Deep into the third wave of the COVID-19 pandemic, Canada is racing to catch up with a virus spreading and mutating across the globe at an incredible pace. No longer is the collective goal to “flatten the curve” – this time, armed with vaccines, the aim is to break the chain of infection altogether.

In this three-part series, YFile investigates the COVID-19 vaccine as an injection of hope for recovery. Today, in part three, we look at the road to recovery.

Every year, there are roughly 200 events that have the potential to become a pandemic.

Let that sink in a moment: That means each year, 200 diseases that emerge in different parts of the world are tracked by scientists and public health experts for signs of high transmission, severe outcomes and rapid spread across borders.

While nearly all of these diseases do not go very far, the ones that do start to emerge with concerning traits must be contained before they spread globally, explains Steven J. Hoffman, the Dahdaleh Distinguished Chair in Global Governance and Legal Epidemiology, a professor of global health, law and political science, and the director of the Global Strategy Lab at York University.

With the novel coronavirus SARS-CoV-2, we are well past that point. “Not only do we now have a virus that is in every country in the world, but there is so much of this virus in the world that by random chance and evolutionary pressure we are seeing increasing numbers of mutations,” says Hoffman.

The good news is the COVID-19 vaccines seem to be effective against these variants of concern (VOCs). The bad news? We still could see future mutations that introduce a new threat, even if an entire population is vaccinated.

We might then ask: If we know there is potential for a global pandemic roughly 200 times a year, why weren’t we more prepared for COVID-19 and how did it become so unmanageable? What haven’t we learned from previous pandemics?

Hoffman posed a similar question in 2016 when he published the article “How many people must die from pandemics before the world learns?” to investigate the underlying global institutional failures that allowed the Ebola pandemic to proliferate. He concluded that a death toll of 11,323 was not enough to instigate this change.

“What a tragedy it would be if we need a far worse pandemic than Ebola, one that kills many more people and wreaks even greater havoc, to finally motivate the global institutional changes that are urgently required,” the 2016 article reads.

Yet, here we are.

“The article concludes with the idea that, given how global politics work, a whole lot more people are going to need to die before the world treats pandemics seriously,” he says. “There has been so much suffering for everyone during this pandemic that if COVID-19 doesn’t trigger the kind of changes we need, I don’t know what will.”

Changes, he says, to the underlying inequities and problems that exist in society and around the world that demonstrate how poorly prepared we are for these types of transnational threats that have the power to shape the future.

“I am genuinely hopeful, however, and I think there are a lot of people who feel like that – that this is the time to make these changes,” says Hoffman. “I hope it’s a recovery and that it’s a good recovery.”

Vaccination, he says, is one element of the recovery that will benefit not just individuals, but families and communities. The more people with COVID-19, the worse it is for everyone: hospitals overwhelmed, businesses closed, livelihoods at risk, children learning remotely.

“In that respect,” he says, “vaccinations are good for individual health but also equally or even more important for communities.”

But there is more to consider.

Planning for a potential fourth wave of COVID-19 – and possibly a fifth and sixth wave and so on – relies on more than vaccination campaigns, says Eric Kennedy, assistant professor at York University in the Disaster and Emergency Management program. Breaking the chain of infection is a global issue that requires collaborative solutions.

Kennedy notes two paradigms that have emerged in response to the global spread of COVID-19 since it emerged in March 2020: one perspective is to shut down the country’s borders, prevent foreigners from coming in and on-shore production of vaccines, personal protective equipment and resources to keep the virus out; the other perspective is to position public health as a “team sport” and participate in collaborative, international networks and respond with a global lens.

The latter is the approach Canada has taken.

“I think the fourth wave and onward waves come from the potential of the virus to mutate, and when we have unconstrained outbreaks in the world – especially in places where vaccination rates are low – we are giving the virus the chance to mutate and change,” says Kennedy.

The strategy to encapsulate a country and “go it alone” therefore cannot keep you safe, he says, because it creates potential for outbreaks and mutations in other parts of the world. Closing borders to keep the virus out isn’t sustainable over a long period, and mutations will eventually find a way in.

“We need to get COVID-19 under control around the world, reduce the opportunity for the virus to mutate and change, and slow the pace at which that happens so our vaccines can stabilize around it,” he says, adding this will be the determinant of future waves.

