Hundreds of Deaths Among Older Adults Attributable to Canada’s Patchwork Approach to COVID-19 Vaccination 

Vaccination rates among older adults have progressively increased since Canada began its national rollout in December 2020, but several factors contributed to the preventable deaths of potentially hundreds of older adults.

While Canada has much to be proud of today—with 96% of Canadians aged 70 years and older having received at least one dose of a COVID-19 vaccine and 93% having received two shots as of August 21, 2021—federal and provincial governments missed important opportunities to vaccinate older adults in a timely and equitable way. This caused undue harm and preventable deaths within the population that is most vulnerable to serious health outcomes as a result of COVID-19.

The lack of national coordination, inconsistent prioritization of older Canadians, and a failure to focus on speed, led to a tragic loss of older lives across the country. Between April and June 2021 alone, the deaths of more than 350 older adults in Ontario could have been prevented with earlier administration of second doses of COVID-19 vaccines.

In A Cautionary Tale: Canada’s COVID-19 Vaccine Rollout for Older Canadians, the National Institute on Ageing provides an overview of Canada’s vaccine rollout in long-term care (LTC) settings and for community-dwelling older adults. The report describes the issues that emerged during Canada’s vaccine rollout and compares its approach to those of five international vaccination leaders: Chile, Denmark, Israel, the United Kingdom, and the United States. In analyzing and comparing Canada’s rollout to those of international vaccination leaders, the report identifies several important lessons. It also provides five policy recommendations to improve future vaccine rollouts and better protect older adults and other vulnerable populations. These insights are applicable to Canada and to many other countries around the globe. 

In tracking Canada’s vaccine rollout among LTC residents, staff and community-dwelling older adults, the following issues were identified:

  1. Limited vaccine availability during the early stages of Canada’s vaccine rollout

  2. Varying jurisdictional interpretation of the National Advisory Committee on Immunization (NACI) guidance for the prioritization of older adults

  3. Delayed second vaccines doses

  4. Issues with vaccine booking systems

  5. Barriers to accessing vaccination centers

To provide one example, the NIA compared second dose vaccination strategies between Alberta and Ontario. Older Albertans received their second doses of COVID-19 vaccines more than a month before their Ontario counterparts. This was due in part to an early first-dose start date, as well as the delayed adoption of a second-dose interval extension in Alberta. To quantify how the shorter second dose interval in Alberta impacted the effects of COVID-19 on older adults, the NIA also compared mortality rates amongst the older populations in the two provinces during the period of January to July 2021. We found that Ontario saw much higher COVID-19 mortality rates amongst its older population than Alberta. The observed risk of death from COVID-19 was substantially higher (76% to 150%) among adults aged 60 years and older in Ontario than in Alberta during this time.

Comparing Canada’s vaccine rollout to leading international countries revealed efficient and effective methods of protecting older adults: following a simple prioritization strategy, emphasizing speed, and ensuring national coordination governed by a central agency. The NIA also identified the following lessons that will help contribute to more efficient vaccination rollouts among older adults:

  1. Vaccine supply security leads to improved stability of vaccine rollouts plans, which enables better decision making and direction from national to local governments

  2. The most effective rollout strategies rely on scientific evidence and avoid politicization

  3. Greater efforts to address both socio-economic and cultural barriers along with the physical, and cognitive limitations of older adults are needed to facilitate access to vaccine appointments

  4. Faster efficient rollouts save lives

  5. Vaccines are highly effective at preventing hospitalization and death among older adults

Based on this research, the NIA has proposed five actionable policy recommendations to improve both ongoing COVID-19 vaccination efforts and to inform future mass-vaccination programs, both in Canada and internationally:

  1. Invest in the creation of greater domestic vaccine production capacity

  2. Vaccine rollout strategies should be kept simple, evidence based, and focused on targeting the highest-risk populations whenever possible

  3. Strengthen Canada’s digital health infrastructure capacity to more efficiently facilitate vaccine appointments

  4. Expand access to vaccines through pharmacies, primary health care providers, community clinics, and targeted homebound vaccination programs

  5. Develop a national health emergency preparedness plan and train health care workers to deliver effective emergency preparedness and response measures 

The NIA strongly encourages jurisdictions to take stock of these lessons and to adopt the five policy recommendations outlined above and in the report, especially as the possible need for booster shots increases. By implementing these best practices immediately, local, regional, and federal governments can more effectively vaccinate their older populations against COVID-19 today and improve the efficiency of future vaccine rollouts to support the health and safety of all.

Dr. Samir Sinha is Director of Health Policy Research at the NIA.
Natalie Iciaszczyk is Policy Analyst at the NIA.
Cameron Feil is Research Coordinator at the NIA.

National Institute on Ageing