Michelle Quick, 33, gets her second dose of the Pfizer-BioNTech COVID-19 vaccine at a one-day pop-up clinic in the Eaton Centre shopping mall in Toronto on July 27. (Evan Mitsui/CBC)

COVID-19 vaccine mandates are coming — whether Canadians want them or not

'Patchwork' system of vaccine mandates emerging in Canada as 4th wave takes off

Adam Miller

Like it or not, COVID-19 vaccine mandates are coming to Canada. 

Whether they're government-ordered for certain jobs and activities, or implemented in a piecemeal way by the private sector, Canadians can expect to see more aspects of society require proof of vaccination in the weeks and months ahead. 

And with a fourth wave underway in much of the country ahead of schools restarting and borders reopening to some fully vaccinated travellers next month, experts say now is the time to put vaccine mandates in place before another potential surge.

"They're coming — one way or the other," said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.

"Do you want to do it while we are calm in the water? Or do you want to do it when the storm is raging around us?" 
 

Pedestrians in Toronto carry and don masks on Aug. 12. Health officials are citing rising COVID-19 case counts as a sign Ontario is in a fourth wave of infection. (Evan Mitsui/CBC)

Provinces 'choosing their own adventure'

Instead of a co-ordinated approach across the country, a patchwork system of vaccine certification is emerging throughout Canada as some provinces outright oppose the concept while others fully embrace it. 

Quebec took the bold first step of announcing this week that vaccine passports for non-essential services, like bars, restaurants, gyms and festivals, would be mandated on Sept. 1 in an effort to avoid reintroducing lockdown measures.

British Columbia announced Thursday that anyone working in long-term care and assisted-living facilities in the province will be required to be vaccinated by Oct. 12, and Manitoba has launched a new proof-of-immunization mobile app for fully vaccinated residents.

But Alberta has repeatedly said it will not bring in vaccine passports and Premier Jason Kenney has outright dismissed the notion of mandatory vaccinations, even amending the province's Public Health Act to remove a 100-year-old power allowing the government to force people to be vaccinated.

Ontario Premier Doug Ford also firmly rejected the possibility of vaccine passports last month, even for health-care workers, saying the province is "not going to have a split society."

The federal government made its position known Friday ahead of an election call, announcing it will soon require all public servants to be vaccinated, as well as passengers on commercial planes, cruise ships and interprovincial trains in Canada.

But while Ottawa has taken a hard line on vaccine mandates and committed to creating proof-of-vaccination documentation for international travel by early fall, it stopped short of implementing a domestic vaccine passport system across Canada.

"Unfortunately, the provincial and territorial scene is likely to remain a patchwork for ideological reasons," said Dr. David Naylor, who led the federal inquiry into Canada's response to the 2003 SARS epidemic and now co-chairs the federal government's COVID-19 immunity task force.

"And I don't think the federal government can force vaccine certificates on subnational jurisdictions." 

Naylor says he hopes the federal government can work with provinces and territories to adapt the newly announced vaccine document for international travel into a national vaccine passport for use in all provinces and territories in the future. 

"The provinces would probably wave that idea off," he said. "But in a rational universe, we'd have one standardized Canadian document for domestic and international use."

Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario's COVID-19 vaccine task force, says it's become clear that Canada will not take a national approach to vaccine certification because the federal government doesn't have the authority to direct provinces and territories to come on board.

"We're going to have vastly different strategies, with Alberta at one end of the spectrum, and Quebec at the other end of the spectrum — and probably many provinces in between," he said. 

"But from a policy standpoint, it's clear that the provinces are choosing their own adventure." 
 

Instead of a co-ordinated approach across the country, a patchwork system of vaccine certification is emerging throughout Canada as each province and territory takes its own path. (Evan Mitsui/CBC)

Mandating vaccines 'not the be all and end all'

The question remains as to how effective vaccine mandates will be in controlling the spread of COVID-19 among the unvaccinated during the fourth wave, and whether testing is sufficient enough to keep community transmission low. 

"You can definitely see how mixing vaccinated and unvaccinated people in high-risk environments could ripple out into unvaccinated populations — particularly ones that are high risk," said Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare Hamilton and an associate professor at McMaster University. 

"It makes sense if you get to a certain community incidence, where the odds of someone walking into that place with COVID-19 are starting to get higher and higher by the day, it could start a chain effect." 

Chagla says Quebec's approach of only mandating vaccines for non-essential services prevents ostracizing those who aren't vaccinated — due to choice, eligibility or accessibility — while encouraging more people to get vaccinated so they can engage in more activities.

People walk by a COVID-19 vaccination sign in Montreal on Aug. 8. Quebec became the first province in Canada this week to introduce a wide-ranging vaccine passport system, to begin on Sept. 1. (Graham Hughes/The Canadian Press)

Dr. Lisa Barrett, an infectious diseases physician and immunologist at Dalhousie University in Halifax, says that while she's fully in favour of vaccine passports, there are other options for keeping Canadians safe in high-risk settings for COVID-19 transmission. 

"We want to protect public places and people attending them by not having infectious folks around. You can do that with double vaccine — or by showing a negative test for the minority not vaccinated for various reasons," she said. 

"It's obviously better on a personal front to be vaccinated, but it preserves some choice while people are getting there." 

Barrett says while she prefers vaccination for controlling COVID-19 levels, she hates the idea of exclusion until all other options have been exhausted; she points to the ample supply of rapid antigen tests in Canada to help bridge the gap.

