Reaching vaccine targets is key to a return to mostly-normal life. But can the hesitant be swayed?

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Canada’s path back to normality hinges on getting enough people vaccinated.

Some provinces have even announced specific targets, including Ontario, where hair salons and amusement parks can reopen when 70 per cent of eligible adults are vaccinated with one dose and 20 per cent with two. Gyms, theatres, bingo halls and indoor dining are allowed once 70 to 80 per cent have received one shot, and a quarter are wholly inoculated.

But vaccine targets are at least partially arbitrary. The threshold needed to achieve population immunity against SARS-CoV-2 is still being debated, the goalposts ever-shifting. Once 60 per cent, now 70 to 80 per cent — and maybe higher. “What if we get stalled at 78 per cent,” said Peter Loewen, professor of political science, global affairs and public policy at the University of Toronto. “Do we just keep holding off? When do we round up?”

Until now, the biggest challenge limiting vaccination rates has been supply and rollout. Soon, it could be the hesitant and reluctant. While Canada appears to be riding a wave of vaccine confidence, with millions falling over themselves trying to land shots in fragmented booking systems, 20 per cent appear to be sitting on the sidelines, surveys suggest. Will it take incentives to sway them? Coercive policies?

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Across the U.S., state leaders and companies are dangling vaccine perks, from free Krispy Kremes to Ohio’s “vax-a-million” statewide lotteries. Manitoba Premier Brian Pallister has promised to introduce an incentive program for vaccine-hesitant Manitobans next week. “If you haven’t chosen to get a vaccine yet, these words are for you: I respect your right to choose,” Pallister said Thursday. “Your body is your body. Your decision is your decision. But you’re not alone in the impacts of the decision.” Quebec and other provinces have hinted restaurants, concerts and other public venues might become off limits to the unvaccinated.

Overall, vaccine hesitancy is falling in Canada. According to data from the COVID-19 Vaccine Skepticism in Canada project, “vaccine willingness” increased from 67 per cent in January, to 80 per cent by May 11 — an increase driven by a nine-percentage-point drop in those saying no to vaccines, Loewen wrote in his latest dispatch for the Media Ecosystem Observatory, or MEO, and a four-percentage-point dip in the not-sure’s.

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Since March 2020, MEO, a collaborative effort of three research sites, has conducted more than 92,000 interviews of Canadians in more than 45 waves of data collection. Back in November, skittishness over the safety of vaccines was holding the semi-hesitant back. That, and uncertainty over the seriousness of COVID. More people now appreciate the magnitude of the latter and, despite “overblown concerns” about a rare blood clotting syndrome linked to AstraZeneca shots, “they see that vaccines largely work,” Loewen said.

Plain social pressure is also moving the needle. “They see that their friends are doing it; it seems like the right thing to do, so they move into that camp of wanting to conform to that social pressure.”

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But there are also subtle expressions of vaccine hesitancy, like waiting – waiting for more people to get vaccinated “to see what happens,” waiting for the “better” vaccine, experts said during a Public Health Agency of Canada panel discussion this week on COVID-19 vaccine hesitancy.

Racialized and Black people have indicated a lower willingness to be vaccinated, because of lived experiences of stigma and discrimination in the healthcare system, and historic and contemporary experiences of racism, said Dr. Akwatu Khenti, an assistant professor at the U of Toronto’s Dalla Lana School of Public health who chairs a city of Toronto Black scientists’ task force around vaccine equity. All erode trust.

Don’t do harm by invalidating their perspectives, Khenti advises healthcare providers. “You have to assume that if someone expresses vaccine distrust or mistrust it has to be grounded in reason, even though it’s something you may not agree with.” Listen respectfully, share the facts, provide the science and let people make a decision, he said. When a vaccine clinic for Black people was held in one of the hardest hit areas of Toronto two weeks ago, the line started forming by five in the morning. This, in a very vaccine hesitant community. “What that showed us was trust, and an equity approach which didn’t involve registration, it was a walk-in clinic targeting Black people, worked,” Khenti said.

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Nationally, the percentage of those firmly opposed to a COVID vaccine, full stop, hovers at around ten per cent of the population, data from Loewen’s team and pollsters suggest. Those higher in “anti-intellectualism,” disdain for experts or scientific expertise are less likely to get vaccinated. Women also seem less keen than men, though the difference isn’t huge, and Loewen’s careful not to make sweeping generalizations. “It’s all small, relative differences, which makes it hard for us to know exactly what to say to try to convince them they really should get vaccinated.”

The biggest driver is concern about COVID, which may make convincing people more difficult the further out the mass vaccination campaigns go. The more people immunized, the higher population immunity builds, the lower the threat of COVID. “The last person is the hardest,” Loewen said, which is why his advice to public health leaders is to continue communicating the threat of COVID, including a possible fourth wave, if high levels of vaccination aren’t achieved.

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Despite Ontario’s highly calibrated reopening plan, “what’s going to matter is whether people use common sense or not, and whether they’re willing to hold off on seeing friends for a month, not whatever complicated set of precise rules public health has come up with,” Loewen said. (Late Friday afternoon the province scrambled to add splash pads and spray pads to “outdoor recreational amenities” permitted to open this weekend after pushback from several mayors.)

Loewen’s puzzled by the pandemic. “I don’t think we have anything close to a full picture of what’s happened.” His intuition? “We have gotten through this thing principally because of the massive fiscal firepower of the federal government that staved off economic collapse” and through the willingness and good graces of Canadians to incur massive personal sacrifices to get through this nightmare.

The provincial reopening plans, in many ways, represent the first time governments have squared up with people, he said.

“Remember when we needed two weeks to crush the curve? We’re on week 64. We are down to the short strokes here. But there are another few months to get through this thing. Hopefully the fall will be normal.”

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