Immigrants. The working poor. Essential workers. Third doses lag in Toronto’s most vulnerable areas


Throughout the COVID-19 vaccine rollout, Torontonians have watched as neighborhoods home to those experiencing some of the harshest outcomes of the pandemic have had among the lowest vaccination rates.

Now, as public health and community organizations work on the ground to improve third-dose uptake, new data from the Gattuso Center for Social Medicine at University Health Network lays bare the stark demographic differences between the Toronto neighborhoods with the highest rates of third-dose vaccination and those with the lowest.

What it shows in granular detail is that many of our most vulnerable citizens — immigrants, the working poor and essential workers in trades and manufacturing — live in areas where third-dose vaccinations just aren’t happening anywhere near the rates seen in some of Toronto’s richest and least-racialized neighborhoods.

For example, 71 per cent of the population is racialized in the bottom 20 per cent of Toronto neighborhoods ranked by third-dose uptake. That compares to just 24 per cent in the top 20 per cent of neighborhoods with the highest rates of third-dose vaccination.

Similarly, the percentage of the population that meets low-income thresholds in the areas with the lowest third-dose vaccination rates is nearly double that in neighborhoods with the most administered.

“It doesn’t need to be this way. There was great success in narrowing the access gap for the rollout of Dose 1. It can be done again. We can’t afford not to,” said Dr. Andrew Boozary, executive director of the Gattuso Centre.

“If we don’t address the pathologies of poverty, if we don’t shift more public investment into these neglected neighbourhoods, we will continue to see worse health outcomes and wider health disparities than we’ve ever seen.”

The Gattuso Center’s analysis also shows that neighborhoods with the lowest third-dose uptake have higher proportions of essential workers in manufacturing, utilities, trades, transport and equipment operation — sectors that don’t conform to regular nine-to-five workdays and that are not conducive to allowing workers to take time off to get vaccinated during clinic hours.

Indeed, the percentage of the population working in manufacturing and utilities is 10 times higher in areas with the lowest rates of third-dose vaccination than in those with the highest rates. Likewise, the percentage of people employed in the trades, transport and equipment operation is more than four times higher in the bottom 20 per cent of Toronto neighborhoods by third-dose vaccination than in the highest 20 per cent.

“If racialized community members are getting their third doses at a third of the rate compared to non-racialized communities, we need to make specific, targeted interventions that are going to provide information in a culturally appropriate and safe way for these communities,” he said Michelle Westin, senior analyst for planning, quality and risk at Black Creek Community Health Center who has been leading mobile vaccination clinics in northwest Toronto.

“We need to be having ambassadors who are representative of these communities to help build that trust. We have to have vaccinators that are representative of these racialized communities. We need to make sure that vaccinations are accessible to people who are low income, so ensuring that they are in spaces that they can get to easily, assist with providing transportation if needed, ensuring that hours of the clinic work with folks that are having to work different hours of the day and multiple jobs,” she added.

The city of Toronto has been waging a three-pillared operation to get shots into arms in the neighborhoods with the lowest uptakes. This includes hyperlocal clinics in malls, transit stations, workplaces and schools; outreach around these clinics through 155 community agencies and more than 400 neighborhood vaccine ambassadors; and a get-out-the-vote style campaign, dubbed “VaxTO,” using text messages, phone calls, emails and town halls to get information out.

“We know that when we announced our target to reach 90 per cent of residents for their first dose, people told us it was impossible in a city as large and diverse as ours. We proved that it was possible when you commit to equity and you don’t stop,” said Coun. Joe Cressy, chair of the Toronto Board of Health. “You literally have to go door-to-door, building-by-building in every language with trusted local leaders. It’s not quick because tackling inequity is never quick. But it works.”

To date, 60 per cent of eligible residents in Toronto have received a third dose.

But there is still a long way to go. The Gattuso Center found that the gap between the neighborhoods with the most and least third dose-uptake has widened substantially over the past seven weeks. In Kingsway South, for example, 68 per cent of eligible residents have received a third dose, compared to just 27 per cent in Mount Olive-Silverstone-Jamestown — a gap of 41 percentage points.

“The gap is striking, especially given what we’ve learned throughout the pandemic. We’ve seen real success in earlier stages of the vaccine rollout when community leadership has been supported with the resources and focus to ensure there is true access. It obliterated many notions of vaccine hesitancy early on,” Boozary said.

“But if we stray from that, we will continue to see this widening of a gap and it will not be recoverable if we do not ensure that those same investments and resources and supports are there for everyone.”

Luwam Ogbaselassie, implementation lead with the Gattuso Center who has been supporting the vaccination effort in the Humber River-Black Creek region, said the involvement of community leadership is key to narrowing the third-dose uptake gap.

“Wherever there are resources being allocated towards vaccines, it should be guided by community leaders around how best to structure those clinics and how best to reach the people who have been the hardest to reach and continue to be the hardest to reach,” she said , noting that she has seen first-hand the meaningful impact of community ambassadors who live in the same buildings and in the same neighborhoods as those who may harbor mistrust of the health care system.

“I’ve always said as a hospital partner, we bring the vaccines, we bring the clinical teams, but we look to our community partners to guide us on how to set up the clinics, how to engage with people who live in the community .

“Community leadership makes all the difference.”

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