Bogoch agrees that while vaccine mandates are an effective strategy at increasing our vaccination levels across the country, unvaccinated Canadians are a diverse population with many different reasons for foregoing a shot — and that needs to be approached with care.

"Some people still have remaining questions and issues and anxiety that hasn't been addressed. We obviously have to take those questions and issues and anxieties seriously, and address that in an empathetic manner," he said. 

"I think it's also fair to say that some people regardless of what we say — regardless of science, reason, logic — some people are just never going to get vaccinated."
 

'Window of opportunity' to prevent brutal 4th wave

Canada has emerged as one of the most vaccinated countries in the world, with more than 60 per cent of the Canadian population fully vaccinated after a relatively slow start to the rollout. 

But with 40 per cent of the population with lower protection from COVID-19, with only one shot or none at all, there are still millions of susceptible Canadians — especially in the face of the more contagious and potentially more deadly delta variant.

"Given the fact that we're about to open everything up, it seems likely that those 40 per cent are going to get infected at some point, which means that we're going to have a lot of stress on our society," Deonandan said. 

"There's a window of opportunity to prevent a lot of societal suffering and frankly, the selling point should be to businesses — do you want to stay open? Do you want your employees to have jobs? This is what we do to make sure that happens, because we see a storm coming."
 

Rising vaccination rates, alongside public health measures like mask-wearing, may ward off the worst outcomes of a fourth wave, even as delta spreads. But medical experts warn pressure on Canada's hospital system remains a possibility if cases continue to spike. (Graham Hughes/The Canadian Press)

'No doubt' Canada now in 4th wave of COVID-19 as cases spike across much of the country

With COVID-19 cases rising in multiple provinces after a summer lull, more signs point to Canada entering an expected fourth wave of the pandemic — one which could be dramatically different from earlier surges, thanks to rising vaccination rates, but not entirely pain-free.

The country's seven-day average for new daily cases is now close to 1,300 — an increase of nearly 60 per cent over the previous week, with cases ticking back up mainly in B.C., Alberta, Saskatchewan, Ontario and Quebec.

"We're absolutely in the fourth wave," said Dr. Peter Juni, who is the scientific director of Ontario's COVID-19 Science Advisory Table. "There's no doubt about that."

But unlike previous waves, which overwhelmed various hospital systems and led to catastrophic death in long-term care facilities, there is hope this spike won't be quite so dire.

High vaccination uptake across the country has changed the game: Roughly 60 per cent of Canadians are now fully vaccinated, and research continues to show leading vaccines offer high levels of protection from serious illness, even against the fast-spreading delta variant.

"We can effectively have more cases in our population without having as severe an impact on our health-care system," explained Ashleigh Tuite, an epidemiologist with the University of Toronto's Dalla Lana School of Public Health.

"But that doesn't mean that we're out of the woods."

Multiple experts who spoke to CBC News stressed the need to keep precautions like mask-wearing in place to avoid the worst of what this wave could bring, while also striving to ensure as many Canadians as possible get their shots.

"The point is we can't go back to normal," said Juni. "Because we continue to have a challenge with the large proportion of people who remain unvaccinated."

Read more from CBC Health's Lauren Pelley on Canada's fourth wave of the pandemic. 

Parents walk their children on the first day of school, amid the coronavirus (COVID-19) pandemic, at West Tampa Elementary School in Tampa, Florida, U.S., August 10, 2021.

Why the delta variant is hitting kids hard in the U.S. and how we can prevent that in Canada

As back-to-school season approaches, many Canadian parents are alarmed by reports of unprecedented cases of COVID-19 among children and teens — as well as increased hospitalizations — in parts of the U.S.

According to the American Academy of Pediatrics, the majority of these illnesses are driven by the delta variant, which it has called "hyper infectious."

Although the delta variant is on the rise in Canada too, pediatric infectious disease specialists and public health experts say we're not in the same boat as U.S. hotspots — and that there are measures we can take to avoid getting there.
 

What's happening in the U.S.?

"Right now, things are really bad in the southern and southeastern parts of the United States," said Dr. David Kimberlin, with the Children's Hospital of Alabama and a professor of pediatrics at the University of Alabama at Birmingham.

"We have more pediatric cases, more pediatric hospitalizations, more pediatric severe disease cases than we've ever had throughout this pandemic," he said.

"What we're experiencing is much worse than it was even in the dark days of January and February … during the wintertime surge."

One reason for that is the dominance of the delta variant, which Kimberlin estimates is about 90 per cent of the COVID-19 cases he's seeing now.

The other big reason, he said, is "abysmal vaccination rates" in COVID hotspots.

"You put a highly, even much more infectious — hyper-infectious, hyper-transmissible — virus that this delta variant represents into a population that's … a third vaccinated, you got a recipe for disaster," said Kimberlin. 

"We're living that disaster right now." 

Data from the Centers for Disease Control and Prevention show a 27.3 per cent rise in the seven-day average for U.S. COVID-19 hospital admissions among children from 0 to 17 years old between the week of July 28 to Aug. 3 and the week of Aug. 4 to Aug. 10. 

According to additional CDC data, the highest COVID-19 case rates per 100,000 people are in Alabama, Arkansas, Louisiana, Mississippi and Florida. 

Thanks for reading! You can email us any time at secondopinion@cbc.ca with your comments, questions, thoughts or ideas.