Calls for expansion of 4th dose eligibility as wastewater data shows uptick in COVID-19 cases

As Toronto’s festival season is in high gear, the city’s public health unit is hosting vaccine clinics at numerous events. Faiza Amin reports on the city’s vaccine efforts, and the calls for the province to expand fourth dose eligibility.

By Faiza Amin and Meredith Bond

Toronto Public Health is ramping up vaccine efforts this summer, setting up pop-ups at various events, to prepare for the fall when COVID-19 cases are expected to start rising. However, another wave could come sooner than expected.

The clinics are operating as many have called for an expansion of fourth dose eligibility in the province. In Quebec, anyone over the age of 18 is eligible to receive their second booster, but in Ontario, it is still limited to a select group of people.

Those who are 60 years of age and older, Indigenous people, and those who live in high-risk settings are eligible to receive their next vaccine three months after their third dose.

The renewed calls come as wastewater data shows yet another uptick in COVID-19 infections and the threat of new variants.

Global health epidemiologist Raywat Deonandan said he doesn’t see any reason not to expand the eligibility.

“We have an increase in transmission as perceived via the wastewater data. B.4 and B.5 [variants] are supplanting B.1 and B.2. Those have a potentially higher risk of reinfecting those who have previously been infected, and a fourth dose increases your ability to prevent reinfection. So I think now’s the time,” said Deonandan.

Epidemiologist and Professor at Toronto Metropolitan University, Timothy Sly says the data shows hospitalizations are higher than they were at this time last year.

According to data from Ontario Public Health, as of June 23, 2022, there were 486 people in hospital. At the same time last year, there were 295.

“The indication from wastewater is going up and that’s a good indicator. So this thing has not gone away it’s lurking there. And those people who are well protected can still become infected.”

The Ontario government tells CityNews they are currently waiting on the National Advisory Committee on Immunization (NACI) for recommendations on booster doses for the rest of the population. Meanwhile, Health Canada’s response was to contact the provincial government for further information.

Deonandan says that in Israel, where fourth doses have been widely given out, data showed there were no additional safety issues with a fourth dose.

“The Israeli data shows that a fourth dose offers considerable additional protection against infection, symptomatic disease, hospitalization and death above and beyond the third dose.”

Compared to the first and second doses, the population who has received the third dose is much lower. Over 82 per cent of the population has received two doses of a COVID-19 vaccine, however, just 50 per cent have had their third jab.

Deonandan said the reason for this can likely be attributed to public health messaging.

“One is the strange narrative that the pandemic is over. It’s not over. Second, is failure to communicate to the public that this is, at minimum a three-dose vaccine, not a two-dose vaccine,” said Deonandan. “So this is fundamentally a problem of public health, communication and public education, and our inability to combat the enormous amounts of misinformation that are floating.”

Sly said he understands the urgency to get people third doses and reserve those but says “it would be an awful situation if many of those doses had to be dumped because they are expired.”

“Let’s not waste them simply because people, for whatever reason, don’t show up. Let’s get it into anybody’s arms who really want it and that means the fourth dose for many people.”

Ontario’s Medical Officer of Health Dr. Kieran Moore had previously said a new round of COVID-19 booster doses would be rolled out this fall, likely in October.

He said he anticipates that in the fall a new generation of vaccine will be available that targets the original COVID strain plus a more up-to-date one that is circulating, such as for Omicron.

Board of Health Chair and City Councillor Joe Mihevc said he expects an announcement soon on whether eligibility should be expanded for fourth doses.

“I think that announcement will be forthcoming in the next little while so that over the summertime, people get ready for what we expect to be an uptick in COVID-19 transmission in the fall.”

Who is currently eligible for a fourth dose of the COVID-19 vaccine?

The Ontario government currently offers a fourth dose to the following populations in the province:

  • 60 years old or older
  • First Nations, Inuit and Métis individuals aged 18 and over or a non-Indigenous household member aged 18 and over
  • a resident of a long-term care home
  • a resident of a retirement home
  • a resident of an elder care lodge
  • older adults living in other congregate settings that provide assisted-living and health services

Eligible immunocompromised individuals aged 12 and over who received three doses as a part of their primary series can receive a first booster (fourth dose) after their third dose:

  • 12 to 17 years old can get a first booster six months (168 days) after completion of the three-dose primary series
  • 18 years and over can get a first booster three months (84 days) after completion of the three-dose primary series

In the meantime, Toronto will continue to operate clinics at city festivals throughout the summer in order to get people vaccinated as conveniently as possible. A full list of pop-up clinics can be found here.

Editor’s note: A previous version of this story included a quote that said hospitalizations were currently triple what they were at this time last year. It has been updated.

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