to play a role in the world we live in, defending those rights,” said Dennys.

“He couldn’t be silenced by fear, and I think that point is something he will continue to make if, as we all hope, he survives,” she said.

Dennys said the attack is already having the opposite effect of its suspected intentions given the outpouring of support from the international literary community, as well as activists and government officials, who cited Rushdie’s courage for his longtime free speech advocacy despite risks to his own safety.

“It’s brought everyone together to realize how precious and fragile our freedoms are and how important it is to speak up for them,” Dennys said.

The president of PEN Canada, an organization defending authors’ freedom of expression, condemned the “savage attack” on their “friend and colleague” Rushdie, who is a member.

Canadian writer John Ralston Saul, who has known Rushdie since the 1990s, said the author was always aware that someone might attack him but he chose to live publicly in order to speak out against those trying to silence free expression and debate.

“(Rushdie’s) work and whole life are a reminder of what the life of the public writer is in reality,” he said. “This would be the worst possible time to give in or show any sense that we must be more careful with our words. We’re not really writers if we give in to that kind of threat.”

Rushdie’s alleged attacker, Hadi Matar, was arrested after the attack at the Chautauqua Institution, a non-profit education and retreat centre. Matar’s lawyer entered a not guilty plea in a New York court on Saturday to charges of attempted murder and assault.

After the attack, some longtime visitors to the centre questioned why there wasn’t tighter security for the event, given the threats against Rushdie and a bounty on his head offering more than US$3 million to anyone who killed him.

Saul, who spoke at the Chautauqua Institution years before Rushdie’s attack, said it has an “open tradition” of debate, free expression and anti-violence going back over 100 years.

“It’s one of the freest places to take advantage of our belief in freedom,” he said.

Director of the Toronto International Festival of Authors Roland Gulliver tweeted Saturday that literary festivals and book events are “spaces of expression, to tell your stories in friendship, safety and respect.”

“To see this so violently broken is incredibly shocking,” he wrote.

Expressions of sympathy came from the political realm as well, with Prime Minister Justin Trudeau condemning the attack as a “cowardly … strike against freedom of expression.”

“No one should be threatened or harmed on the basis of what they have written,” read a statement posted to Trudeau’s official Twitter account. “I’m wishing him a speedy recovery.”

The 75-year-old Rushdie suffered a damaged liver, severed nerves in his arm and is likely to lose an eye as a result of the attack, Rushdie’s agent Andrew Wylie said Friday evening.

A physician who witnessed the attack and was among those who rushed to help described Rushdie’s wounds as “serious but recoverable.”

With files from the Associated Press. This report by The Canadian Press was first published Aug. 13, 2022.

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What you need to know about Canada's divisive ArriveCAN app – CBC News



Ottawa is making plans to expand the capabilities of its ArriveCAN app even as criticism continues to mount over the mandatory online data-entry system for travellers entering the country. 

Earlier this week, Transport Canada gave an update on its plans to improve the app, including by adding an optional, online advance CBSA declaration feature for people going to the Calgary, Edmonton, Winnipeg, Billy Bishop Toronto City, Ottawa, Québec City and Halifax international airports.

The feature, which Transport Canada says cuts the amount of time travellers spend at a Canada Border Services Agency kiosk by a third, is currently only available to those passing through Toronto Pearson, Vancouver or Montreal-Trudeau international airports.

“With the thousands of travellers arriving in Vancouver, Toronto and Montreal airports each day, the use of the optional advance CBSA declaration has the potential to save hours in wait time,” according to Transport Canada’s release.

With Ottawa signalling no plans to do away with the app, here’s a refresher on how it works, why it’s in place — and who’s for and against its continued use. 

Why was it put in place?

Though the app was introduced earlier in the pandemic, the version of ArriveCAN people are familiar with today launched in July 2021, when Canada began easing public health restrictions on people coming into Canada. Fully vaccinated Canadians and permanent residents crossing the border were no longer required to quarantine upon their return. 

But Canada still wanted a way to account for people’s vaccination statuses and COVID-19 results from a recent test. The app allowed travellers to take a photo or upload a snapshot of their vaccine documentation into the app before going through customs.

How does it work today?

Canada has lifted most of its travel restrictions for fully vaccinated travellers, including the need for domestic travellers to show proof of vaccination while travelling by train or plane. 

But regardless of vaccination status, all travellers coming into Canada are required to submit their information to the ArriveCAN app — or the website version if they don’t have a smartphone — up to 72 hours before entering Canada.

When travellers finish inputting their information, they’re emailed a receipt to show a Canadian border officer upon arrival, along with their COVID-19 test results and any vaccination documents.

The app has not been without its issues. Last month, Public Safety Canada acknowledged a glitch incorrectly informed some travellers to quarantine when in fact they didn’t have to.

What are the potential penalties for non-compliance?

Travellers who fail to provide the required information won’t be denied entry but may face a 14-day quarantine, the need to take a COVID-19 test on arrival and a followup test eight days later.

They may also be fined $5,000 and face “additional delays at the border for public health questioning,” according to Canada’s main ArriveCAN information page.

In anyone exempt from using ArriveCAN?

Yes, including people who can’t access the app or website because of cognitive or physical impairments.

Instead, they may provide the information verbally at the border or by completing a paper form. 

The exemption also applies to people who can’t fill out the information online because of a natural disaster, censorship, lack of access to internet or an ArriveCAN outage. 

