Toronto's new 'hyper-local' strategy the right move to target the unvaccinated, experts say

Toronto is moving to a tighter, more targeted vaccine strategy in the coming weeks — away from mass clinics in arenas and community centres to mobile teams bringing doses directly to residents.

The city will close five of its nine clinics on Aug. 22 and redeploy 700 staff to 17 "hyper-local" mobile clinics, in addition to the five currently operating, said Medical Officer of Health Dr. Eileen de Villa at the city's final COVID-19 update news conference on Wednesday.

"This will allow us to bring vaccines directly into workplaces and into communities and organizations who are experiencing low vaccine uptake," de Villa said.

It's the right plan as hundreds of thousands of people remain without their first dose, says Dr. Andrew Boozary, the executive director of the University Health Network Social Medicine program. 

"We saw early on there was this massive mismatch between the fires that were happening with COVID and where there was vaccine access," Boozary said. "This is really about how to remove some of those barriers.

"I think if that stays as a hyperfocus, it will not just have benefits for certain communities. It actually will have much broader impacts for all of us, especially coming into the fall."

'Bring the vaccine to them'

Neighbourhoods in Toronto's northwest corner have some of the lowest vaccination rates, according to city data released Friday. For example, just 52 per cent of adults in Elms-Old Rexdale have both doses, compared to the city-wide average of 71 per cent.

Toronto Public Health said it will shut down two mass clinics that served those neighbourhoods — the Carmine Stefano Community Centre and Toronto Congress Centre — in part because of declining demand, despite lagging vaccination rates.

Michelle Dagnino, executive director at Jane/Finch Community and Family Centre, said these types of clinics missed the mark for many in the Black Creek and Rexdale neighbourhoods.

Some residents with language barriers or without Internet access struggle to book appointments online or don't trust the health-care system. Others may not have access to transit, cars or be able to afford paid ride services, Dagnino said.

Many residents have also continued to go into work during the pandemic, said Dagnino. That's why paid time off and making vaccines available at workplaces are crucial to getting people vaccinated, she said.

"If people can't get to the vaccine, you bring the vaccine to them," she said. 

Mobile clinics have already been successful in Jane-Finch, Black Creek and Rexdale, she added. 

"This shift is important when thinking about vaccine equity and will ensure that more communities will see an uptake in vaccination rates," Dagnino said.

Kids need to feel urgency

Kids continue to lag behind the city's average as well, with only 57 per cent of 12 to 17 olds having gotten both doses.

While that rate remains low, the city has been doing a good job getting first doses to this age group (75 per cent) compared to other Ontario municipalities, said Dr. Barry Pakes, a public health professor at the University of Toronto.

But for kids to be safe this fall, "There's no question, before school we need to get that [number] significantly higher," Pakes said. 

The key to getting more kids vaccinated is to create a sense of urgency as the school year approaches, even if it is only halfway through summer break, he said.

Pakes said the messaging to kids has to be: "If you want to be back to normal, if you want to do your extracurriculars, that's what you need to do."

And to parents: "If you don't want your kid home on virtual school, and just for your kid's wellbeing, they need to understand this is something they need to do." 

When the province releases its back-to-school guidelines for the fall, that may spur kids and parents into action, Pakes said.