Hamilton’s richest neighbourhoods, least hard-hit by COVID, are ahead in vaccine rollout

When it comes to catching COVID-19 or being vaccinated against the deadly virus, where you live in Hamilton matters.

A Spectator analysis of COVID-19 vaccination rates in nearly two dozen forward sortation areas or FSAs - geographic units based on the first three characters in a postal code, such as L9H or L9G - has found residents in the city's most economically disadvantaged areas are being vaccinated at far lower rates than those in more affluent neighbourhoods.

At the same time, residents in the wealthiest FSAs, as well as those areas with the lowest COVID infection rates, are disproportionately ahead in the vaccine rollout.

This is happening despite city interventions, such as targeted vaccine clinics, aimed at making the shots more accessible to Hamilton's most vulnerable populations.

The Spectator analysis is based on data compiled by the non-profit research institute IC/ES, which has been cross-referenced with Statistics Canada data from the 2016 census. The IC/ES data applies to residents of all ages (although not those living in long-term care homes) and spans the course of the pandemic up until April 18.

According to The Spec's findings, five of the six least-vaccinated FSAs are in the lower city, where median household incomes range from $37,200 to $53,100 - significantly below the city average of $69,000.

Meanwhile, two of the three FSAs that have the highest median household incomes and lowest COVID-19 infection rates also have the highest rates of vaccinations.

L9H in Dundas, where the median household income is $92,300, and L9G in Ancaster, where it is $122,965, have inoculated the highest and second-highest proportions of eligible residents at 34 per cent and 31 per cent, respectively.

Those two FSAs also have the lowest infection rates at 1.27 cases per 100 people in Dundas and 1.85 cases per 100 people in Ancaster.

Compare that with the five least-vaccinated FSAs in the lower city, which have among the highest infection rates, and it reveals a very typical pattern we see" in Hamilton, said Jim Dunn, an associate professor of health, aging and society at McMaster University.

That is, that people living in higher-income areas not only have better access to COVID vaccines, but tend to have better access to health care in general.

Here's more evidence:

• L8M, which runs east of Wentworth Street South past Gage Park and south of King Street East to the Sherman Access, has the third-highest COVID-19 hospitalization/death rate out of a whopping 514 FSAs in Ontario.

• L8N, in neighbouring Stinson and Corktown, has the city's lowest median household income and is tied for the highest infection rate at 2.99 cases per 100 people.

• Both L8L in the north end and L8R downtown have infection and hospitalization/death rates that well exceed the city averages of 2.40 per 100 people and 2.03 per 1,000, respectively.

In each of these FSAs, where vaccination figures range from 16 per cent to 19 per cent, residents have been inoculated at roughly half the rate of the city's most affluent neighbourhoods.

Two of those areas - L8N and L8L - were among the five FSAs designated by either the city or province earlier this month as COVID-19 hot spots and prioritized for the vaccine rollout.

But the data suggests that some hot spots - specifically those in wealthier neighbourhoods - have higher inoculation rates and contain more pharmacies offering vaccines.

In L9C and L9K, which span the west Mountain and parts of Ancaster, including the Meadowlands, about 26 per cent of eligible residents have been vaccinated.

There are 10 pharmacies in those two FSAs that are approved to administer vaccines. Eight of them are in L9C alone - including four clustered in a 850-metre section of Upper James Street.

Meanwhile, in L8L in north Hamilton, 16 per cent of residents have received at least one dose of the vaccine. In L8N in Corktown and Stinson, 19 per cent have been inoculated. In L8W on the east Mountain, the vaccination rate is 21 per cent.

L8L and L8N have three pharmacies doling out vaccines between them, while L8W, where the median household income is approximately double that in L8L and L8N, has seven.

Dunn said the discrepancies between the city's advantaged and disadvantaged areas are clear in the vaccine rollout.

But a big part of that, he said, is tied to the province's overcomplicated, free-for-all-type booking system that inherently favours people from advantaged backgrounds.

There are structural barriers to people accessing vaccines in the way that they're currently accessible, which is mainly through online appointments across multiple pharmacy chains with pretty limited availability," said Dunn.

There's the provincial sites, there's local sites, there's pharmacy sites ... It's a pretty complicated, chaotic (way) to get access. The system is unintentionally designed so that people who have the greatest wherewithal, the greatest flexibility, can get it."

In Ontario, the absence of a central booking system to register for a vaccine - and an emphasis on a first-come, first-serve type policy - has made it difficult for people without reliable Wi-Fi, paid time off work or child care to secure vaccine appointments.

Is the rollout equal? Sure, said Dunn. But it's certainly not equitable.

If we open (booking) slots at 8 a.m. on such and such a date, and there's all these different websites, OK, everybody has an equal chance," said Dunn. But they don't have an equitable opportunity because it really depends on people's skills, wherewithal, resources (and) availability to get an appointment."

On some level, it also depends on access.

Of the 52 pharmacies in Hamilton currently offering vaccines to residents, 43 of them are in suburban or rural areas, including 23 on the Mountain.

Just nine are in the lower city.

Paul Johnson, the city's director of the Emergency Operations Centre, said it was the province, not Hamilton public health, that determined the location of pharmacies.

I can tell you there was an extreme amount of frustration when we looked at that initial (list) of where pharmacies were located, because it just did not match up with anything we had been talking about," said Johnson, referring to the province's April 1 pharmacy vaccine announcement that didn't include any lower-city locations.

Johnson agreed there are gaps in the vaccine rollout between Hamilton's affluent and poorer neighbourhoods.

He also said the shortcomings boil down to limited supply and decisions that are out of the control of local officials.

We have to be present in these neighbourhoods where we make access very straightforward," said Johnson. There needs to be this partnership of our local public health unit and the province to really understand what's happening here in Hamilton.

That doesn't mean we don't have things to do - but, man, it would be great if we had that true partnership of, Here is where we see from a local perspective (of) where we need to invest time, energy and resources.'"

Some of the steps the city is taking to address the disparities include pop-up and mobile vaccine clinics - like the ones last weekend for Black and racialized adults living in hot spot FSAs - and mass vaccination sites operating seven days a week.

But there is still the issue of supply.

Johnson said the city's three mass clinics - First Ontario Centre, Hamilton General Hospital and St. Joseph's West 5th Campus - are operating at 40 to 50 per cent of capacity because of limited doses.

While new shipments come in every week, doses have to be spaced out so appointments aren't cancelled, he said.

We've got a very powerful engine here that's not getting out of first or second gear," he said. We can have a number of (vaccination) strategies, but we have very limited supply. That's what would really help us."

Sebastian Bron is a Hamilton-based reporter at The Spectator. Reach him via email: sbron@thespec.com