‘It’s a public health misstep’: Health policy expert calls for expansion of COVID-19 shot coverage

Lorian Hardcastle on Alberta Primetime, August 21, 2025

Lorian Hardcastle with the University of Calgary’s Faculty of Law and Cumming School of Medicine joins Alberta Primetime host Michael Higgins to discuss the United Conservative government’s COVID-19 vaccine policies.

This interview has been edited for clarity and length.

Michael Higgins: Let’s start with the element of health-care workers no longer having to cover the cost of getting a COVID-19 shot if they want one.

What do you expect the impact of this policy reversal to be? How will it change Alberta’s health dynamic this fall?

Lorian Hardcastle: I do think the initial decision to make people pay was, of course, going to decrease the number of people being vaccinated. It would disproportionately hit those who are particularly price sensitive, who are often among the least healthy Albertans.

There’s this connection between health and wealth. So I think reversing course on health-care workers is important because they have extensive contact with vulnerable people. They’re in contact with sick people themselves who are at risk.

But I think that it’s not enough.... I think it’s a public health misstep to not cover the vaccination for any Albertan who wants it.

MH: There’s been considerable pushback since this new approach to COVID-19 immunization was announced in June.

What do you think ultimately pushed the government to reverse policy, at least where the health workers are concerned?

LH: Health-care workers in Alberta over the last several years, throughout COVID-19 and throughout the negotiations with the government over their contract, have become a really powerful force and are able to mobilize - and can move the needle at times on policy.

I think it is their pushing and their advocacy that led the government to change its mind with respect to (providing COVID-19 vaccines to) health-care workers.

One hopes that now increased calls for advocacy by health care workers, by the general public, may push them to also reverse course and to make the vaccine available free of charge to all Albertans.

MH: How much of a signal of re-evaluation of policy do you see going on here?

How deep does that re-evaluation go?

LH: It’s pretty significant when a government makes a bold policy choice that other governments across the country aren’t making, and it makes a choice in the face of significant criticism.

To reverse course on that, I think, is difficult for the government to do, and it comes at a at a political cost, and can be potentially embarrassing to so quickly reverse course.

But ultimately, I do think it’s the right decision.

MH: If paying out of pocket goes ahead for most Albertans this fall, how will that compare to national guidelines for access to the latest vaccine?

LH: Other provinces have not adopted this user-pay model, and so really we would stand apart from other jurisdictions. It would significantly reduce the number of Albertans that get vaccinated.

Most likely Alberta already has lower-than-average vaccination rates on some of the other vaccines. And of course, we’ve seen measles cases in Alberta linked to low rates of vaccines. This would only add to that.

I think what we would see is Alberta’s emergency rooms under more pressure than other provinces if people aren’t having widespread access to the covid vaccine.

MH: What do you make of the process of Albertans needing to book appointments for shots, pre-registering by Sept. 30?

How does that change dynamics of Alberta’s immunization efforts?

LH: Because vaccines are so important from a public-health perspective, the policy goal should be to remove barriers to access - not create barriers. So, not make people have to pre-order and pay and have to make appointments ahead of time and all of these things.

What you want is for anyone who wants a vaccine to be able to get one as freely and easily as possible, and to have many different places they can get that vaccine and not to have to pre-order it.

I also worry this business around pre-ordering vaccines is going to result in the government under-ordering the number of doses. If they’re basing their order on people who learned that you have to pre-register, that’s a problem, because there are going to be people who don’t do that but still want the vaccine.

MH: On the point of access, we’re to understand the vaccine will only be available at public health clinics.

How might the exclusion of pharmacies impact the rollout of immunizations?

LH: It can affect access quite significantly. There are not public health clinics as widely distributed as pharmacies. Pharmacies have really long opening hours, and so it just makes it more easy for people to get it.

There are a lot of people who will go out of their way to make appointments, to pre-book, to go to public health clinics to drive where they need to drive, but there are also a whole bunch of people who will only do it if it’s easy to them. If those clinics aren’t distributed widely around the city and don’t have long opening hours, some people may just not bother.

MH: If universal access does not come through, but the government is maybe still re-evaluating and ends up expanding its partial reversal, what other groups need to be at the front of the queue?

LH: They’ve already looked at some of the vulnerable people, like those in congregate living (and) health-care workers. Those are important groups. Age-based exemptions to having to pay, income based exemptions to having to pay.

We do know that when it comes to health-care services - for example, this has been studied widely with drugs - people can be price sensitive, and particularly those with lower incomes. So if they aren’t going to expand it universally, they need to come up with points of access for those who can’t afford to pay the 100 plus dollars to get the vaccine.