Nearly 200,000 Ontarians aged 80 and older have not signed up for a COVID-19 vaccination

A little under three-quartersof Ontariansage 80 and older have either been vaccinated against COVID-19 or have signed up for a shot, a proportion that has some health experts say is not high enough.

Officials are hoping for significantly higher uptake of vaccines among the population as a whole but particularly among the age group that's most vulnerable to death and serious illness from the coronavirus infection.

Demand for vaccination appointments amongpeople age80 and up in Ontario slowed to such a crawl last week that the government opened up accessto the nextage group earlier than planned.

There are several possible reasons why such a significant portion of Ontario's oldest demographic hasyet to join the queue for their COVID-19 vaccinations, according to interviews with experts:

• Reluctance among some seniorsto go to mass-vaccination sitesfor their shots, either because of transportation ormobilityissues or because they fear it will increase their contact with others and therefore their risk of contracting the virus.
• Limited opportunity to get vaccinated by their family doctor.
• Language, literacy and technological barriers to booking a vaccination appointment.
• Lingering concerns about the efficacy rate of the AstraZeneca-Oxfordvaccineand reluctance to take it because ofinitial guidance from the National Advisory Committee on Immunization (NACI) that it should not be used for adults 65 and older.
• Vaccine hesitancy, in particular among seniors worried about interaction with their prescribed medications.

Almost 200,000 in 80+ group still not signed up

Figures provided Monday by the Ontario government suggest thatabout 71 per cent of people in the 80-plus age group provincewide had either had at least one dose of a COVID-19 vaccine or booked an appointment for one.

It means nearly 200,000 of the oldest Ontarians have not signed up to be vaccinated.

Current vaccine uptake among Ontario's 80-plus-year-olds is "one of the more upsetting figures I've seen in some time," said Dr. Nathan Stall, a geriatric specialist at Sinai Health in Toronto.

"That is truly a very large number of individuals we are missing." he said."Compared to our peers like Quebec, we are well behind when it comes to vaccinating this population."

In Montreal, more than 75 per cent of all residents age65 and older had received their first shot by the middle of last week, according to local health officials.

"We really need to see much higher rates, hopefully, 90 to 100 per cent uptake of the vaccine in the population that's most vulnerable," said Sophia Ikura, executive director of the Health Commons Solutions Lab, a provincially funded organizationthat works in communities to improvehealth outcomes.

"If we want to get back to some version of normal, our ability to vaccinate the people who are most likely to end up in hospital is the best and fastest strategy."

Transportation to vaccination site a hurdle for some

Stall, Ikura and others are calling for multiple measures to make it easier for seniors to get vaccinated and a concerted effort to help seniors who are hesitant about the vaccines speak to medical providers they trust.

• Coronavirus tracker:Follow the pace of COVID-19 cases, vaccinations in Canada.

After taking vaccines directly to seniors in its long-term care centres and retirement homes, Ontario is now predominantly relying on the rest of the 80-plus population to come to one of the 150 massvaccination clinics set up across the province.

Ikura participated in door-to-door vaccination campaigns in seniors' apartment buildings in Toronto last week and found seniors gratefulnot to have to travel to one of the 150 sites to get the vaccine.

"I heard things like, 'Oh, wow, I'm so glad you're coming to us because I didn't even know how I was going to get there (to a mass vaccination clinic), and I wasn't sure how I could stand in line for so long,'" Ikura said.

She said a personal approach from someone people feel they can trust can ease anxiety about the vaccine.

"You need to spend some time with them," said Ikura. "Just slow down the conversation, talk about the different kinds of vaccines, talk about the choice that they can make."

Limited number of GPs have access to vaccines

Ontario has provideddoses of the AstraZeneca-Oxford vaccine to around 350 pharmacies in Toronto, Windsor and Kingston for people age60 and up. The province has also supplied a limited number of primary care providers with vaccines for their senior patients. However, this currently includes onlya fraction of Ontario's 13,000 family doctors.

Family physicians are getting calls from patients asking if they can get vaccinated at the doctor's office, said Dr. Samantha Hill, president of the Ontario Medical Association.

"Many of these patients don't want to go to any given pharmacy or to a mass vaccination clinic," Hill said in an interview. "They want to go to a place that they're comfortable. They want to minimize their travel. They want to minimize their contact with other people."

Hill says it's completely understandable why some senior citizens after a year of being told to protect themselves by staying at home are not keen on any of the options currently available for getting vaccinated.

"The idea of travelling, oftentimes by public transport, to a site that's vaccinating hundreds of people a day or to a pharmacy where everyone walks in and out of freely, it's terrifying for them," said Hill.

Toronto offering support for seniors

The cabinet minister responsible for vaccine distribution is defending the government's approach.

"We have ensured that there are multiple pathways for individuals who want to get a vaccine to have access to it," Solicitor General Sylvia Jones told reporters at Queen's Park onMonday.

Jones also said there could bemore ways to get vaccinated once the supply of vaccines ramps up. Ontario is expecting to receive more than 550,000 doses this week, mostly of the Pfizer-BioNTechvaccine.

The City of Toronto is already taking several steps to try to increase vaccination uptake among seniors by:

• Taking mobile vaccination teams to 23 Toronto Community Housing seniors apartment buildings.
• Mobilizing librarians to call more than 35,000seniors to offer helpsigning up for vaccinations.
• Providing financial support to agencies serving seniors to do outreach in their communities.

Dr. Zain Chagla, an infectious diseases specialist in Hamilton and an associateprofessor of medicine at McMaster University, says fears about the vaccines are contributing to the low uptake among seniors.

"There is a lot of work that needs to be done on vaccine hesitation," Chagla said in an interview.

"If you're seeing this level of vaccine hesitation amongst people that areat super-high risk of dying, what's going to happen when you get out to the [younger]populations that actually aren't that high risk?"