Kennedy is leading a project conducting surveys and interviews to understand social experiences, attitudes and perspectives, and adaptations regarding the COVID-19 outbreak in Canada. This work aims to inform policy through a better understanding of concerns and expectations. One of the key findings to date is the need to approach vaccination with a trust-building dialogue rather than a deficit model correction.

“The deficit model can be very seductive: the simplistic belief that if we simply share facts with the public, they’ll be eager to get vaccinated,” Kennedy warns. “But what we’ve found is that people have all sorts of very detailed and nuanced questions. The way to resolve this isn’t to bombard them with more public service announcements but to take these concerns seriously … and give really good answers that are evidence-based,” he says.

Factors affecting decision-making around vaccination, he says, have been consistent through these inquiries: people want evidence and advice from medical doctors.

Hoffman, who led the development of the UN Research Roadmap for the COVID-19 Recovery, says science is the way out of this pandemic.

“Science is the way we are going to ensure that next year we do things better than this year, and it is science that is allowing us to do better this year than last year,” says Hoffman. “This is the way we are going to make a better society in the future.

“I think what’s clear is that science is the way out of this pandemic. Science is also the way out of other global challenges we are going to face in the future, and we need everyone to be champions for science.”

If science is the answer, what will be the catalyst for recovery?

Kennedy suggests one opportunity is to use vaccination targets as a type of “social contract” to motivate a return to normal – much like Ontario has recently announced, simply with higher targets.

“I want to be clear that in no way do I expect the vaccine is going to solve this perfectly, but the vaccine will get us to a point where we are not dealing with severe illness and overwhelmed hospitals,” he says.

“I do expect that widespread vaccination and declining case rates will bring a little bit of a bookend to this.”

This concludes YFile‘s three-part series. For previous stories, visit yfile.news.yorku.ca/2021/06/09/an-injection-of-hope-herd-immunity-where-are-we-now and yfile.news.yorku.ca/2021/06/13/an-injection-of-hope-what-we-learned-from-the-vaccine-rollout.

By Ashley Goodfellow Craig, deputy editor, YFile

Deep into the third wave of the COVID-19 pandemic, Canada is racing to catch up with a virus spreading and mutating across the globe at an incredible pace. No longer is the collective goal to “flatten the curve” – this time, armed with vaccines, the aim is to break the chain of infection altogether.

In this three-part series, YFile investigates the COVID-19 vaccine as an injection of hope for recovery. Today, in part two, we look at vaccine access, equity and rollout.

Imagine you are someone working in a highly exposed job in a hot-spot community during the COVID-19 pandemic. Imagine that without this job, you cannot pay your rent, feed your family or meet your responsibilities. Imagine this job does not offer personal days, sick pay or time off from your regular schedule.

Now imagine all this means that despite desperately needing it, you cannot access a vaccine for COVID-19.

This is just one example of the unfair burden the novel coronavirus has placed on marginalized populations. The pandemic has disproportionally affected people who are already facing systemic inequities within our society – structural, racial, economic and so on – resulting in higher transmission and case counts, less access to health resources, and unfair working and living conditions among these populations.

The vaccine rollout has been no different.

“There is more to consider in terms of vaccine uptake than the vaccine decision or intention – a lot of people may have the intention to get the vaccine but are running into barriers in terms of availability, access or timing,” says Eric Kennedy, assistant professor at York University in the Disaster and Emergency Management program. “There are many people who want to take this vaccine but encounter substantial barriers.”

Numbers from the Science Advisory Table during the vaccine rollout, he says, indicate higher rates of vaccination among those in lower risk categories, which highlights the structural and logistical barriers preventing equitable vaccination opportunities.

“It has not necessarily been made clear that we’ve been doing a good job of protecting those communities that are the most vulnerable,” he says.

Professor Steven J. Hoffman agrees. Hoffman is the Dahdaleh Distinguished Chair in Global Governance and Legal Epidemiology, a professor of global health, law and political science, and the director of the Global Strategy Lab at York University.

When looking at data for Toronto, he says wealthier people have had better access to the vaccine over those living in poverty and in marginalized communities. Take the Jane and Finch area, for example. This community, says Hoffman, has a greater burden of COVID-19 and more severe consequences of the virus, yet the high-risk factors there were not immediately considered in the province’s vaccination strategy.

