COVID-19 vaccine mandates are coming whether Canadians want them or not

This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven't subscribed yet, you can do that by clicking here.

Like it or not, COVID-19 vaccine mandates are coming to Canada. 

Whether they're government-ordered for certain jobs and activities, or implemented in a piecemeal way by the private sector, Canadians can expect to see more aspects of society require proof of vaccination in the weeks and months ahead. 

And with a fourth wave underway in much of the country ahead of schools restarting and borders reopening to some fully vaccinated travellers next month, experts say now is the time to put vaccine mandates in place before another potential surge.

Michelle Quick, 33, gets her second dose of the Pfizer-BioNTech COVID-19 vaccine at a one-day pop-up clinic in the Eaton Centre shopping mall in Toronto on July 27. (Evan Mitsui/CBC)

"They're coming â€" one way or the other," said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.

"Do you want to do it while we are calm in the water? Or do you want to do it when the storm is raging around us?" 

Pedestrians in Toronto carry and don masks on Aug. 12. Health officials are citing rising COVID-19 case counts as a sign Ontario is in a fourth wave of infection. (Evan Mitsui/CBC) Provinces 'choosing their own adventure'

Instead of a co-ordinated approach across the country, a patchwork system of vaccine certification is emerging throughout Canada as some provinces outright oppose the concept while others fully embrace it. 

Quebec took the bold first step of announcing this week that vaccine passports for non-essential services, like bars, restaurants, gyms and festivals, would be mandated on Sept. 1 in an effort to avoid reintroducing lockdown measures.

British Columbia announced Thursday that anyone working in long-term care and assisted-living facilities in the province will be required to be vaccinated by Oct. 12, and Manitoba has launched a new proof-of-immunization mobile app for fully vaccinated residents.

But Alberta has repeatedly said it will not bring in vaccine passports and Premier Jason Kenney has outright dismissed the notion of mandatory vaccinations, even amending the province's Public Health Act to remove a 100-year-old power allowing the government to force people to be vaccinated.

Ontario Premier Doug Ford also firmly rejected the possibility of vaccine passports last month, even for health-care workers, saying the province is "not going to have a split society."

The federal government made its position known Friday ahead of an election call, announcing it will soon require all public servants to be vaccinated, as well as passengers on commercial planes, cruise ships and interprovincial trains in Canada.

But while Ottawa has taken a hard line on vaccine mandates and committed to creating proof-of-vaccination documentation for international travel by early fall, it stopped short of implementing a domestic vaccine passport system across Canada.

"Unfortunately, the provincial and territorial scene is likely to remain a patchwork for ideological reasons," said Dr. David Naylor, who led the federal inquiry into Canada's response to the 2003 SARS epidemic and now co-chairs the federal government's COVID-19 immunity task force.

"And I don't think the federal government can force vaccine certificates on subnational jurisdictions." 

Ottawa working out details of vaccine passport3 days agoThe federal government says it is working on the details of a COVID-19 vaccine passport that can be used for international travel, which it hopes will be available by the fall. 1:36

Naylor says he hopes the federal government can work with provinces and territories to adapt the newly announced vaccine document for international travel into a national vaccine passport for use in all provinces and territories in the future. 

"The provinces would probably wave that idea off," he said. "But in a rational universe, we'd have one standardized Canadian document for domestic and international use."

Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario's COVID-19 vaccine task force, says it's become clear that Canada will not take a national approach to vaccine certification because the federal government doesn't have the authority to direct provinces and territories to come on board.

"We're going to have vastly different strategies, with Alberta at one end of the spectrum, and Quebec at the other end of the spectrum â€" and probably many provinces in between," he said. 

"But from a policy standpoint, it's clear that the provinces are choosing their own adventure." 

Instead of a co-ordinated approach across the country, a patchwork system of vaccine certification is emerging throughout Canada as each province and territory takes its own path. (Evan Mitsui/CBC) Mandating vaccines 'not the be all and end all'

The question remains as to how effective vaccine mandates will be in controlling the spread of COVID-19 among the unvaccinated during the fourth wave, and whether testing is sufficient enough to keep community transmission low. 

"You can definitely see how mixing vaccinated and unvaccinated people in high-risk environments could ripple out into unvaccinated populations â€" particularly ones that are high risk," said Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare Hamilton and an associate professor at McMaster University. 

"It makes sense if you get to a certain community incidence, where the odds of someone walking into that place with COVID-19 are starting to get higher and higher by the day, it could start a chain effect." 

Chagla says Quebec's approach of only mandating vaccines for non-essential services prevents ostracizing those who aren't vaccinated â€" due to choice, eligibility or accessibility â€" while encouraging more people to get vaccinated so they can engage in more activities.

He doesn't think vaccine passports are the "be all and end all" in the push to get people vaccinated. "But it certainly is a downstream effect that you do bring people on board and … make them minimize the risk even more going forward," he said.

"The verification of vaccines is going to be really important, especially as we're struggling with this in the next little while â€" maybe the next six months â€" where we're going to see a little bit of discomfort with more transmission." 

People walk by a COVID-19 vaccination sign in Montreal on Aug. 8. Quebec became the first province in Canada this week to introduce a wide-ranging vaccine passport system, to begin on Sept. 1. (Graham Hughes/The Canadian Press)

Dr. Lisa Barrett, an infectious diseases physician and immunologist at Dalhousie University in Halifax, says that while she's fully in favour of vaccine passports, there are other options for keeping Canadians safe in high-risk settings for COVID-19 transmission. 

"We want to protect public places and people attending them by not having infectious folks around. You can do that with double vaccine â€" or by showing a negative test for the minority not vaccinated for various reasons," she said. 

"It's obviously better on a personal front to be vaccinated, but it preserves some choice while people are getting there." 

Barrett says while she prefers vaccination for controlling COVID-19 levels, she hates the idea of exclusion until all other options have been exhausted; she points to the ample supply of rapid antigen tests in Canada to help bridge the gap.

Bogoch agrees that while vaccine mandates are an effective strategy at increasing our vaccination levels across the country, unvaccinated Canadians are a diverse population with many different reasons for foregoing a shot â€" and that needs to be approached with care.

"Some people still have remaining questions and issues and anxiety that hasn't been addressed. We obviously have to take those questions and issues and anxieties seriously, and address that in an empathetic manner," he said. 

"I think it's also fair to say that some people regardless of what we say â€" regardless of science, reason, logic â€" some people are just never going to get vaccinated."

'Window of opportunity' to prevent brutal 4th wave

Canada has emerged as one of the most vaccinated countries in the world, with more than 60 per cent of the Canadian population fully vaccinated after a relatively slow start to the rollout. 

But with 40 per cent of the population with lower protection from COVID-19, with only one shot or none at all, there are still millions of susceptible Canadians â€" especially in the face of the more contagious and potentially more deadly delta variant. 

Unvaccinated adults driving COVID-19 case increase in Canada5 days agoThere is growing concern about a fourth wave of COVID-19 as cases start to climb again across much of Canada, with the increase being overwhelmingly driven by unvaccinated people in western provinces. 1:54

"Given the fact that we're about to open everything up, it seems likely that those 40 per cent are going to get infected at some point, which means that we're going to have a lot of stress on our society," Deonandan said. 

"There's a window of opportunity to prevent a lot of societal suffering and frankly, the selling point should be to businesses â€" do you want to stay open? Do you want your employees to have jobs? This is what we do to make sure that happens, because we see a storm coming."

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