Hot-spot clinics not robust enough

Vaccination strategy didn’t reduce cases enough, study shows

Inequalities in COVID-19 infection rates have remained in Toronto, despite hot-spot neighbourhoods reaching a similar vaccination rate to regions with a lower burden of infection.

Those hot-spot areas, which predominantly house immigrants and have often faced long-standing inequalities related to lack of social services and other supports, have had persistent levels of the virus that are higher compared to wealthier Toronto neighbourhoods.

The province’s hot-spot vaccination strategy was not robust enough to move the dial on the relative burden of the virus in regions most affected, new research from Western University shows.

To improve COVID-19 infection rates in hot spots, vaccination rates need to match the risk of exposure per neighbourhood, the study indicates.

“We found that despite the fact COVID-19 vaccination rates became near equal, COVID-19 infection rates, and the inequalities in it, continued to persist,” said Kate Choi, an associate professor of sociology and director of the university’s Centre for Research on Social Inequality who co-authored the study.

“If we only look at equal vaccination rates … these communities that were more vulnerable to start with, they will have more new cases,” she said.

The report indicates that when Ontario prioritized vaccines for hot-spot neighbourhoods for a two-week period in May, those vaccination rates did not increase fast enough to significantly combat the spread of infection in those areas.

Choi and her colleagues used public health administrative data from the city of Toronto to compare vaccination rates in neighbourhoods with low, moderate and high rates of COVID-19 during the period of April 17 to June 23.

They found that in April, neighbourhoods that had high rates of COVID-19 had vaccination rates that were about 5.8 percentage points lower than communities with low rates of the virus.

By mid-June, due to those hotspot neighbourhoods receiving priority later on in the rollout, that margin had been reduced to 1.7 points.

A Star analysis in partnership with The Local Magazine in June also found vaccination rates in Toronto hot spots to be slipping relative to non-hot spots.

But the number of new cases overall in hot spots continued to increase at a faster rate, compared to neighbourhoods with lower infection rates, the study showed.

Those who live in communities the province has deemed as hot spots are twice as likely to be racialized, and four times as likely to work in manufacturing and utilities, compared to other neighbourhoods, an analysis from the University Health Network indicated in May.

Reporting from the Star indicates that neighbourhoods that have had a higher burden of infection since the start of the pandemic have lacked longterm investments in their communities and often rely on community organizations, which have limited resources, to support the population.

Other factors that make residents in neighbourhoods like Toronto’s northwest corner or Scarborough more vulnerable include a higher percentage of workers who take temporary positions to pay the bills, that involve working at factories where risk of exposure is heightened.

Choi said the research indicates that with the vaccination approach, governments need to rethink what equity means.

“In a community where you have residents who because of their work circumstances, they are less likely to work remotely, or because they live in crowded households … equal vaccination rates will not necessarily mean that they will have equal COVID-19 infection rates,” she said.

“We need to vaccinate at rates that are proportional to their COVID-19 virus exposure incidence,” she said.

If booster shots are something the province is considering, hot-spot neighbourhoods should be given access first and for a period longer than two weeks, said Choi.

“For us to achieve health equity, we really need to systematically know what those barriers are and make efforts to address those barriers, so that we can have health equity over time.”