Quebec still struggling to vaccinate workers in long-term care homes, leaving most vulnerable at risk

Even as Quebec's COVID-19 vaccination campaign expands to more of the population, many of the people working with those most vulnerable to the disease appear resistant to getting a shot.

Data compiled by the province's public health institute, the INSPQ, circulating online shows that roughly 37 per cent of workers in public long-term care homes have not been vaccinated. In private homes, that number is even higher: 43 per cent.

The numbers varied widely by region.

In Laval, only 49 per cent of employees at public CHSLDs have gotten vaccinated. Saguenay–Lac-Saint-Jean, by contrast, has a vaccination rate of nearly 80 per cent.

The INSPQ confirmed the data but said the full report won't be made public for several weeks.

We know we have to have everyone who can be vaccinated get vaccinated if we're going to get out of this thing.- Jeff Begley, union representative

Health-care workers in CHSLDs were first eligible to get a dose of vaccine last December, with the second round of doses currently underway.

Experts say the reluctance of workers to get a shot risks leading to further illness and death in CHSLDs, which bore the brunt of the province's first wave. 

Jeff Begley, president of the federation of health and social services at the CSN union, said he's optimistic more workers are prepared to get a shot, after not doing so during the first round of inoculations — either because they were hesitant or because they were on leave.

"We're encouraged," Begley said. "We know we have to have everyone who can be vaccinated get vaccinated if we're going to get out of this thing."

Dr. Leighanne Parkes, who worked on a study about the willingness of health-care workers to take the vaccine, said it was clear last fall, when vaccines were in the clinical trial phase, that there would be apprehension. 

"We're in an era where we have rapid access to a lot of unfiltered information," said Parkes, the head of infection prevention and control at Montreal's Jewish General Hospital.

Her study noted hesitancy was high in December, though that improved in the months that followed. In February, 76 per cent of those polled said they would be willing to take the vaccine.

The Health Ministry sent its own numbers late Friday claiming slightly higher vaccination rates, with only 35 per cent of workers in public CHSLDs and 40 per cent in private ones not vaccinated. 

Marie-Ève Despatie-Gagnon, a spokesperson for the Laval health authority, also said the percentage of workers vaccinated is likely higher than stated, given that some of the workers included in the INSPQ figures are on leave.

But she added that the health authority is making every effort to vaccinate its employees.

"All employees of public CHSLDs who wish to be vaccinated still have the possibility of receiving the vaccine," she said in a statement.

A decree, and a 'carrot' approach

Health Minister Christian Dubé has in the past expressed his concern about low vaccination rates at some CHSLDs and, earlier this month, the Health Ministry issued a decree making COVID-19 vaccinations mandatory for health-care workers in certain sectors, including long-term care homes.

The decree states that workers in certain sectors will have to show their employer proof of COVID-19 vaccination. Those who refuse will need to undergo recurrent testing or be transferred to another position.

In issuing the decree, the government cited "the growing risk presented by the transmission of new highly contagious variants" and concerns about "large-scale outbreaks."

Begley, however, said he doesn't believe the decree has been enforced. He also doesn't think it's the most effective way to get workers to comply.

"The carrot is a much more effective way of doing it," he said.

A study in Ontario released in February suggested more workers — especially those who are precariously employed — would be willing to get vaccinated if they were provided modest financial assistance and additional access to paid sick leave.

"We need to build trust and ensure equitable access to the COVID-19 vaccine," said Dr. Noah Ivers, a family physician and scientist at the Women's College Research Institute and the University of Toronto.

'Imperative' that workers get vaccinated

A recent study in the United States underscored the importance of ensuring health-care workers at nursing homes are vaccinated.

An unvaccinated worker at a Kentucky nursing home set off a major outbreak, resulting in dozens of infections, including 22 cases among residents and employees who were already fully vaccinated and the death of one resident, according to the study by the U.S. Centers for Disease Control and Prevention.

The study concluded that it is "imperative" that health-care workers in nursing homes be vaccinated.

Parkes said in her own territory, in Montreal's west end, there have been three or four "cluster" outbreaks since the vaccination campaign began, in some cases beginning with a person who wasn't vaccinated.

"This will become more important as we see more variants of concern," she said.

"We know the elderly don't mount a very robust immune response to a vaccine, so they are more likely to be infected and more likely to have symptomatic infection."