Four million people in Ontario got 2 doses of COVID-19 vaccine but not a third. Why?

Public education needed for face masks Epidemiologist Dr. Colin Furness says face mask mandates without proper public messaging social violence and confusion could ensue.

More than four million people who have gotten two doses of COVID-19 vaccine have not yet gotten their booster, provincial data shows, prompting a sense of urgency among health experts who say now is the time to get that third shot in order to protect themselves from waning immunity.

Ontario is now in another wave of the pandemic, fuelled in part by the fast-spreading Omicron subvariant BA.5, which is now the dominant strain in the province.

Despite this fact, vaccine uptake has plateaued. According to provincial data from June 30, about 57 per cent of eligible Ontarians aged 12 and up have received three shots. This means that a little more than 4.4 million people who got the first two doses have yet to roll up their sleeves for their booster as officials argue whether eligibility should be expanded for fourth doses.

“I think it has to do with the lifting of restrictions,” said Dr. Zahid Butt, an assistant professor in the school of public health sciences at the University of Waterloo. “I think people thought that maybe … because it's not as severe anymore, maybe we don’t need the booster shot.”

“That's the message they got when we lifted all the restrictions.”

Unsurprisingly, the demographic that was most diligent in getting the booster’s fit into the older populations. Nearly 90 per cent of those aged 70 and up have been triple vaccinated against the novel coronavirus.

About 80 per cent of those between the ages of 60 and 69 have received all three shots.

That percentage drops drastically in the younger demographics—those who are also not yet eligible for a fourth dose.

More than one million people between the ages of 18 and 29 got two doses and are considered fully vaccinated under the provincial classification, but have yet to get their third shot. That’s about 39 per cent of those eligible.

“After the initial enthusiasm and hype of getting first dose, second dose, it just dies off. It's lost its appeal,” Dr. Susy Hota, medical director for infection prevention and control at the University Health Network, told CTV News Toronto.

“It's not surprising that we've lagged a bit with third doses.”

In combination with the mixed messaging involved in lifting public health restrictions, Hota adds that many may think they have enough immunity from contracting COVID-19 that they don’t require another shot.

“People's willingness to accept COVID has changed,” she said. “But that message is confusing people. We are seeing movement in one direction when it comes to restrictions and pandemic response measures, but it doesn't mean that the pandemic is over.”

Antibodies that protect against the novel coronavirus—both created by a vaccine or by contracting the virus—can wane after about six months, Butt explained, which is why it’s so important to get the boosters.

“The goal of the booster vaccination is accurate to boost your immunity,” he said. “That's why you see that all the booster doses, the recommendation is that they should be given six months after you get your second dose. And for people who have gotten their first booster, you will see that now, actually, their six months have also passed.”

Both Butt and Hota say that eligibility for fourth doses should be expanded considering the waning immunity within the community. As it stands, only residents who are over the age of 60, individuals who are immunocompromised, and Indigenous adults are eligible for a fourth dose.

The Ontario Ministry of Health has previously said they are following national guidelines and will be providing more details about fall booster shots in the coming weeks.

‘CLEVER MARKETING’ NEEDED TO ENCOURAGE BOOSTERS

In light of a fall booster plan, public health experts say that the summer is the perfect time to get caught up on vaccinations. But there remains challenges when it comes to convincing people to continue the process.

“I think it becomes clever marketing to try and get people's attention again,” Hota explains. “You know, we've been a bit exhausted by all the COVID messaging over the last two and a half years. Nobody wants to read about it anymore.”

“We need to find different ways of getting that message out there that's going to attract attention.”

Hota said she has heard of instances in which cities piggy back off of festivals and large events where people will be gathering, but is not sure how successful those campaigns have been. She also urged residents not to wait for other vaccines currently being tested against more recent variants or strains of COVID-19, adding that it’s more important to get the boosters when they are offered as they still provide protection against severe symptoms, hospitalization and risk of death.

This kind of messaging should be front and centre, Butt added, saying that public health communications is all about consistency—residents need to be reminded often about the importance of vaccination and not just once a month.

On Wednesday, Ontario's COVID-19 Science Advisory Table released a series of Tweets confirming the province has entered into a new wave of the pandemic and indicating that vaccination remains "critical to protect against severe disease."

"If you are over 18 and haven’t received your third dose – get it now," they said.

In the past, public health units have done everything from hosting mass vaccination events, using mobile clinics in high-risk priority neighbourhoods and spearheading family-centric advertising campaigns. In Toronto, a region that has been considered a COVID-19 hot spot for years, strategies have also included targeted phone call campaigns and utilizing places in which people gather, such as public libraries, malls and schools.

Toronto’s vaccination campaign has largely scaled down over the last six months. There are currently six city clinics open during the day, as well as multiple pharmacies offering the COVID-19 vaccine.