‘Hope givers’ of community
How vaccine ambassadors moved the needle on jab rates
Of all the people that Shreya Rao helped throughout the pandemic, one stands out.
At an apartment building clinic last September, an older woman wanted the same brand as her first for her second COVID-19 shot, but they didn’t have any Moderna in stock.
So Rao and her team found a pharmacy that did, called ahead, put her in an Uber and even sat with her to talk afterward over some peanut butter bars.
“She literally teared up,” recalls the 36-year-old. Although it’s safe and effective to mix and match, Rao wanted to get the woman what she needed to roll up her sleeve.
“Because we didn’t see her as a target to get one more vaccine, we saw her as a person who wanted to get a vaccine, who needed help.”
It’s an experience that’s been recreated thousands of times across the city, under an innovative program that has seen clear results.
A small army of community COVID ambassadors fanned out in their own neighbourhoods, armed with facts, to combat misinformation, language barriers and other obstacles, and move the needle on vaccine rates in some of the city’s most vulnerable neighbourhoods.
Now, at a time when the will and funding to fight COVID are drying up, the city is asking the province for about $6 million to continue the program until at least the end of the year, citing a track record of success, and the potential to build on this model to deliver other healthcare services in the future — from cancer screenings to checks for high blood pressure.
Toronto has high vaccination coverage compared to major U.S. and European cities. But vaccine rates in the city’s lower-income racialized neighbourhoods, in places like Scarborough, Thorncliffe Park and the northwest corner, have lagged, despite the fact that they had higher rates of COVID.
But at a meeting last month of the Board of Health, there was some evidence of progress to narrow this gap. The disparity between COVID rates in racialized and white people, and between people with lower and higher incomes, decreased in the fourth wave, according to analysis presented at the meeting.
As well, the 35 neighbourhoods prioritized for intense neighbourhood clinics and community ambassadors saw an average increase of 19 percentage points from June 2021 to April 2022, in first-dose vaccine coverage, (66 to 85 per cent), while all other neighbourhoods had a rise of 13 percentage points.
That doesn’t mean that all of these long-standing issues are solved. According to the latest data from nonprofit research group ICES, formerly known as the Institute for Clinical Evaluative Sciences, the percentage of people of all ages vaccinated with at least two doses is at least 70 per cent in every neighbourhood across the city.
But postal code M4H (Thorncliffe Park) at just over 70 per cent and M3N (Jane and Finch) at almost 76 per cent, are still among those with the least coverage.
When it comes to third doses, there’s still lots of room for improvement with just over 31 per cent of all people with a third dose in Thorncliffe Park and 34 per cent in Jane and Finch, again among the lowest in the city.
“There still is some gap but that gap is closing and in particular in some neighbourhoods in the northwest there’s been a tremendous amount of change in the right direction,” said Dr. Na-Koshie Lamptey, deputy medical officer of health at Toronto Public Health.
“The vaccine engagement teams have been really integral and key to the very remarkable success we’ve had,” she added. There are more than 600 ambassadors, like Rao, who have spent hundreds of hours doing outreach for neighbourhood vaccine clinics and testing, helping residents navigate booking portals, holding the hands of nervous kids, and basically doing whatever it takes, in 43 languages.
The city is now requesting that the province for funding to carry the program from July through December.
Asked if this would be approved, Ministry of Health spokesperson Bill Campbell said in an email that the agency “will have opportunities to request reimbursement of COVID-19 extraordinary costs, including vaccine related expenses, throughout the 2022 funding year.”
With about 82 per cent of Toronto residents vaccinated with two doses, it may seem like the heavy lifting is done.
But Sophia Ikura, executive director of the Health Commons Solutions Lab, a publicly funded, not-for-profit organization at Sinai Health, said there’s still a lot of work — from third and now fourth doses, to childhood shots, and outreach around antivirals such as Paxlovid.
Just over half of Toronto residents have had three doses, and the ambassador teams will also be needed if and when a vaccine is approved for kids under five.
These roles have existed for a long time, but were funded and formalized during the pandemic, Ikura said.
Already some community agencies, facing COVID fatigue from the public, are thinking more broadly, she said, such as holding health fairs instead of just vaccine clinics.
She sees huge potential for the wider use of the teams already in place, for things like getting women to Pap smears, or reaching seniors and young people who feel isolated.
“Part of what we need to do is just show that they can pivot away from COVID response to those bigger health questions,” said Ikura. “We need a ground game for getting to people before they end up in crisis and coming to us.”
Unfortunately one of the challenges right now is getting past the harassment that can sometimes come when trying to talk about COVID.
Twenty-two-year-old Jaspreet Kaur, who started as community health ambassador and is now assistant program co-ordinator for the Dixie Bloor Neighbourhood Centre, recalls one woman who even whipped out a camera and threatened to call the cops, at an apartment vaccine clinic.
They encounter this kind of thing all too often, she said, as “misinformation and disinformation are very powerful.” But at the same time, it’s clear they’ve built a rapport with many in the communities where they live and work.
For Rao, who speaks four languages, including Hindi, and works in Scarborough, the position has also been a point of personal pride, an opportunity at an uncertain time.
She had struggled to find a foothold after arriving from Hyderabad, India, in 2018, where she had a background in marketing, communications and journalism.
“This job gave me a break to dip into something substantial with some potential,” she said. “When people were losing hope, we were the hope givers.”
There are more than 600 ambassadors who have spent hundreds of hours doing outreach for area vaccine clinics and testing