TORONTO — As more Ontarians become eligible for a second dose of a COVID-19 vaccine, public health officials and experts say more efforts are needed to reach those who aren't yet protected against the virus.
Just over 76 per cent of adults in the province had received at least one dose of a COVID-19 vaccine as of Wednesday, and 27 per cent were fully vaccinated.
"Unfortunately, that does mean there's one in four people who haven't got their first dose," said Dr. Dirk Huyer, the province's chief coroner and a member of the vaccine task force.
"It's so important to protect those people and provide that opportunity ... to protect themselves from serious illness and hospitalization."
The province moved up its vaccine rollout this week to allow more people to receive their second dose, as the more infectious Delta variant, which people with only one dose of the vaccine remain vulnerable to, gains traction.
Residents in Delta hot spots who got Pfizer and Moderna shots on or before May 30 became eligible to move up their second shots on Wednesday, and the province aims to further expand access next week.
Amid that push, there are some signs that registration for first doses is waning. A mass vaccination event planned for Sunday in Toronto had seen 10,000 appointments booked as of Tuesday but just 615 of those were first-dose appointments, the city said.
The top doctor in Simcoe-Muskoka noted this week that the region, which includes the city of Barrie, is hitting a "plateau" for interest in first doses and might struggle to reach 80 per cent coverage without stronger efforts.
“We are going to need to work harder to be able to reach others," Dr. Charles Gardner said.
Maria Sundaram, an infectious disease epidemiologist at the University of Toronto, said "confidence, convenience and complacency" are three main barriers that keep people from getting vaccinated.
People may feel they don't need to get vaccinated as they watch so many of their neighbours get their shots, Sundaram said. They might also be hesitant to take the vaccine or lack easy access.
Whatever their reason, Sundaram said efforts should be made to reach those people because with more transmissible variants of the virus circulating, it will be hard to reach herd immunity and beat the pandemic.
"We really need to do the extra legwork to go that extra mile, or even at this point it's more like a foot towards that finish line," she said in an interview, noting that "the last inch is often just as difficult as the first 100 miles" in infectious disease eradication strategies.
Ontario's vaccine rollout has been criticized for its time-consuming and fractured appointment booking system, which is less accessible to people who lack the technology and time to deal with the various websites.
There is also concern about vaccine access in hot spots where essential workers live and work and where local pop-up clinics have drawn long lines, demonstrating interest but lack of options.
Sundaram said inequities in the vaccine rollout need to be addressed, and more vaccination options in hot spot areas would help.
"It really should be so easy to get vaccinated that you almost can accidentally get vaccinated," she said.
A spokeswoman for the provincial health minister said Ontario is working with health partners and community leaders to develop strategies for boosting vaccine confidence and removing barriers to access.
"They will use a more tailored approach including mobile and community clinics to reach these communities," Alexandra Hilkene said in a statement.
Ford maintained on Wednesday that the vaccine rollout is going well.
"I encourage you to go get your first dose and then shortly thereafter, get your second dose," he said. "That's just going to speed everything up and keep our hospitals safe and everyone else safe."
Officials have said the province isn't considering incentives like the "vaccine lotteries" on offer in other provinces, but Sundaram said such incentives aren't a bad idea as long as equitable access is also being addressed.
When it comes to vaccine confidence, Sundaram said there's a big spectrum of people ranging from those who want more information to people dead-set against vaccination.
"Among this group, I think it's really, really important to ask, what questions do you have? Can I help answer those questions," she said, adding that sharing personal experiences -- and approaching conversations with patience -- can help.
Physicians who have relationships with patients have an important role to play in increasing uptake, the head of the Ontario Medical Association said.
"It's about having that personal relationship with someone that you trust, and the OMA and physicians believe that those relationships that that they've been able to develop over years in many ways is the path forward," Dr. Adam Kassam said in an interview.
The association said 600 primary care practices are currently doing COVID-19 vaccinations -- significantly fewer sites than the thousands of pharmacy locations and other clinics across the province.
Kassam said the association supports prioritizing education about vaccines, providing culturally and language-appropriate messaging and redeploying vaccines to hot spots when infections spike.
Ontario reported 255 new cases of COVID-19 on Wednesday and 11 more deaths linked to the virus.
This report by The Canadian Press was first published June 23, 2021.
Holly McKenzie-Sutter, The Canadian Press