Little rural vs urban difference in vaccine uptake

Ontario’s rural health units have kept pace with urban vaccination rates but there are reasons why some have higher rates than others. 

The Leeds, Grenville & Lanark District Health Unit (LG&LDHU) dominates Ontario’s efforts to get as much of the population vaccinated as possible. It is just three per cent shy of vaccinating the entire eligible population with first doses and 93 per cent are fully vaccinated. 

Why it matters: Rural areas in other parts of North America, including the United States, vary greatly in their rural vaccination rates, while Ontario’s are consistent with urban areas.

With 58 per cent of the population being rural, LG&LDHU has increased vaccine uptake in agriculture communities within its catchment area. 

Access to trusted health practitioners to explain the science and alleviate fears and concerns was an integral part of vaccine uptake success, said Rebecca Kavanagh, LG&LDHU’s acting director for the Healthy Living and Development department. 

“This was not a public health-led and dominated approach. It really was public health supporting the community in their call to action,” she said. “The community owned it, and therefore that gave us the running start and continuation. Everybody just felt like they were part of it.”

After the initial balancing act of vaccine supply and demand, and then addressing the volume of people at their six main sites, Kavanagh said the health unit began looking at how to reach the rural population.  

The Eastern Ontario health unit covers 6,329 square kilometres and 58 per cent of the population is rural, with no public transport access. Urban appointment-only clinics required a significant time commitment. 

The unit partnered with local municipalities, health care providers and pharmacists to organize rural pop-up walk-in clinics, using a combination of their contacts, media and social media to spread the word. 

A lack of reliable internet and the older age demographic of the rural population required word-of-mouth and neighbour encouragement to play a role in success of the rural clinics, said Kavanagh.

The presence of trusted health care providers, doctors, nurses, paramedics and pharmacists from within the rural communities at the clinics helped address vaccine concerns and likely increased uptake, she added. 

During phase two of the vaccine rollout, Kavanagh said they contacted local agricultural partners and large farm operations to arrange workplace clinics, mobile on-farm clinics and extend invitations to local pop-up clinics.

“We actually did go to many large farms and agricultural businesses and did on-site clinics,” she said. “We would go into the smaller hamlets and villages and small towns that didn’t have the kind of bigger centres and hosted smaller clinics at fire halls and arenas.”

Kavanagh suspects the impact of the first wave, which tore through the district’s old age facilities, likely factored into reaching higher than average numbers for full vaccination.

“We had a lot of deaths in that first wave, and it was so sad and almost traumatic for people that I think we were primed when the vaccine came,” she said. 

“Especially with that older pocket, they were primed and did not want to go back to what we had to endure that first round.”

No Ontario community has less than 79 per cent fully vaccinated, which is a substantial number, said Kavanagh. However, reaching that final 20 per cent requires the support of local government, health care practitioners, communities and trust. 

The process of reaching out to the 7,000 registered residents of the LG&LDHU who don’t have a single dose began Oct. 8 through the province’s Unrostered-Unvaccinated Contact Centre Reach Out initiative. It is designed to connect people with clinics or paramedics to do home visits if they are unable to travel for medical reasons.

“For us to fulfill our mandate, we’ve had to rely on partnerships in the past,” said Kavanagh. “That’s just the magic of a small rural kind of community. And to get that last group, you really need to connect with them.”

Ontario areas with the three lowest vaccination rates are in Chatham-Kent, Renfrew County and District and Lambton. Each has 79 per cent of people fully vaccinated and better than 83 per cent with first doses.

Dr. Sudit Ranade, Medical Officer of Health for Lambton Public Health, said three cultural shifts created a perfect storm that continues to impede vaccine uptake within the final 15 per cent of the population. 

Though vaccines are a medical product, people began shopping for their preferred COVID-19 vaccine. Then an anti-science trend left people feeling they’d obtained an expertise level higher than that of top scientists by simply running a Google search and attempting to interpret scientific papers. 

The final ingredient in the perfect storm is a deep and growing mistrust of institutions in general, particularly the government, he said.

The latter segment is the most challenging sector to reassure and gain vaccine uptake regardless of location.

“We still have the same obligation whether they’re in the rural community or in the urban community, which is to make sure that they have trustworthy, clear information and accurate information about what we know and what we don’t know,” Ranade said.

Combining the ‘I want what I want’ mentality with a mistrust of scientists, doctors or the government fuels a demand or belief in inviolable rights.

“We’ve all seen this pandemic has been so divisive, and it’s put people really on edge with each other in a way that is unfortunate and really detrimental to all of our health,” he said. 

“But part of it is getting the ability to talk to each other back, and then we can have the conversation about what are we trying to do here.”

The public needs to see clear rationales from the government on the vaccine mandates and how they will achieve the associated goals. That should be done without changing the rules so rapidly that the average person no longer knows what is allowed, said Ranade.

“We need to be super clear about what the goals are because otherwise people just see it as, ‘You’re just taking away my options, you’re just taking away my rights,’” he said. 

That said, Ontario as a whole and even the bottom three counties are doing well with their vaccine rates, he added.

Instead of focusing on whether the narrow difference between 79 per cent or 82 per cent has a meaningful impact on viral spread, the attention should focus on provinces with similar rates that are experiencing significant stress on their health care systems. 

“If 77 per cent is not enough, I doubt that 80 per cent is enough,” Ranade said. “We may need to work towards everyone being at 90 or 95 per cent in order to avoid serious issues in our health care system’s ability to look after both patients with COVID and patients without COVID.”