HAMILTON — When Samira Mokenan saw a notice in her apartment building indicating she could get a COVID-19 vaccine at a nearby mass-vaccination clinic, she had concerns.
As her husband works during the day and her youngest is only one, Mokenan was worried about the logistics. “I'm thinking, How am I going to leave and get the vaccine? I want to get it — not for myself, but for my kids and to protect the community, the building, the tenants, the neighbourhood.”
For eight years, the mother of four has lived in Hamilton’s Rebecca Towers, an apartment complex, in the Beasley neighbourhood, that was the site of a COVID-19 outbreak in May. The notice about vaccinations came after Hamilton Public Health Services had declared the outbreak and tested residents for the virus, going door to door.
Shortly after the first notice was posted, though, a second one went up: this one informed residents about planned in-unit vaccinations. Mokenan called public health and booked an appointment, and, on the weekend of May 15, a team came by and vaccinated 28 residents, including her. “That was so nice. We were thankful,” Mokenan says.
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Hamilton public health reserves the approach for homebound residents, saying that it’s resource-intensive. But the Rebecca Towers Tenant Committee, which advocates for people living in the building, says that the city should offer the service to all residents of apartment buildings — and experts say it’s critical to diversify approaches to get more shots in arms.
A Hamilton Public Health Services spokesperson tells TVO.org via email that its primary-care partners vaccinated Rebecca Towers residents who “required on-site homebound appointments for medical reasons” or were isolating as a result of being close contacts of a positive case. They also indicate that three residents of Wellington Place and two residents of the Village Apartments who required on-site homebound appointments were immunized onsite by the Hamilton Paramedic Services Homebound Vaccine Team. About 1,400 people have gotten the shot at their residence; although the program has since closed, they say, if more eligible people are identified, public health and its partners will work to ensure they get their vaccination.
While HPHS facilitates onsite vaccinations in certain circumstances, officials have repeatedly said that they’re harder to organize than the public may appreciate. At May 17 media briefing, Medical Officer of Health Elizabeth Richardson said, "We do look at setting up mobile clinics in many different scenarios to support people. Of course we can't set up a mobile clinic in every neighbourhood. We can't set up one in every building in Hamilton."
According to the HPHS spokesperson, “Pop-up vaccination clinics and in-unit vaccinations require more human resources capacity per vaccine administered” and mean that health-care workers need to travel and schedule appointment times with residents. Mobile pop-up vaccination clinics administer upwards of 120 to 150 doses per day, they note; by contrast, a large-scale vaccination clinic, such as the FirstOntario Centre, has the capacity to administer up to 3,000 doses per day. That, they say, makes large clinics “the most effective way to vaccinate large numbers of community members.”
The Rebecca Towers Tenant Committee argues, though, that the benefits would outweigh those initial costs. Emily Power, an organizer with the committee who lives nearby, notes that, according to the most recent census data, 15.9 per cent of the Hamilton population lives in apartment buildings taller than five stories — that adds up to about 85,000 people. “Many of these buildings are concentrated in neighbourhoods that have high rates of COVID infection but low rates of vaccination,” she says. In Hamilton, as elsewhere in Ontario, data shows that lower-income people, many of whom are renters, are more at risk from COVID-19 than are people with higher incomes.
“To me, that suggests the outbreak at Rebecca Towers will not be the last and that there's a high risk of similar disasters happening at other buildings across the city,” Power says. “There's an urgent need for Hamilton public health to change their approach to the vaccination strategy and to bring the vaccine to the doors of the people who need it most.”
Another alternative, she says, could be more pop-up clinics in at-risk neighbourhoods near high-rise communities, similar to ones that have been held in Toronto. “It would make sense to host pop-up clinics on the lawn outside a building or at a nearby park, where all the people who live in these high-rise buildings could come and easily drop in and get their vaccine,” she says.
The HPHS spokesperson notes that pop-up clinics in rural areas and areas with low vaccination coverage are a part of its strategy. Pop-ups, they add, “have been located at Restoration House for Black and other Racialized Populations/People of Colour, Perkins Centre for Indigenous community members, and the Downtown and Mountain Mosques.” On June 15 and 16, the Ontario Ministry of Health’s mobile-vaccination unit will be in Stoney Creek offering a pop-up clinic targeting an area with lower vaccination rates.
“Where there is an identified need that cannot be met, City of Hamilton Public Health Services and its healthcare partners will work together with the community to ensure everyone who wants a vaccine can access a vaccine,” they write.
Tim O’Shea, an infectious-disease and internal-medicine specialist based at Hamilton’s Juravinski Hospital and working in McMaster’s Department of Family Medicine, says he thinks what the Rebecca Towers committee is calling for makes sense “from a public-health point of view in terms of getting the right populations vaccinated as quickly as possible.”
O’Shea works with Shelter Health Hamilton to stage pop-ups targeting vulnerable populations and is also part of the Hamilton Social Medicine Response Team. “As we have been able to get more of the general population that is able to access vaccines at centralized clinics vaccinated there,” he says, “my preference would be that we start to shift more to a decentralized approach in order to ensure that especially the highest-risk groups have easy and equitable access to the vaccines.”
While a centralized strategy based on mass-vaccination clinics has merit, he adds, in his view, it’s time to lean more toward a decentralized approach. That would involve medical professionals providing care “in places that people are most comfortable receiving it, whether that be at homes or coffee shops, shelters or on sidewalks,” he says. “Although the structures we've set up to provide care traditionally worked for a lot of people, there is a fair segment of the population for which they don't,” due to discomfort, prior negative experiences with health care, or barriers to access. “One piece that we could do a better job of as a system is listening to the communities that are at highest risk and taking into account their perspectives on how best to do this.”
Tia Pham, a team physician lead and associate professor at the University of Toronto’s Temerty Faculty of Medicine, agrees that public-health units need to think outside the box when it comes to vaccinating harder-to-reach community members. “You organize your beautiful mass-vaccination clinics and hope that the people come to you,” she says. “And it'll be that educated, affluent group of people that get themselves organized and figure out how to register online. And people, I find, who live in large apartment building complexes often aren't that affluent. Everything that we assume about, internet, mobility, being tech-savvy, knowing how to register online — it doesn't apply.” This leads people to delay booking their shots, she says.
Between March and late May, Pham and her team of family doctors vaccinated homebound residents throughout Scarborough, completing their list of identified patients, whom she says tend to be at high risk from COVID-19. They did this by mapping routes so they could take allotted doses of the Moderna vaccine on the road and complete their rounds within six hours (the time limit for that vaccine to be mobile). For Pham, the fact that family doctors have been able to vaccinate so many homebound residents shows the value of a more “patient-centred” approach.
Pham says families have told her that pop-up clinics work well because everyone in a household can get vaccinated at once, without the work needed to organize multiple vaccinations and transportation to various appointments. “I think you just have to bring the things to the people if you want to get them vaccinated. Different populations require different approaches, and some of that needs to be much more patient-centred than organizationally centred.”
Rhea Suresh, a Rebecca Towers resident and committee member, contracted COVID-19 during the building’s outbreak, as did her husband and then-four-month-old daughter. Suresh calls the experience “traumatic” but notes that their symptoms were mild and they all recovered. On the weekend of May 15, she and her husband were vaccinated in their unit. In her view, even in places without outbreaks, people with pre-existing health conditions, disabilities, or young children should be eligible for onsite shots or have more pop-up-clinic options. “It'd be really helpful if the city could help people,” she says.
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