Debate over ‘fully vaccinated’ as Ontario businesses prepare to reopen

Restaurants, gyms, cinemas and many other businesses in Ontario are set to open their doors once again on Monday to fully vaccinated patrons, but with COVID-19 levels likely just past a peak, some question if “fully vaccinated” should be redefined.

Businesses and facilities that were closed early this month in response to surging cases driven by the highly transmissible Omicron variant are being allowed to reopen with capacity limits and will need to operate under the vaccine certificate system. That means only allowing customers who show proof they’ve received two doses of a COVID-19 vaccine, which is currently considered fully vaccinated.

But experts have noted the vaccine certificate system was designed when the Delta variant was dominant and two doses offered robust protection against both severe illness and infection. Omicron, now responsible for nearly all COVID-19 activity in the province, is a different beast and the government has been urging residents to get a booster shot.

Dr. Gerald Evans, an infectious diseases physician and member of Ontario’s science advisory table, said three doses should now be the definition of fully vaccinated.

“I think there’s a lot of us who, understanding vaccine science and looking at how we deal with other kinds of vaccines for various infectious diseases, have really said this is probably a three-dose vaccine,” he said in a recent interview.

Ontario’s science table has pointed to evidence that two doses of an mRNA vaccine have about 35 per cent effectiveness against Omicron infection 14 weeks after receiving a second dose, while three doses can offer 75 per cent protection in the first month.

When it comes to preventing not just infection, but severe illness and death, that booster dose can be 90 per cent effective or more, said infectious diseases physician Dr. Andrew Morris.

“We know that for most people, after the second dose, because of the time since when they got the last dose, immunity has waned pretty substantially and so it’s not nearly as protective as it was,” he said.

“So it is important to have that extra dose, I think, overall for public control and for people to feel relatively safer, wherever they’re going to be congregating indoors, whether that’s at restaurants or stores, etc. So I think there are a lot of opportunities to mandate a third dose as part of any vaccine strategy.”

Since booster shots didn’t start becoming widely available until late December, it may make sense to announce that a third dose would be mandatory for the vaccine certificate system at some later date, Morris said.

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But Premier Doug Ford quickly shot down a recent question of whether the system would be updated to require three doses instead of two.

“Not right at this point,” he said, when announcing the province’s reopening plan.

Both NDP Leader Andrea Horwath and Ontario Liberal Leader Steven Del Duca called for vaccine certificates to require third doses, saying it would help encourage more people to get boosters.

“With lives and livelihoods at stake, we cannot afford Doug Ford bungling another reopening,” Del Duca wrote in a statement this month.

“He needs to strengthen the vaccine certificate now to make sure this reopening is permanent, so that we can all get back to doing the things we love sooner, and so that businesses are not shut down again.”

Horwath suggested that Ontario hasn’t updated its vaccine certificate requirements because the government has “failed” in getting third doses into arms.

“I get it,” she said earlier this month. “You’ve got to give a little bit of time for people to get those booster shots, those third doses, but that time has passed.”

More than 80 per cent of people aged 70 and older have received a booster, but that percentage drops to 70 per cent for people aged 60-69. About 56 per cent of people aged 50-59 have received a booster, with far lower percentages in the younger age groups.

Meanwhile, Dr. Sumon Chakrabarti, an infectious diseases doctor, said he would “strongly disagree” with calls to define fully vaccinated as having three doses.

Third doses are proving beneficial for people over 60 and people who are immunocompromised to help them avoid severe disease, he said, but evidence shows that young and healthy people are still well protected against hospitalizations with two doses, even nearly a year after receiving a second dose.

“Once you start to get over the age of about 65, your risk starts to really climb for severe disease,” he said. “So a 20-year-old with two doses is very different than a 65-year-old with two doses. So to make a blanket policy for everybody doesn’t make sense.”