No masks and 4th doses? Experts concerned about ‘mixed’ COVID-19 messaging

More Canadians are now eligible for a fourth COVID-19 vaccine dose, but with less than half of the population having received a third shot and most restrictions lifted across the country, experts are questioning the “mixed messaging” coming from public health officials.

On Tuesday, the National Advisory Committee on Immunization (NACI) published new guidance, recommending second boosters for older Canadians over the age of 70.

Several provinces, including Ontario, British Columbia, Quebec, Alberta and Manitoba, have announced their plans to roll out fourth doses to older demographics.

The rollout comes as Canadian provinces grapple with a sixth wave of COVID-19, which public health officials say is being driven by the highly-transmissible BA.2 subvariant of Omicron and lifting of restrictions including masking and proof of vaccination, in most settings.

Experts say Canadians need more information and better communication from public health authorities on how this fourth dose could be helpful in fighting the latest Omicron surge.

“I think a lot of the messaging right now is very mixed,” said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network hospitals in Toronto.

Sinha said it is difficult to convince people to get a fourth dose when at the same time they are being told that masks are not necessary anymore — and it’s up to them to wear one or not.

Quebec has decided to prolong its mask requirement in public places through the month of April amid a surge in hospitalizations and cases related to COVID-19.

But Ontario says there is no need to re-impose a widespread mask mandate in the province despite evidence of increased COVID-19 spread. As things stand now, only Nunavut, P.E.I. and Quebec still have their mask mandates in place.

Most provinces told Global News Wednesday they have no plans to reintroduce COVID-19 restrictions.

“I think all this mixed messaging is challenging because now people hear fourth doses. ‘Well, what does it matter? Why would I get a fourth dose when I don’t even need to wear a mask?’” said Sinha.

Kerry Bowman, a professor of bioethics and global health at the University of Toronto, is concerned that what is being communicated — or not — is not only creating confusion but sowing divisions.

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“I think our messages are becoming increasingly diluted. And also, we know that as a society, we are increasingly divided as well on so much of this,” he said.

A national survey by the Canadian Hub for Applied and Social Research at the University of Saskatchewan published Monday found that 72 per cent of respondents said the COVID-19 pandemic was a divisive issue over the past year.

About 40 per cent of those surveyed said they have reduced contact with friends or family over an argument about the pandemic or politics.

Even though more than 81 per cent of the Canadian population has received two doses of a COVID-19 vaccine, uptake of a first booster, or third dose, has been slow — currently at 47 per cent.

Sinha said he is particularly worried that among older vulnerable Canadians, only 80 per cent have received three doses compared to 94 per cent who have gotten two doses.

Part of the problem, according to Sinha, is that Canada’s definition of what is considered to be fully vaccinated still includes two doses when older adults are now recommended to get four.

“I think we really need to start getting rid of this term ‘fully vaccinated’ as meaning just two doses,” he said. “It’s time we start revising our language.”

Bowman said convincing people who have had COVID-19 after being triple-vaccinated to get a fourth dose is “going to be very difficult.”

This is why the onus falls on the public health authorities to provide more information and evidence on the need for additional doses, he said.

According to NACI, the intent of a booster dose is to restore protection that may have decreased over time or is no longer sufficient in individuals who initially responded adequately to a complete primary vaccine series.

In the context of sixth wave, a fourth dose will be “really important” to lessen the burden of disease among the oldest Canadians, said Sinha.

“I think we’re doing a disservice for older people when they don’t appreciate that actually four doses is what we’re recommending for you now and that if you only have two, you’re only 50 per cent to where you need to be,” he said.