Fahad Razak, Arthur Slutsky and David Naylor are physicians and professors in the department of medicine at the University of Toronto. Dr. Razak and Dr. Slutsky are also on the medical staff of Unity Health Toronto.
The world recently marked two years since the WHO’s declaration of COVID-19 as a global pandemic. With the third year of the pandemic unfolding, it seems timely to reflect on Canada’s experience relative to other countries as we chart a way forward.
Picking individual comparators is fraught with potential bias. In a recently released analysis in the Canadian Medical Association Journal, we chose the G10 countries as a group, given their similar economic and political systems.
If, for example, Canada had the same infection rate as France, nearly nine million more Canadians would have been infected during the first two years. And if Canada had the same mortality rate as the U.S., nearly 70,000 more Canadians would have died. In fact, among the G10, only Japan had superior outcomes to Canada.
The reasons for Japan’s outcomes are still being debated. Similarly, it’s difficult based on these broad comparisons, to pinpoint why Canada did relatively well. Major kudos are clearly owing to all frontline workers, not least health care workers, who faced extreme pressures because of Canada’s notably low hospital and critical care capacity. However, the factors most likely to explain Canada’s advantage are that we had the highest two-dose vaccination rate among the G10, along with stringent and sustained public-health measures. Governments deserve some credit on both those fronts but Canada’s citizens remain the unsung heroes here. They got vaccinated at record speed, and stoically complied with wide ranging, frustrating measures aimed at containing COVID-19.
However, since the Omicron variant became dominant, public attitudes have changed. Canada’s third-dose vaccination rates are middle of the pack, not top of the G10. Meanwhile, the public is becoming harder to reach – a recent survey found that only 42 per cent of Canadians trusted the news, compared to 52 per cent in 2018.
We wonder if some of that shift has been caused by revisionist history. For example, two-dose vaccine mandates seem off-base now given Omicron’s breakthrough patterns, but there’s clear evidence that vaccines were effective against infection with other variants and that mandates hastened vaccine uptake across Canada.
Combatting these negative narratives is important for two reasons. A difficult fall looms, with multiple respiratory viruses likely to be circulating, and policymakers need to find new strategies to improve Canada’s vaccine uptake of the essential third dose for adults (currently 59 per cent), and second-dose vaccinations for children age five to 11 (currently 42 per cent). Any strategy must sustain outreach to marginalized groups, and include family doctors, who are trusted frontline sources of expertise.
But governments also need a new storyline – one that celebrates the effects of vaccines in preventing serious disease and death, while acknowledging the declining marginal yields of repeated administration of current vaccines when it comes to preventing infection with later variants. That shift explains evolving vaccine mandates and underpins the case for vaccines currently in development and regulatory review. It’s also counterproductive to talk about two doses as “full vaccination” – the number of vaccine doses needed for protection against serious COVID-19 varies by age, health status and circulating variant.
Public-health restrictions must also evolve. Not because of the lies being told about their past ineffectiveness, but because every effort should be made to avoid broad-brush restrictions on public gatherings, as well as school and business shutdowns. The logical way forward is careful surveillance using wastewater testing, a focus on quickly identifying new circulating variants, a requirement for masks for indoor settings during periods of high viral spread and investments in improved air filtering and sterilization. Vaccine mandates can now defensibly focus on healthcare and long-term care settings, with broader reconsideration if newer vaccines clearly reduce transmission risk.
It’s also a concern that Canada currently has among the lowest G10 rates of PCR testing. This impedes both understanding of the spread of mutations and effective use of prophylactic therapies. Securing and administering those therapeutics is a challenge in many provinces, as Canada lags behind test-to-treat programs used in the U.S. and elsewhere.
In the last two years, COVID-19 has taken a tragic toll on Canadians, with well-recognized differential impacts by age, housing status, race and other determinants of health. There have been policy misfires, but our overall record compared to peer countries is very strong. Governments and public-health leaders have been slow to highlight that record and adequately credit Canada’s citizenry for it. Their future communications might start with that recognition, while cautioning that resting on our laurels puts at risk the commendable gains made to date.
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