Vaccination rate in north Hamilton hot spot low despite priority access

Despite targeted interventions, such as early access to vaccines and several pop-up clinics, one Hamilton neighbourhood continues to lag behind other parts of the city in the COVID-19 vaccine rollout.

L8L, a sprawling, densely populated area that stretches roughly from Bayfront Park to Ottawa Street, north of King Street, has vaccinated the smallest proportion of residents out of nearly two dozen forward sortation areas in the city. FSAs are geographic units based on the first three characters of a postal code.

With just 43 per cent of its residents having received at least one dose, L8L is also among the least vaccinated FSAs in the province.

L8L is one of five Hamilton FSAs designated in early April as COVID hot spots by either the city or the province, giving many of its residents early and priority access to vaccines. The others are L8W on the east Mountain, L9C on the west Mountain, L8N in Corktown and Stinson, and L9K on the west Mountain and in parts of Ancaster.

A Spectator analysis of data from the non-profit research institute ICES shows that while vaccination rates have significantly increased over the past month in most FSAs in Hamilton - including hot spots - L8L is lagging behind.

Take a look at the hot spots. Between April 26 and May 30, vaccination rates for residents of all ages in those neighbourhoods rose from:

• 23 per cent to 51 per cent in L8N;

• 25 per cent to 53 per cent in L8W; and

• 30 per cent to 59 per cent in both L9C and L9K.

L8L, meanwhile, went from 19 per cent to 43 per cent - a jump of 24 percentage points and the lowest month-to-month increase in the city.

People 50 and older living in hot spots were eligible for vaccines 24 days earlier than the general public, while those 18 and older were eligible 15 days earlier.

That head start was buoyed by other targeted interventions, including mobile and pop-up clinics, early access for Black and racialized residents, an expanded list of pharmacies offering inoculations, and a city vaccine ambassador" program designed to help build public confidence in the vaccine.

So why are vaccination rates - across all age groups - still so low in L8L?

There's been so much public health work that helps us understand there's disproportionate inequities felt by a lot of people in certain postal codes, and L8L is certainly one of them," said Dr. Cathy Risdon, a Hamilton physician and professor in the department of family at McMaster University.

But as we move into more vaccine abundance, more supply, extra resources have to go in addressing barriers."

Part of that public health work Risdon alluded to includes access - getting vaccines to places in need, and early. And L8L, a neighbourhood with several social and economic disadvantages, such as relatively low incomes and low rates of educational attainment, is certainly in need. But so are other FSAs, such as L8N in nearby Corktown and Stinson, where the vaccination rate is eight percentage points higher.

In L8L, improving access has been a priority. In fact, there have been more inoculation sites there than in nearly every other FSA in Hamilton.

It's hosted several pop-up clinics at the Bernie Morelli and Pinky Lewis recreation centres, including some as early as April 7, as well as a mass clinic at Hamilton Health Sciences on Wellington Street North. There are also other clinics within walking distance, including a recent pop-up at the Hamilton Downtown Mosque and a mass clinic at FirstOntario Centre.

And so, Risdon said, the next phase of the vaccine rollout needs to look at factors beyond access. There's no one-size-fits-all solution for vaccine rollouts, especially when structural barriers are at play.

The most efficient way to deliver vaccines is in a mass vaccination site, and we've seen the people for whom that method works," she said. What we're seeing now in a sharper (way) is for whom that method doesn't work."

The COVID experience is not universal, Risdon added. People who carried the burden of inequity, income, race, education, newcomer status, language" prior to the health crisis now face extra barriers to cope with the pandemic, extra barriers to get testing and vaccines," she said.

Indeed, a Spectator analysis of vaccination rates in late April found the city's most economically disadvantaged areas were being inoculated at far lower rates than those in more affluent neighbourhoods.

Six weeks later, that trend continues.

The four least vaccinated FSAs, where inoculation rates ranged from 43 per cent to 49 per cent as of May 30, are in the lower city, where median household incomes range from $38,050 to $53,100 - significantly below the city average of $69,000.

Meanwhile, the five most vaccinated FSAs, where rates range from 59 to 66 per cent, are in areas that boast the lowest COVID infection rates. And two of them - L9H in Dundas and L9G in Ancaster - are among the three wealthiest neighbourhoods in Hamilton.

But income is just one piece of the puzzle when it comes to systemic inequities, said Neil Johnston, a researcher of medicine at McMaster University who collaborated on The Spectator's Code Red series.

Income, education, family structure ... so many of these things are correlated," said Johnston. The relationship is not really with income, but it's relation to the factors that drive income and education and empowerment."

This means a high vaccination rate comes down to what those who are getting vaccinated possess - everything from time and literacy, to access and wherewithal.

Sometimes you have to do more than just bring the vaccines to the people," said Johnston. If you're a single mother with two kids under the age of five in your basement apartment on Catharine Street, and somebody comes to the door with a vaccine, OK, maybe that would work. But otherwise, you've got a lot of pressure to not get it done."

Johnston also commended public health on the investments made to target marginalized communities in the vaccine rollout to date.

They deserve some credit for getting the rates as high as they did," he said. But the simple answer is: can you ever do enough?"

Hamilton's medical officer of health, Dr. Elizabeth Richardson, said in an emailed statement the city remains committed to prioritizing access to and uptake of vaccines in hot spots like L8L.

That means bridging the gap in vaccine access, removing barriers, increasing public confidence and, ultimately, promoting inoculation in the places that need it most, she said.

We recognize that getting a COVID-19 vaccine is an individual decision, however the factors contributing to lower coverage rates are complex, with roots in systemic inequities, including low socioeconomic status, which preceded and have been exacerbated by the COVID-19 pandemic," said Richardson, who declined an interview request.

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

Highs and lows

Here's a look at the five most and least vaccinated FSAs in Hamilton as of May 30, along with their median household incomes. Income data is from the 2016 census:

Highs

L9H: 66 per cent, $92,326

L9G: 62 per cent, $122,965

L8S: 62 per cent, $51,045

L8P: 61 per cent, $45,513

L8B: 59 per cent, N/A

Lows

L8L: 43 per cent, $45,151

L8H: 43 per cent, $53,126

L8M: 47 per cent, $43,533

L8R: 49 per cent, $38,054

L8E: 49 per cent, $75,771

Source: ICES, Statistics Canada