September 23, 2022

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COVID-19 vaccines aimed at both the original strain and Omicron variants are expected in Canada this fall.

But messaging on booster doses has been mixed across the country. Some experts like virologist Angela Rasmussen recommend getting the first available booster, while other officials like Manitoba’s Chief Provincial Public Health Officer Dr. Brent Roussin say his province will wait to open up fourth doses for all adults until new bivalent vaccines are approved. 

The mixed messaging on vaccines has led to some Canadians facing what experts call “vaccine fatigue” — or being overwhelmed by COVID-19 vaccine information.

And that fatigue might have an impact on booster uptake. About 82 per cent of Canadians have had their primary series completed, about 57 per cent of residents 12 and older have received at least one additional dose and about 12 per cent of the population have gotten two additional doses.

Some virologists and public health experts say if we’re going to roll out new vaccines or offer more doses of existing jabs, government messaging needs to be clear about why people should get vaccinated at this stage of the pandemic.

“Sitting here [in] mid-August, it’s a little bit hard to sort of know what people’s response is going to be in the fall,” said Julie Bettinger, a University of British Columbia pediatrics professor and vaccine safety scientist at the Vaccine Evaluation Center in B.C. 

“There does need to probably be specific messaging for that [vaccine fatigued] group in terms of why a booster dose is important and what sort of additional protection it provides.”

Nurse Megan Buehholz administers a dose of the Pfizer-BioNTech COVID-19 vaccine to care home worker Melissa Vitug at a clinic in St. Michael’s Hospital in Toronto in 2020. (Evan Mitsui/CBC News)

Health experts say the messaging needs to be clear about the effectiveness of the vaccines and the protection they offer.

Data has shown that a third dose offers a significant increase in protection against infection, hospitalization and death from COVID-19. 

Research suggests some people do benefit from a fourth dose, including long-term care residents, the elderly and other vulnerable groups, but data showing a clear benefit to those under the age of 60 is lacking.

In addition to clear messaging on vaccine protection, it also needs to be easy for people to get their booster shots or future bivalent vaccines, health experts said. 

“If we can make getting a COVID booster as easy as it is to get a flu shot or some other regular health behaviour, I think that will reduce the barriers quite a lot,” said Devon Greyson, an assistant professor at the University of British Columbia’s School of Population and Public Health. 

What we know about why people aren’t getting boosters

Vaccine hesitancy is one reason why a small portion of the public is not getting vaccinated, but vaccine fatigue may also “compromise people’s vaccination intention.” 

That’s what researchers in the U.S., Brazil and China found in a literature review published in peer-reviewed journal Frontiers in Immunology in March. 

The researchers looked at 37 studies to find factors that shape people’s vaccine fatigue, which they defined as “inertia or inaction towards vaccine information or instruction due to perceived burden and burnout.” 

They found there can be several precursors to vaccine fatigue, like frequency of immunization demands, vaccine side effects and misconceptions around the need to vaccinate. 

Health experts say the messaging needs to be clear about the effectiveness of the vaccines and the protection they offer against COVID-19. (Robert Short/CBC)

There are varying opinions on booster doses in Canada. An Angus Reid survey published last month found that one in five of the 1,583 Canadians surveyed believe there’s no immediate urgency and that booster doses can wait until fall.

About a quarter of respondents said there’s no need to expand booster eligibility at all. The Angus Reid Institute conducted the online survey from July 13-15 among a representative randomized sample of adults who are members of Angus Reid Forum. For comparison purposes only, a probability sample of this size would carry a margin of error of +/- 2.0 percentage points, 19 times out of 20.

Access to booster shots is another reason why rates are low, experts say. Nova Scotia, ManitobaNorthwest Territories and Newfoundland and Labrador aren’t yet giving fourth doses to all adults. 

Greyson said vaccine rollout has been complex but making sure people understand the need for vaccination is important if we want to boost vaccination rates.

Studies have shown that vaccine effectiveness was strong after three doses of the Pfizer or Moderna vaccines in protecting against infection and COVID-19-associated emergency department and urgent care visits. 

A third dose was at least 90 per cent effective at preventing hospitalizations for COVID-19, both during the Delta and Omicron periods, a U.S. study found.

“If people understand what they’re supposed to do and why the science is suggesting that, they’re far more likely to follow the instructions than if it seems arbitrary, politically motivated, financially motivated or for some other reason,” Greyson said.

What works and what doesn’t

Bettinger adds what happens this fall in terms of COVID-19 cases could drive people to get a booster dose.

“If we see a real uptick in cases this fall … and it’s still one of the strains that the vaccine can protect against, I think that will probably motivate a lot of people to go get a booster dose if they know that the vaccine is going to prevent them from getting sick,” she said.

“If we suddenly see an emerging strain that the vaccine just doesn’t protect against, it’s hard then to sort of make that argument that you need this vaccine.”

WATCH | The efforts to convince some of Canada’s most COVID-19 vaccine hesitant to get a shot:

The efforts to convince some of Canada’s most COVID-19 vaccine hesitant to get a shot

Aylmer, Ont., is one of the least vaccinated parts of Canada, but the community is using information and targeted campaigns to convince the vaccine hesitant to get COVID-19 shots.

Canada’s Chief Public Health Officer Dr. Theresa Tam said Friday that Health Canada regulatory approval staff are reviewing Moderna’s and Pfizer’s bivalent vaccine applications. A Health Canada spokesperson said Monday that a decision on Moderna’s bivalent vaccine is expected within the next two weeks.

Tam said based on the information submitted by Moderna and Pfizer-BioNTech, their bivalent vaccines would protect against the original coronavirus strain and the BA.1 strain.

Angela Rasmussen, a virologist with the University of Saskatchewan’s Vaccine and Infectious Disease Organization, said messaging around the bivalent vaccines will need to be specific. 

“The messaging needs to be if you haven’t gotten a booster yet, you need to get one. But you really need to get this one because this booster is really tailored to protect against the viruses and the variants that are currently circulating in our population now,” she said. 

WATCH | Study links COVID-19 with long-term elevated risk of brain fog:

Study links COVID-19 with long-term elevated risk of brain fog

Brain fog, dementia and other neurological conditions are more common two years after getting COVID-19, than after other respiratory infections, a new study in Lancet suggests.

As we’ve seen with earlier vaccine rollouts, one size does not fit all when it comes to vaccination campaigns. 

Instead, some regions saw vaccine uptake increase when vaccination clinics came into communities, or when incentives were offered to residents.

“It will be interesting to see what provinces try over the coming year if we do bring out new vaccines and bivalent vaccines and want to get everyone updated with the new vaccine,” Greyson said.

Public health officials will need to work on addressing vaccine confidence, complacency and convenience once again in the next few months, Greyson said.

They said confidence is “quite high in Canada” for the vaccines and since most that have received vaccinations have fared well with COVID infections, confidence has grown. 

“We have fallen into some complacency as we’ve had this degree of protection and gotten more accustomed to living with COVID,” Greyson said.

“To really have successful fall booster campaigns as we’re looking at going into our typical respiratory illness season … we’re going to need to make it very easy for people to follow the clear recommendations that are made.”

WATCH | New vaccine that targets Omicron expected in Canada: 

Health Canada poised to approve new Omicron-targeting vaccine

Health Canada says it could make a decision on approving Moderna’s new Omicron-targeting vaccine within two weeks. If approved, it will leave Canadians with a decision: wait for the new shot, or get boosted with an existing vaccine.

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