“If you were running a vaccine rollout in the most effective way possible, you would consider the full range of risk factors and you would plan accordingly,” he says. “The way Ontario has fared during this pandemic is largely the result of decisions made by our provincial government. Those decisions have sometimes had deadly consequences.”

Eventual changes to vaccine distribution in Ontario – such as prioritizing hot-spot postal codes, holding vaccination campaigns within workplaces and offering extended-hours vaccination clinics – have addressed some of these barriers.

This was an attempt to correct the “double inequity that comes from both the unfair burden of this virus on people who face conditions of marginalization and lower access to vaccines for those same populations,” says Hoffman, who says this strategy came too late.

“Once you know this is a global pandemic, you want to make sure your jurisdiction is ready for vaccine rollout. That didn’t happen here.”

The rollout in Ontario, he says, has been “pretty terrible” and was delivered with a slurry of confusing communications about the vaccine, a lack of consistency in delivery and difficult-to-follow protocols.

“This is my area of research, and at times I myself have been so confused by the province’s messaging,” he says. “It was changing so fast, and communication has been terrible – and it doesn’t actually all make sense. It makes it really hard for people to keep track, and so we are at the stage where it is increasingly important for the government and public health authorities to make it as easy as possible for people to be vaccinated.”

This rings true when looking at populations that lack the tools to access information – language, technology and health-care supports like provincial health insurance, for example.

However, both Hoffman and Kennedy agree that the vaccination rate in Canada is tracking well – especially compared to other G20 countries – and both say decisions made by the federal government have been successful in addressing other vaccine challenges.

Kennedy applauds Canada’s decisions around vaccine procurement and says the strategy to “spread our eggs in multiple baskets” allowed the country to respond with agility.

“There have been a lot of complaints about not having domestic vaccine production capacity, but if we had focused on one or two domestic vaccines alone, it would have been a huge gamble on availability and effectiveness. Instead, the strategy we took was to establish a large number of options and be able to pivot toward the most effective and available vaccines.”

He cites this as the “hidden gem” of the federal COVID-19 response.

And we are getting there, however slowly.

Using these experiences to inform policy around pandemic planning and response, and equity in public health and safety, will be the key to managing future outbreaks of COVID-19 and preventing the spread of highly transmissible disease going forward.

To guide and change policy, it will be crucial to recognize that decision-making around vaccines is not always based on rationale, but can be rooted in logistical barriers, lack of opportunity and cognitive fatigue.

“Disaster communication is often very local and tangible: community members turn to emergency managers for real-time information about the threat they’re facing, like a fire, flood or tornado,” says Kennedy. “But this case is dramatically different. The duration, complexity and interconnectedness really demands a more collaborative approach in engaging the public.”

This means taking dialogue seriously, rather than just disseminating facts, and understanding people’s values, challenges and expectations.

The UN Research Roadmap for the COVID-19 Recovery, a report led by Hoffman in his role as scientific director of the Institute of Population and Public Health at the Canadian Institutes of Health Research, outlines national and international strategies for the COVID-19 recovery period and puts this people-first perspective at the forefront.

The report, issued in November 2020, advocates for policies that are informed by evidence, address inequalities and prioritize human rights within a framework of five main pillars: health systems and services; social protection and basic services; economic response and recovery programs; macroeconomic policies and multilateral collaboration; and social cohesion and community resilience.

Hoffman remains positive that a more equitable balance can be achieved, and there is progress being made to policy around vaccine rollout provincially and federally.

“We live in a world where people, systems and generations are all interdependent,” says Hoffman. “That’s why I am pouring all my time and energy to encourage a better recovery – one that is more equitable, more resilient and more sustainable. I think those are the three key variables we need to think about, and I am hopeful – because if not now, then when?”

Read part one here: yfile.news.yorku.ca/2021/06/09/an-injection-of-hope-herd-immunity-where-are-we-now. For part three, visit: https://yfile.news.yorku.ca/2021/06/15/an-injection-of-hope-covid-19-and-the-road-to-recovery/.

By Ashley Goodfellow Craig, deputy editor, YFile