Political strategies

Opinion: We need new strategies to fight COVID this fall

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 at Unity Health Toronto.

The world recently marked two years since the WHO declared COVID-19 as a global problem pandemic. As the third year of the pandemic unfolds, it seems timely to reflect on Canada’s experience relative to other countries as we chart the way forward.

Choosing individual comparators is fraught with potential biases. In an analysis recently published 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 in the first two years. And if Canada had the same death rate as the United States, nearly 70,000 more Canadians would have died. In fact, among the G10, only Japan performed better than Canada.

The reasons for Japan’s results are still debated. Similarly, it is difficult, on the basis of these general comparisons, to determine why Canada has performed relatively well. Major congratulations are clearly due to all frontline workers, especially healthcare workers, who have faced extreme pressures due to the particularly weak hospital and intensive care capacity. However, the factors most likely to explain Canada’s advantage are that we had the highest two-dose vaccination rate among G10 countries, as well as strong and sustained public health measures. Governments deserve some credit on both fronts, but Canadian citizens remain the unsung heroes here. They were vaccinated at record speed and stoically adhered to frustrating far-reaching measures to contain COVID-19.

However, since the Omicron variant has become mainstream, public attitudes have changed. Third-dose vaccination rates in Canada are in the middle of the pack, not at the top of the G10. Meanwhile, audiences are getting harder and harder to reach – a recent poll found just 42% of Canadians trust the news, up from 52% in 2018.

We wonder if part of this change was caused by revisionist history. For example, two-dose vaccination mandates seem off base now given Omicron’s breakthrough regimens, but there is clear evidence that the vaccines were efficient against infection by other variants and which makes mandatory hurry vaccination rates across Canada.

Combating these negative narratives is important for two reasons. A tough fall looms, with multiple respiratory viruses likely to circulate, and policymakers must find new strategies to improve Canada’s immunization coverage of the essential third dose for adults (currently 59 per cent) and second dose vaccinations for children aged five to 11 (currently 42%). Any strategy must support outreach to marginalized groups and include family physicians, who are trusted front-line sources of expertise.

But governments also need a new storyline – one that celebrates the effects of vaccines in preventing serious illness and death, while acknowledging the declining marginal returns of repeated administration of current vaccines when they are This is to prevent infection from later variants. This change explains the evolution of vaccine mandates and supports the case for vaccines currently in circulation. development and regulatory review. It is also counterproductive to refer to two doses as a “full vaccination” – the number of vaccine doses needed to protect against severe COVID-19 varies by age, health status and variant. in circulation.

Public health restrictions must also evolve. Not because of the lies told about their past ineffectiveness, but because every effort must be made to avoid blanket restrictions on public gatherings, as well as school and business closures. The logical way forward is careful monitoring using sewage testing, a focus on quickly identifying new variants in circulation, a requirement for masks for indoor environments during times of high viral spread, and investments in improving air filtering and sterilization. Vaccination mandates can now arguably focus on health care and long-term care settings, with broader reconsideration if new vaccines clearly reduce the risk of transmission.

It is also concerning that Canada currently has one of the lowest PCR testing rates in the G10. This hampers both the understanding of the spread of mutations and the effective use of prophylactic therapies. Securing and administering these therapies is a challenge in many provinces, while Canada lags behind test programs to treat used in the United States and elsewhere.

Over the past two years, COVID-19 has taken a tragic toll on Canadians, with well-known differential impacts by age, housing status, race and other determinants of health. There have been political hiccups, but our overall record against peers is very strong. Governments and public health leaders have been slow to acknowledge this record and adequately thank Canadian citizens. Their future communications could begin with this recognition, while warning that resting on our laurels jeopardizes the laudable gains made to date.

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