There is a degree of leeway for some people at land border crossings too. 

As of May 24, “to allow for more flexibility,” the Canada Border Services Agency began letting fully vaccinated Canadian land travellers off with a warning the first time they neglect to fill out the app if they had no prior history of non-compliance. 

The union representing border workers told CBC News last month that between 30 and 40 per cent of travellers entering into Canada in Windsor, Ont., weren’t completing the app before arriving.

Who’s against it?

Border city mayors have said the app is a barrier for tourists looking to enter Canada, and for trade.

Other politicians — including Conservative Party of Canada leadership candidates Jean Charest, Pierre Poilievre, Leslyn Lewis and Scott Aitchison — have called for the app to be scrapped, saying it creates headaches for some travellers and and contributes to delays at airports. 

In a tweet last month, Poilievre called on Canada to “stop forcing ArriveCAN on people” and “restore sanity to our airports.” The tweet included video, which CBC News has not verified, of an elderly person without a cell phone calling the app “bureaucracy run amok” while at a Toronto airport. 

Lewis more recently called the app a “surveillance experiment” that needs to end.

Who wants the app to stay?

MP Taylor Bachrach, the New Democrats’ transport critic, said ArriveCAN continues to play “an important role” in helping screen international arrivals for new variants and for verifying that visitors to Canada are fully vaccinated to protect the country’s health care system. 

“But the government must make the app work as intended so it can reduce wait times at airports and border crossings as promised,” Bachrach said in a statement. 

The government also needs to better address people who can’t use the online app for accessibility reasons, he added.

“It is totally inappropriate for customs agents to be acting as IT technicians as they troubleshoot travellers’ technology challenges” he said.

Green Party MP Elizabeth May said she has found the app helpful and easy to use during her travels. 

“The recent glitch, on the other hand, demonstrates a serious problem in terms of privacy breaches,” she said in a statement.

What does the government have to say about it?

In its release earlier this week, Transport Canada said 1,600 security screening officers with the Canadian Air Transport Security Authority have been hired across Canada since April, while 30 new customs inspection kiosks have been recently added at Toronto Pearson International Airport.

In its own statement to CBC News, the CBSA said 99.53 per cent of air travellers used ArrivedCAN in the week ending July 17, according to the most recently available data.

Millions of people have used the app without issue, the spokesperson added.

“Without ArriveCAN, processing times for travellers would increase significantly, as these public health functions would need to be completed manually for each traveller by CBSA officers at the port of entry.”

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Medical assistance in dying given to 10K Canadians in 2021 – CTV News



More Canadians are ending their lives with a medically-assisted death, says the third federal annual report on medical assistance in dying (MAID). Data shows that 10,064 people died in 2021 with medical aid, an increase of 32 per cent over 2020.

The report says that 3.3 per cent of all deaths in Canada in 2021 were assisted deaths. On a provincial level, the rate was higher in provinces such as Quebec, at 4.7 per cent, and British Columbia, at 4.8 per cent.

“It is rising remarkably fast,” University of Toronto law professor Trudo Lemmens, who was a member of the Council of Canadian Academies Expert Panel on Medical Assistance in Dying, wrote in an email to CTV News. He noted that some regions in the country have quickly matched or surpassed rates in Belgium and the Netherlands, where the practice has been in place for over two decades.

Advocates say it isn’t surprising because Canadians are growing more comfortable with MAID and some expect the rising rates may level off.

“The…. expectation has always been it (the rate) will be something around four to five per cent, (as in) Europe. We will probably, in the end, saw off at around the same rate,” said Dr. Jean Marmoreo, a family physician and MAID provider in Toronto.

The report uses data collected from files submitted by doctors, nurse practitioners and pharmacists across the country involving written requests for MAID.

Among the findings:

  • All provinces saw increases in MAID deaths, ranging from 1.2 per cent (Newfoundland & Labrador) to a high of 4.8 per cent (British Columbia);
  • More men (52.3 per cent) than women (47.7 per cent) received MAID;
  • The average age was 76.3 years;
  • Sixty-five per cent of those provided with assisted death had cancer. Heart disease or strokes were cited in 19 per cent of cases, followed by chronic lung diseases (12 per cent) and neurological conditions like ALS (12 per cent);
  • Just over two per cent of assisted deaths were offered to a newer group of patients: those with chronic illnesses but who were not dying of their condition, with new legislation in 2021 allowing expanded access to MAID.

Documents show that 81 per cent of written applications for MAID were approved.

Thirteen per cent of patients died before MAID could be provided, with almost two per cent withdrawing their application before the procedure was offered.

Four per cent of people who made written applications for medical assistance were rejected. The report says some were deemed ineligible because assessors felt the patient was not voluntarily applying for MAID. The majority of requests were denied because patients were deemed not mentally capable of making the decision.

But other countries with long-established programs reject far more assisted death requests, said Lemmens, citing data that shows 12 to 16 per cent of applicants in the Netherlands are told no.

“It ….may be an indication that restrictions (in my view safeguards) are weaker here than in the most liberal euthanasia regimes,” he wrote in his email to CTV News.

But Marmoreo, who has offered MAID since 2016, sees Canada’s low rejection rate differently.

“It is more like that the right cases are put forward,” she said.

“We have a very good screening process right from the get-go. So before people actually even make a formal request to have assisted dying, they have a lot of information that’s been given to them by the intake….here’s what’s involved in seeking an assisted death, you must meet these eligibility criteria.”

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