A Neighbourhood Approach for Effective Vaccine Sequencing Strategies

As phase 2 of the vaccination roll out began in April, immigrant and racialized people, ages 18+ and living in the hardest hit COVID-19 neighbourhoods will be eligible for vaccination.

This is the result of the coordinated work between OLIP partners and a recommendation brought forward on March 2^nd by OLIP to the Ottawa Vaccine Sequencing Task Force, to continue utilizing the neighbourhood and community engagement model approach first developed to improve access to COVID-19 testing and isolation measures, for planning and executing targeted vaccination operations that will bring vaccine equity to immigrant and racialized communities.

OLIP proposed to the Ottawa Vaccine Sequencing Task Force (OVSTF) that: immigrant and racialized populations should be considered a transversal high risk population, and sequenced utilizing a neighbourhood (geographic) risk of COVID-19 illness/death approach, to prioritize those living in the COVID-19 hardest hit neighbourhoods; presenting a compelling case using local and provincial data and research on the big positive impact a sooner prioritization would have in slowing the spread, as well as reducing more severe negative outcomes from infection.

According to the 2016 Census, racialized groups make only 29% of Ottawa’s population, yet they account for 63% of the Covid-19 cases in the City. 78% of those who are racialized are immigrant.

High material deprivation has been identified by Public Health Ontario as a major contributor of Covid-19 incidence and increased likelihood of experiencing severe outcomes. For example, hospitalization rates were 69% higher, ICU admission rates were almost two times higher; and death rates were 52% higher in population experiencing high material deprivation compared to people in neighbourhoods experiencing lower levels of material deprivation

In Ottawa, 50% of newcomer immigrants live in poverty and an Ottawa Pubic Health study has confirmed that neighbourhoods with a high proportion of racialized communities and high material deprivation have higher rates of COVID-19 compared to areas with a lower proportion of racialized communities or lower material deprivation.

Socioeconomic characteristics of immigrant and racialized populations also impact the age of people being infected, with young people (aged 0-29) accounting for 40% of infection compared to 25% in non-racialized population of the same age bracket. The higher risk of infection is also due to factors such as higher density housing and/or employment in essential work that is often ‘precarious’ – low-wage, temporary, unstable and without pensions and benefits (e.g., emergency or sick leave).

Similarly, regarding occupation as a determinant risk factor, while people working in health-related occupations have been most affected by COVID-19; people who are racialized are over-represented across all occupation categories, including health-related occupations. For example, out of 100,000 people in Ottawa who are employed in a health occupation and have been diagnosed with COVID-19, 2,169 people are racialized compared to 703 people who are not racialized (white).

Therefore, OLIP’s recommendation focused on the big impact a faster vaccination of immigrant and racialized people would have in helping reduce the transmission in the hardest hit neighbourhoods, which in turn will reduce the spread of the virus across the city; especially considering the threat new variants pose.

The recommendation was approved on March 9^th stating that: “immigrant and racialized populations should be considered a transversal high risk population, and sequenced utilizing a neighbourhood (geographic) risk of COVID-19 illness/death approach, with [an initial] focus on adults over 50 years of age”, due to vaccine supply constraints.

The initial earlier vaccination of immigrant adults over 50 years of age aimed at reducing mortality outcomes, as studies within OECD countries have “as a well-established fact that groups of population with socio-economic disadvantages are more likely to have poor health conditions and suffer more from chronic diseases, which can increase the risk of co-morbidity in the context of COVID‑19. Immigrants in most OECD countries are overrepresented among these vulnerable groups”.This was confirmed by Public Health Ontario statistics which showed people living in the most diverse neighbourhoods were also more likely to experience severe outcomes (hospitalizations, ICU admissions and deaths) than people living in the least diverse neighbourhoods: hospitalization rates were four times higher; ICU admission rates were four times higher; and death rates were twice as high.

The later quick expansion of the vaccination eligibility to all adults over 18+ in the hardest hit neighbourhoods in Ottawa was celebrated by OLIP, as our initial recommendation had shown the high infection rates in the younger population ages 0-29.  As the vaccine rolls out into our most affected neighbourhoods, OLIP will continue supporting its partners plan for vaccine accessibility equity to immigrant and racialized communities, including campaigns reflective of the rich diversity of our people.