| Efforts should be made to increase access to immunization services to reduce health inequities without further stigmatization or discrimination, and to engage systematically marginalized and racialized populations in immunization program planning (see NACI’s Equity Matrix, Appendix D in the full guideline). |
Health inequities exist in part because of differential access to health care, as well as differential exposure, susceptibility and severity of infectious diseases (see Equity Matrix, Appendix D in the full guideline). Interventions to reduce these inequities rather than potentiate them with further stigmatization or discrimination should be implemented as part of any immunization program. As with any immunization program, efforts should be made to ensure consideration of the needs of diverse population groups, based on health status, ethnicity or culture, ability, and other socioeconomic and demographic factors that may place individuals in vulnerable circumstances (e.g., occupational, social, economic or biological vulnerabilities). These efforts should include integrating the values and preferences of these populations in vaccine program planning and building capacity to ensure access and convenience of immunization services. There is evidence of important or large independent associations of severe COVID-19 with race or ethnicity (low certainty of evidence of hospital admission or death), low socioeconomic status (low certainty of evidence for hospital admission), homelessness (low certainty of evidence for hospital admission), and male sex (moderate certainty of evidence for hospital admission).19 Outbreaks involving large numbers of reported cases have occurred in rural and remote communities in Canada.20 Outbreaks involving large numbers of reported cases have occurred in agricultural work settings, including those with congregate living for migrant workers.20 Visible minorities and Indigenous Canadians appear to be less willing than nonvisible minorities to get an effective recommended SARS-CoV-2 vaccine.12 Reasons for vaccine hesitancy are multifactorial. Although significant differences in willingness to get vaccinated with a SARS-CoV-2 vaccine have not been observed by sex or socioeconomic status,12,13 immunization coverage has tended to be lower among men and those in lower socioeconomic groups for vaccine-preventable diseases, where national data are available.25 Examples of interventions to engage communities and address barriers to accessing vaccine, as summarized in the Equity Matrix (Appendix D in the full guideline), could help reduce inequities. The principle of equity urges consideration of health and economic disparities to ensure a fair distribution of resources.
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| Jurisdictions should begin planning for the implementation of a COVID-19 immunization program, including rapid monitoring of safety, effectiveness and coverage of vaccine(s) in different key populations, as well as effective and efficient immunization of populations in remote and isolated communities (see Feasibility Matrix, Appendix E in the full guideline). |
Stakeholder reviews of feasibility identified multiple challenges requiring advanced planning and complex combinations of program administration through a variety of vaccine delivery models across Canada. Planning is required to address issues specific to a potential COVID-19 immunization program (e.g., storage and dissemination of new vaccine technologies in different vaccine delivery venues; human resources for administration of vaccine, communication, training, data entry, screening for COVID-19, security of supplies, operational planning, etc.), and integration with or enhancement of existing programs (e.g., registries, surveillance, adverse event after immunization reporting). Rapid monitoring of safety, effectiveness and coverage of the vaccine(s) in potentially different key populations will be critical. The feasibility of sequential immunization of different key populations in remote and isolated communities is challenging. In these settings, deploying vaccine to entire communities may be more effective and efficient than sequential immunization of different key populations.
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| Efforts should be made to improve knowledge about the benefits of vaccines in general and of COVID-19 vaccine(s) specifically, once available, to address misinformation about immunization, and to communicate transparently about COVID-19 vaccine allocation decisions (see Acceptability Matrix, Appendix F in the full guideline). |
Willingness to get a safe, effective SARS-CoV-2 vaccine has decreased over time in Canada (from 71% in April to 61% in August 2020).9 The most reported reasons for unwillingness to get a SARS-CoV-2 vaccine across various Canadian surveys are concerns about safety and a lack of confidence and trust in a new SARS-CoV-2 vaccine.12–15 Deemed 1 of the top 10 major global health threats by WHO in 2019, vaccine hesitancy could limit the success of a COVID-19 immunization program. Key reasons for vaccine hesitancy include complacency, inconvenience in accessing vaccines and lack of confidence.16 Efforts should be made to reduce complacency, improve convenient access to vaccines, and improve confidence in and awareness of immunization in the public, key populations for early COVID-19 immunization and health care providers. Transparent, clear communication about vaccine trials, pharmacovigilance26 and vaccine allocation decisions is important to maintain trust and confidence, and improve access to vaccines for key populations. In general, receiving a recommendation from, or being in contact with a health care provider, is linked to increased vaccine acceptability,17 and a notable factor for health care providers to recommend a vaccine is a recommendation by an expert committee.18
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