Months after launch of Quebec's vaccine campaign, hardest-hit areas still struggle with access

Months after the vaccination campaign began in Quebec, Rose Ndjelsays there still isn't a simple and easy way for people in her neighbourhood of Parc-Extension to get a COVID-19 vaccine.

Earlier this month, the province attained the milestone of having more than 70per cent of its population vaccinated with one dose.

But data recently released by Quebec shows some of the cities and neighbourhoods that were hardest hit by the pandemic are trailing behind in vaccination rates.

Park Ex and the borough of Montral-Nord have the lowest vaccination rates in the city, at 47 and 46 per cent respectively.

Montreal and Laval are lagging behind the rest of the province, too. While about 70 per cent of Quebecers over 12 have received at least one dose, the proportion islower in Montreal at 67.5 per centand Laval, at 67.3 per cent.

What those places also have in common ishow hard they were hit by the pandemic, in numbers of deaths and people infected.

Ndjel is the director of Afrique au fminin, an organization based in Park Ex that has been working with the local health board to spread information about COVID-19, testing and vaccines to residents.

"It's all over the place," Ndjel said.

"Right now, my battle is to have a walk-in vaccination clinic that is in just one place, so that people here can know where it is."

One of the principal solutions to improving vaccine accessibility in neighbourhoods shepherded by health boards in Montreal and Quebec City has been temporary walk-in vaccine clinics.

The clinics are typically announced a week or two in advance, last two days and are in different locations, such as community centres or places of worship.

Much of the promotion for those pop-ups, though, is left up to understaffed and underfunded local organizations like Ndjel's.

Ndjel says she and other community workers have been stepping up and seeing a huge response from people in Park Ex, for whom making an appointmentor having to commute to one of the city's mass vaccination centrescan be complicated.

But, she says, people find the shiftinglocations and schedulesof pop-up clinics confusing. What's more, the two clinics in Park Exran out of vaccines.

"Every time, there has been between 50 and 100 people who waited in line who could not get the vaccine," Ndjel said, adding she'd been informed that the health board had trouble finding enough nurses to administer the vaccines at the sites.

Ndjel says she believes it would be easier if the local health board, the CIUSSSdu Centre-Ouest-de-l'le-de-Montral, opened a walk-in vaccination clinic with consistent hours at a popular community centre on Saint-RochStreet.

Laurence Monnais,a medical historian at Universit de Montral, says the disparity in vaccination rates between lower- and higher-income neighbourhoods is among the many ways the COVID-19 pandemic has highlighted social inequities.

"It's much too easy politically, as well to say the lower rates are because people don't want to get the vaccine, but that doesn't address the real issues," Monnais said in an interview.

"It's not about hesitancy, it's about accessibility to vaccination," she added.

There are many reasons why online appointments for mass vaccination centres present barriers to people in places like Park Ex and Montral-Nord, Monnais explained.

Many asylum seekers and immigrants live in those neighbourhoods, working long hours in essential and precariousjobs which makesit difficult for them to get to a vaccination clinic on time without having to take time off work.

As well, many may not know or believe they are eligible to receive it, or may not know how to because of language barriers.

Low vaccination rates reflect pre-existing social inequities

There is also the sense among those neighbourhoods that the government didn't properly protect them at the height of the pandemic.

Monnais who works with CoVivre, a program that aims to mitigate the effects of the pandemic in disproportionately affected communities says that sense of neglect could make some feel like they don't matter in the vaccine effort.

"We really have to pay attention to these issues because they are highlighting how the pandemic was managed [in the province] as a whole, as well as social inequalities that were already there before the pandemic," Monnais said.

The researcher points to innovative ways other cities have found to get vaccines to people, including drive-thru vaccinations early on in the United States and clinics open overnight in the Toronto area.

Francine Dupuis, the head of the CIUSSS, admits the health board is "having difficulties reaching the population."

In an interview over the weekend, Dupuis told CBCthe pop-up clinics have been successful in Park Ex and that the health board will be holding more.

Monday evening, the CIUSSS announced even more dates with extended hours. They are at:

• MIL campus of Universit de Montral,1375 Thrse-Lavoie-
  Roux Avenue, Tuesday, June 8, Wednesday, June 9 from8a.m. to 7:30 p.m.

• Bill-Durnan Arena,4988 Vzina Street. Every day from 8a.m. to7:30 p.m.
  With extended hours onThursday, June 10 and Monday, June 14 from8:10 a.m. to 9:30 p.m.

• Dcarie Square,6900 Dcarie Boulevard. Every day from 8a.m. to7:30 p.m.

• Howie-Morenz Arena,8650 Querbes Avenue. Friday, June 11, Saturday, June 12 from 10 a.m. to3p.m.

• Saint Kevin Church,5600 Cte-des-Neiges Road. Friday, June 182 p.m.to7p.m. and Saturday, June 19 from10a.m. to 3p.m.

Pop-up clinics have been successful in Montral-Nord, too, according to a spokesperson for the local health board overseeing the borough, the CIUSSS du Nord-de-l'le-de-Montral.

"In total, we've been able to vaccinate about 25,000 people in 264 places," spokesperson milie Jacob saidin an email, noting the borough's rate remains among the lowest, but efforts to expand access began early on in the campaign.

"Many of those people probably would never have been able to go to one of the mass vaccination centres."

Monnais saysthe levels of hierarchy in Quebec's health-care system, as well as a number of employee collective agreements make it more difficult and slower to implement some of those ideas, but that health officials appear tobe catching on.

She saysmobile vaccination clinics being rolled out by health boards across the city this week to schools and areas with lower vaccination rates is a good start.

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