Time for Alberta to target COVID-19 vaccine uptake in rural, remote areas: health experts

It's time for Alberta to make COVID-19 vaccines and information about them more accessible to people in rural communities, public health experts say, as provincial data shows uptake in those areas lags behind urban centres.

Hesitancy, lack of trust, poor internet connections and long travel distances are the main hurdles preventing higher vaccination rates in parts of Alberta where the vaccine is needed most.

Experts interviewed by CBC News say these factors could put young children at risk of contracting the novel coronavirus that causes COVID-19, as students return to school next week.

"Having broad messaging is not really going to move the needle a whole lot at this point in time. The utility of that has been exhausted," said Dr. Stephanie Smith, an infectious diseases specialist at the University of Alberta Hospital in Edmonton.

"Now we are looking at more labour-intensive methods to try to get at those more remote populations that may be more hesitant for a variety of reasons."

Some of those methods include getting reliable information directly into people's hands through door-knocking and town halls, and building residents' trust using local health professionals.

Alberta in last place for doses

CBC News analyzed publicly available COVID-19 vaccination data for 132 local geographic areas within the five zones of Alberta Health Services (AHS).

Provincially, 69.8 per cent of eligible Albertans have received two doses of vaccine, and 78 per cent have received the first jab — putting Alberta in last place among all provinces and territories. The analysis shows those rates each drop by more than 10 per cent when factoring in children younger than 12 — a demographic not approved for the vaccine.

The analysis also shows that Calgary and Edmonton are leading vaccine uptake in the province. Vaccination rates in Alberta's two largest urban areas are significantly higher than in many rural areas, particularly in northern locations such as High Prairie and Wood Buffalo.

Three neighbourhoods in Edmonton — Rutherford, Twin Brooks and West Jasper Place — have the highest uptake in Alberta. Each has seen at least 82.2 per cent of eligible people get two doses.

In six other local geographic areas, at least 80 per cent of the eligible population have received two doses of vaccine.

There are 30 areas where at least 80 per cent of eligible people have received one dose. All but two — Jasper and Lethbridge-West — are within the Edmonton or Calgary zones.

Meanwhile, there are 16 areas where second-dose uptake is below 50 per cent. All are in rural Alberta, including 11 in the province's north.

Of 33 local geographic areas in the North zone, only five have had two-thirds of eligible people get a single dose of vaccine.

Access, hesitancy challenges

Health professionals are working to close the vaccination gap that exists between rural and urban areas of the province.

Access and hesitancy are the main challenges — though they are not always mutually exclusive, said Dr. Kathryn Koliaska, lead medical officer of health in the AHS North zone.

Some people simply refuse to get vaccinated. But many residents need more information or answers to questions they have about research findings in order to make an informed decision, she said.

Internet connections are weaker in rural areas, so part of the challenge is just getting reliable information to people, she added.

Others, meanwhile, can't travel long distances to get vaccinated for various reasons, such as lack of transportation or they can't get time off work, Koliaska said.

There is an ideological aspect, too, said John Church, a University of Alberta health policy expert.

Much conservative support — specifically libertarianism — has traditionally rested in rural constituencies, so a portion of those residents don't want the government telling them what to do, he said.

Targeted approach needed

Alberta's vaccination effort has reached a point where the focus must shift to people in rural and remote areas as COVID-19 case numbers rise in the province, due in part to the highly contagious delta variant.

Priority groups and people eager to get protected against COVID-19 are now vaccinated, particularly in urban areas where the vaccine is more accessible.

"The low hanging fruit has been picked," said Shannon MacDonald, an assistant professor of nursing at the University of Alberta.

"What is left are people who either have challenges with access or have outstanding questions about either the effectiveness, safety or necessity of vaccination."

Officials now have to develop plans that address the unique needs of each community, but that process requires time and resources, Koliaska said.

AHS has distributed printed materials or gone door-knocking in places where online information is inaccessible. The health authority has also held — and plans to hold more — town halls to hear and answer concerns and questions, she said.

In one instance, a community told AHS officials that a walk-in style clinic open on a specific day after work hours would boost rates because that was the only time residents could get vaccinated, Koliaska said.

Building trust key to boosting uptake

Specific strategies for different areas will vary, but building trust with people about the vaccine is the key principle moving forward, MacDonald said.

"The principle applies across the board: If the message can be coming from people they trust, there's more likely to be acceptance," she said, citing community and faith leaders as examples.

Family physicians or community health nurses could help with that — especially in the north, where a community may have only one health professional — because Albertans hand-pick those people to be trusted medical advisers, said Myles Leslie, an associate professor of community health sciences at the University of Calgary.

They're not government workers, and they work one-on-one with patients, which gives them a chance to understand their concerns and have quality conversations about the vaccine, he said.

Return to school adds pressure

There are roughly 600,000 children younger than 12 living in Alberta, accounting for more than 13 per cent of the population, provincial data shows. None of them are allowed to receive a COVID-19 vaccine.

Health Canada has only approved vaccines for people aged 12 and older. Clinical trials are underway to determine whether the vaccines are safe for those under 12 and whether younger children need smaller doses.

Factoring children into vaccination rates, uptake in Alberta drops to 66.3 per cent for first doses and 59.4 per cent for two doses, data shows.

Only two local geographic areas — one each in Edmonton and Calgary — have seen 75 per cent of all people get one dose of vaccine. There are only three areas with 70 per cent uptake for two doses, data shows.

With students returning to school, that puts pressure on eligible Albertans to get the shot, MacDonald said.

"What we don't want to have happen is you've got a whole elementary school of unvaccinated children, and one of those kids picks up COVID from an unvaccinated parent and brings it to school," she said.

"If we can protect the kids, we're then — by virtue of protecting them — protecting the rest of us, because they won't get the disease, they won't get sick and they won't transmit the disease."

Church, the health policy expert, said getting vaccinated is a moral question when it comes to children.

"The sacrifices that we've had to make so far, are they really that onerous compared to throwing young kids and young adults under the bus?"