We need guidelines for the partly vaccinated, and we need them soon

OPINION: Expecting Ontarians who’ve had one dose of vaccine to behave as if they’ve had none is not realistic — and it could be dangerous
By John Michael McGrath - Published on Apr 27, 2021
A nurse administers a COVID-19 vaccine at a pop-up clinic in Toronto's Thorncliffe Park neighbourhood. (Frank Gunn/CP)

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Late last week, the province passed a notable milestone: one-quarter of Ontarians have now received a dose of the Pfizer, Moderna, or AstraZeneca vaccines. But only about 2 per cent of Ontarians have received both doses and are considered fully immunized — or, at least, as protected as modern science can manage.

On the one hand, this is very good news: Ontario has been successful at getting vaccines out the door, and it’s paying off. (The government’s failure to distribute those vaccines to the parts of the province where they’ll do the most good is something that still needs to be addressed, though news on that front is expected this week.) But it leaves us with a public-health problem that will get here soon if it’s not here already.

Here's how things will go in the next month or so, assuming Ontario’s vaccination policy works as the government hopes it will and as the science says it should: new cases, hospitalizations, and deaths will start to decline, and before long, they’ll be falling rapidly. By the end of June, every eligible adult in Ontario will have had their first shot, and if that’s too late to save the school year, it’ll at least be good news for the next one.

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But this is where the problems start for the government: in light of these successes, cabinet will be under extreme pressure to start reopening all the amenities and businesses it’s kept closed for much of the past year.

Assuming the government doesn’t relax measures too quickly and incur a fourth wave, businesses are going to want as many customers as they can get, and people are going to want to get out of their houses even if they’re only partly vaccinated. It’s going to be months before most people have had both shots, and true “herd immunity” is going to require much more than a simple majority. (Of course, if something goes wrong, if a new vaccine-resistant mutation of COVID-19 appears, all bets are off.)

The advice from public-health officials so far has amounted to “people who are only partly immunized should maintain all their current precautions.” Basically: wear a mask, wash your hands, physically distance as much as possible, etc. This was, in fact, the advice provided by David Williams this week at Queen’s Park.

“I would say, at this stage, it’s like saying, ‘If I’m wearing a mask, I can go and socialize with anyone up close, and half is better than nothing.’ I would really caution against that in the present state of the variants that we’re seeing,” he said. “While you may have had one dose … you still might be carrying it, and you could transmit it to someone who you thought was vaccinated but is not.”

To be clear, this is still the best advice partly vaccinated people can take. But the dismal experience of the pandemic has shown us that if the government opens up bars and restaurants, people are going to patronize them. And to be equally clear, this is understandable: it’s absurd to ask people who’ve had one dose of a vaccine to behave as if they’ve had zero doses. An abstinence-only approach is not going to cut it: what’s needed are good public policy and good communications.

The public-policy side is going to be tricky, given the levers the province has pulled during the pandemic thus far. We’ve used regional and industry-specific public-health orders — bars and restaurants closed in one public-health unit but open in another, etc. — but the regulations we’ve implemented are not designed for the weird zone of ambiguity we’re about to enter, in which serious illness and death from COVID-19 will be a much rarer but still very real possibility for a large fraction of the province.

The communications side is going to be even trickier. During the past year, there have been a number of times when unclear communications — or clear communications about fundamentally unclear concepts — have come back to haunt government. Early claims by public-health officials that face masks were dangerous still look bad, but even things that looked good on paper (such as Ontario’s attempt at “social circles” — remember that?) eventually failed because they were too hard for normal people to manage.

On this week’s episode of TVO’s #onpoli podcast, I asked Heidi Tworek, a health-communications researcher at the University of British Columbia, about all this. She said the government needs to give people “winnable moments” — and communicating what’ll be permitted as vaccinations progress is part of that.

“How you motivate people to get vaccinated is because, in part, they know that things at some point afterwards will change. They’ll have winnable moments — grandparents hugging their grandkids, that kind of thing. It’s a motivating tool,” she told me. “The other thing to think about is to at least tell people you’re working on this. Help people to understand that you may not have the answer right now, but it’s something that’s in the hopper that you are, in fact, working on, and you’ll come out with a plan, guidelines at some point in the future.”

For now, we’ve got neither “winnable moments” nor a clear sense that the province is working on something. But this isn’t an issue the government can ignore — unless it wants to keep Ontario locked down until August.

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