Ontario lowering vaccine eligibility to 18-plus, doctors forecast pivot to second doses

All adult Ontarians will be eligible to receive a COVID-19 vaccine as of Tuesday morning no matter where they live, the province announced Monday, accelerating its plans for the move by a week.

And the province could pivot soon to delivering more second doses, according to an update from the province's top doctors.

But with that good news came concern from the mayors and chairs of the municipalities of the Greater Toronto and Hamilton Areas, whose municipalities have the highest rates of COVID-19 in the province and the vast majority of COVID-19 cases in Ontario.

For the past two weeks, the province had been allocating 50 per cent of its supply to hot-spot communities, with 25 per cent in weeks prior. But hot-spot communities are no longer getting extra allocations, with doses as of this week allocated based on the remaining unvaccinated populations in each area, resulting in a marked decrease in supply.

According to figures provided by Toronto officials, the city's supply is expected to drop by half over the next two weeks compared to the last.

The GTHA mayors and chairs issued a statement on Monday afternoon raising concerns that they will not have sufficient supply to meet the demand spurred by the move to 18-plus across the board.

"While we welcome this news, we know this will create increased demand for vaccine appointments and we will therefore require additional supply of vaccine from the provincial and federal governments if we are to be able to meet the increased demand for appointments," they said in a statement.

Health Minister Christine Elliott defended the move, saying said local leaders can distribute as many vaccines to hot spots within their jurisdictions as they see fit.

"There will be sufficient quantities to continue to make sure that those areas internally determined to the hot-spot areas will still receive extra doses of vaccines," she said.

The decision to open up eligibility to 18-plus comes as Ontario is expecting to receive more doses than expected this week: 2.2 million in total, after Pfizer agreed to move up the bulk of next week's shipment ahead of the Victoria Day long weekend. But that change does not translate into additional doses overall.

The coming deliveries of the 2.2 million doses should bring the province's grand total to 10 million received since the vaccination campaign began. It explains why the province is expanding the criteria to everyone aged 18 and over — there are approximately 12.5 million Ontarians aged 18-plus.

Meanwhile, Ontario's top doctors said Monday that the province may be shortening the interval between doses soon.

"We're hoping, as the supply goes up and more and more people are getting their first shot we'll be able to start having shorter intervals, particularly for front-line health-care workers and people in high-risk groups," said Associate Chief Medical Officer of Health Dr. Barabra Yaffe Monday, and adding that in some cases those second doses for those groups have already begun.

Chief Medical Officer of Health Dr. David Williams added that when the province gets more supply, "we're not going to leave it in fridges."

"If we feel that we can go on to second doses with people, we certainly will, we won't wait for the four months," said Williams, adding that the provincial COVAX vaccination database allows the province to change people's bookings for their second shots. "We would like to do it sooner if we can."

But Yaffe also said the dose intervals in Ontario are unlikely to become very short as a longer interval between a first and second dose can mean a stronger immune response to the second.

And Ontario's vaccine supply numbers suggest the province may be able to begin a dramatic increase in second-dose administration in the coming weeks — but how quickly that may occur depends both on rates of vaccine confidence in Ontario and how quickly the federal government delivers the rest of the province's supply.

The province has administered almost 7.2 million doses so far, to a total of 6.7 million people. 

There are nearly 15 million Ontarians, about 13 million of them aged 12 and over and currently approved by Health Canada for vaccination. Public health officials have set a benchmark of vaccinating 75 per cent of the population overall, about 11 million people.

Of the total 10 million doses expected in Ontario by the end of May, relatively few have been allocated to booster shots — under half a million of them have been used as second doses so far. But that could switch in the coming weeks once Ontario nears its upper threshold for first shots — whether that's above or below the public health benchmark of about 11 million people is not yet clear. 

Ontario is expecting to receive 4.7 million doses of the Pfizer vaccine alone next month, but the federal government has not yet confirmed the deliveries of any other vaccines.

The only timeline the federal government has offered is an expectation that second doses will be complete by fall.

Federal officials have said the country had placed orders for 84 million Pfizer and Moderna vaccines, in total, by the end of September, which would mean a grand total of 32 million doses of the mRNA vaccines for Ontario alone. However, federal officials were unable to provide additional information as of Monday about when, between June and the end of September, the rest of those doses will arrive.

The other part of the equation is vaccine hesitancy, which would impact how many people decide to get vaccinated and how quickly.

A recent Angus Reid Institute survey included some positive news on vaccine confidence, finding fewer Canadians say they're unsure about the vaccine or would prefer to wait to receive it, with no increase in vaccine refusal. It found 89 per cent of Ontario adults say they've already been vaccinated or want to be, only seven per cent saying they're against the vaccine, with the remainder unsure.