The good news of Toronto’s pandemic response

Of all the people Shreya Rao helped during the pandemic, one stands out.

Last September, at an apartment building clinic, an older woman wanted the same brand as the first for her second COVID vaccine, but they didn’t have Moderna in stock.

So Rao and her team found a pharmacy that did, called ahead, put her in an Uber, and even sat down with her to talk afterward over some peanut butter bars.

“She literally cried,” the 36-year-old recalls. Although it is safe and effective to mix and match, Rao wanted to give the woman what she needed to roll up her sleeves. “Because we didn’t see her as a target to receive one more vaccine, we saw her as a person who wanted to get vaccinated, that she needed help.”

It is an experience that has been recreated thousands of times throughout the city, under an innovative program that has seen clear results. A small army of community COVID ambassadors has fanned out in their own neighborhoods, armed with facts, to combat misinformation, language barriers and other obstacles, and increase vaccination rates in some of the city’s most vulnerable neighborhoods.

Now, at a time when the will and funds to fight COVID are running out, the city is asking the province for about $6 million to continue the program through at least the end of the year, citing a track record of success and the potential to build on this model to provide other health care services in the future, from cancer screenings to high blood pressure checks.

Toronto has high vaccination coverage compared to major cities in the US and Europe. But vaccination rates in the city’s low-income, racialized neighborhoods — in places like Scarborough, Thorncliffe Park and the northwest corner — have lagged behind, even though they had higher rates of COVID.

But at a meeting last month of the Board of Health, there was some evidence of progress in narrowing this gap. The disparity between COVID rates in people of color and whites, and between people with lower and higher incomes, decreased in the fourth wave, according to analysis presented at the meeting.

Additionally, the 35 neighborhoods prioritized for Intensive Neighborhood Clinics and Community Ambassadors saw an average increase of 19 percentage points from June 2021 to April 2022, in first-dose vaccine coverage (66 to 85 percent), while all other neighborhoods saw an increase of 13 percentage points.

That doesn’t mean all of these long-standing problems are solved. According to the latest data from the nonprofit research group ICES, formerly known as the Institute for Clinical Evaluation Sciences, the percentage of people of all ages vaccinated with at least two doses is at least 70 percent across all city ​​neighborhoods. But postcodes M4H (Thorncliffe Park) at just over 70 percent and M3N (Jane and Finch) at almost 76 percent, are still among those with the least coverage. When it comes to third doses, there is still plenty of room for improvement with just over 31 per cent of all people having a third dose in Thorncliffe Park and 34 per cent in Jane and Finch, again among the lowest in the city.

“There is still some gap, but that gap is closing, and in particular in some Northwest neighborhoods there have been a lot of shifts in the right direction,” said Dr. Na-Koshie Lamptey, deputy medical director of health in Toronto. Public Health. .

“The vaccine engagement teams have been really integral and key to the remarkable success we’ve had,” he added. There are more than 600 ambassadors, like Rao, who have spent hundreds of hours doing outreach for neighborhood vaccine clinics and trials, helping residents navigate reservation portals, holding hands with nervous kids, and basically doing whatever they want. necessary, in 43 languages.

The city is now applying to the province for funds to carry out the program from July to December.

When asked if this would pass, Health Ministry spokesman Bill Campbell said in an email that the agency “will have the opportunity to seek reimbursement for extraordinary costs of COVID-19, including expenses related to the vaccine, during the funding year 2022”.

With about 82 percent of Torontonians vaccinated with two doses, it may seem like the heavy lifting has been done. But Sophia Ikura, executive director of the Health Commons Solutions Lab, a publicly funded nonprofit at Sinai Health, said there is still a lot of work to do, from the third and now the fourth dose, to childhood vaccines and outreach on around antivirals. like Paxlovid. Just over half of Torontonians have received three doses, and the ambassador teams will also be needed when a vaccine for children under five is approved.

These roles have been around for a long time, but were funded and formalized during the pandemic, Ikura said.

Some community agencies, facing COVID fatigue from the public, are already thinking more broadly, he said, like holding health fairs instead of just vaccine clinics. She sees great potential for the wider use of the teams that already exist, for things like getting women to have Pap tests or reaching older and younger people who feel isolated.

“Part of what we need to do is show that they can move away from the COVID response to those bigger health questions,” Ikura said.

“We need a basic game to reach people before they end up in crisis and come to us.”

Husna Malik, a social worker at the Carea Community Health Center in Durham, agrees that the model’s success is a “silver side” of the pandemic. The province has also provided funding for COVID support, such as community ambassadors in nearly 20 high-priority communities, including several GTA hotspots. They announced an additional $25 million for this in March.

“I think a lot of that knowledge can be translated into a general health approach to further reduce those disparities in other diseases for sure,” Malik said, adding that in the coming months they will focus more broadly on promoting health: things like chronic disease, diabetes, and high blood cholesterol.

Unfortunately, one of the challenges right now is overcoming the bullying that can sometimes come when it comes to talking about COVID.

Jaspreet Kaur, 22, who started out as a community health ambassador and is now assistant program coordinator for the Dixie Bloor Neighborhood Center, he recalls a woman who even pulled out a camera and threatened to call the police at an apartment vaccination clinic. They come across this kind of thing far too often, she said, because “misinformation and misinformation are so powerful.” But at the same time, it is clear that they have built a relationship with many in the communities where they live and work.

For Rao, who speaks four languages, including Hindi, and works in Scarborough, the job has also been a source of personal pride, an opportunity at an uncertain time. She struggled to find a foothold after arriving from Hyderabad, India, in 2018, where she had a background in marketing, communications, and journalism.

“This job gave me a breathing space to dive into something substantial with some potential,” he said.

“When people were losing hope, we were the hope givers.”

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