Going door to door to vaccinate people against COVID-19 — such as this effort with residents of the San Romanoway apartments in Toronto — is one of the strategies that public health units are using to reach as many unvaccinated people as possible. (Evan Mitsui/CBC – image credit)
With Ontario’s COVID-19 vaccination coverage showing signs of levelling off, the province is enlisting help from family doctors.
About 78 per cent of Ontario adults have received at least one dose of a COVID-19 vaccine, but that figure has increased by just three percentage points in the past three weeks.
To vaccinate as much of the rest of the population as possible, the health-care community widely considers the participation of family doctors critical.
That’s because many unvaccinated people have questions they need answered by a trusted medical source, or don’t want to go to a mass vaccination site or pharmacy to get a shot, says Dr. Liz Muggah, president of the Ontario College of Family Physicians.
“That combination that family doctors offer: the trusted person who knows their history, and a place that they feel comfortable in receiving vaccine, those two things together really mean that we have a really important role to play to help move the dial toward getting to herd immunity,” said Muggah in an interview Wednesday.
Supplied/OCFP
While the provincial Health Ministry was unable to provide any specific figures, it is clear family doctors’ practices account for only a fraction of the 16.1 million doses administered in Ontario so far.
“From the very beginning, family doctors across the province have been saying, ‘Please give us vaccines. We’re expert at this. We want to do this. Our patients are telling us that they want to be vaccinated in office,'” Muggah said.
“To this point, we have not had the supply of vaccines in our offices to address the need that we’re seeing from our patients. So I definitely hope as we head into this last stretch of the vaccination that more vaccines come to us.”
Ontario is not alone in having given family doctors little in the way of vaccine supply.
Manitoba has made vaccines available at more than 50 family doctor clinics. In Alberta, despite promises that family physicians could be administering thousands of shots every day from their offices, the province’s pilot project expanded to just 60 practices.
Other provinces have almost entirely stayed away from providing vaccine doses to family doctors, a situation that was prompted in part by initial concern about meeting the cold-storage requirements for the Pfizer-BioNTech vaccine that accounts for the bulk of Canada’s shots.
Alan Habbick/CBC
Ontario’s family physicians and other primary-care providers have been administering COVID-19 vaccines in about 700 primary care and community settings, said Alexandra Hilkene, spokesperson for Health Minister Christine Elliott. (There are more than 15,000 family doctors in Ontario, some of whom have participated in giving shots at mass vaccination clinics.)
“The onboarding of additional primary care settings to administer vaccines continues and is ongoing by public health units,” said Hilkene in a statement provided to CBC News. “Primary-care providers will play an even larger role in vaccinating Ontarians as we continue to vaccinate harder to reach patients and combat vaccine hesitancy.”
The bulk of family doctors in Ontario are to receive later this month a list of all their patients who have been vaccinated against COVID-19, whether with one or two doses. The provincial agency Ontario Health is asking physicians to reach out to their patients whose names are not on the list.
The idea is that the family doctor can help overcome hesitancy by answering questions that unvaccinated patients still have about the COVID vaccines, said Dr. David Kaplan, chief of clinical quality at Ontario Health.
“Who better than primary care providers that have had lifelong relationships with these patients to build that confidence?” he said in an interview.
Ontario age groups – vaccination coverage by age group
Kaplan, who also practices as a family physician in North York, says talking to patients about their immunizations concerns — from childhood diseases such as measles to diseases that affect seniors such as shingles — is something family doctors do every day.
“We’re used to having these conversations with some of our patients that are a little more hesitant and really build their confidence in knowing why it’s important to be vaccinated, what to expect,” he said. “I think that’s really important for many patients. They’re just worried about what’s going to happen.”
In Ontario, the lowest COVID-19 vaccination rates are among the youngest eligible age groups. About 67 per cent of those aged 18 to 29 have had at least one dose, along with 59 per cent of youth aged 12 to 17, according to Health Ministry figures published Wednesday.
Family doctors say a common fear raised by younger patients is that the vaccines could affect their fertility, although there’s no evidence that’s the case.
Muggah, who practices at the Bruyère Family Health Team in Ottawa, says she tries to ask every patient she encounters — regardless of the nature of the appointment — whether they’ve had a shot.
Submitted/OMA
“If they haven’t been vaccinated, to me, it really is a conversation that has to be approached with great empathy and some curiosity, ” she said, “You can’t assume why somebody may not be ready to get vaccinated.”
Muggah says that combating vaccine hesitancy “isn’t just about giving somebody a whole bunch of information. It really requires meeting that person where they’re at, digging into what their reasons might be, and addressing them.”
Family doctors will be particularly important in ensuring vaccination coverage among the 12 to 17 age group, said Dr. Adam Kassam, president of the Ontario Medical Association.
“We encourage anyone who is still on the fence or still having questions to reach out to their family doctors, reach out to their pediatricians to get the best information to make an informed decision,” he said.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
