Amy Booth, MPH
Research Project Manager, Global HPV Control

Claire Lenouvel, MD, CCFP
Family Physician

In mid December 2020, after months of restrictions and closures, changing public health measures and general uncertainty, people across British Columbia were relieved and excited to hear news of an approved COVID-19 vaccine that would soon be available. However, some British Columbians were uncertain about this new development in the control of the COVID-19 pandemic. While many people booked vaccination appointments with urgency, others were more hesitant, and took their time deciding whether to receive the vaccine.  

In recent years, vaccine hesitancy has been a growing concern in British Columbia, across Canada, and around the world, with the World Health Organization naming vaccine hesitancy as one of the top 10 threats to human health. “Vaccine hesitancy” is a complex concept made up of attitudes, beliefs, and behaviours toward vaccination, but ultimately refers to a delay in acceptance or the refusal of a vaccine, despite the vaccine being readily available.  

Through an online research survey, and with the support of the BCCDC Foundation, Principal Investigators Dr Claire Lenouvel and Dr Gina Ogilvie sought to investigate rates of vaccination among employees of the Northern Health Authority (NHA), and more specifically, sought to better understand vaccine confidence and vaccine hesitancy in individuals working in healthcare settings in Northern BC. With an understanding of the factors that contribute to vaccine hesitancy, public health leaders and Medical Health Officers are able to more effectively address concerns and communicate with the public on issues around vaccines, and strengthen public health programs for future vaccination campaigns.

In this study, individuals working in healthcare settings were of interest for two reasons: 1) they are regularly in close contact with the most medically vulnerable in our society, and therefore, can potentially transmit infection to them, and 2) they are at an elevated risk for infection themselves, due to workplace exposures from sick individuals. The Principal Investigators chose the NHA as the focus region because, at the time, there was concern about COVID-19 vaccination uptake rates from several communities located in the Northern Health Authority. As well, Dr Lenouvel is a resident physician in Northern BC and was especially interested in the topic!

With support from the Medical Health Officers and NHA, Dr Lenouvel was able to collect over 1,700 responses to the online survey from Northern Health employees from July to November 2021. The survey asked individuals about their COVID-19 vaccination history, intentions to receive future COVID-19 vaccines, and their attitudes toward COVID-19 vaccines in general.

Out of 1,700 survey responders, 92% reported that they had received one dose of a COVID-19 vaccine, and 88% had received a second dose. Overall, respondents had positive attitudes toward COVID-19 vaccines, with 89% believing COVID-19 vaccines were beneficial. This was encouraging news; however, the rates of vaccination were not the same across all places of employment, and across all professions.

Among all survey responders who had received two doses of a COVID-19 vaccine, their reasons for getting vaccinated included: concerns about others’ safety, the threat of losing employment, wanting the pandemic to end, and working in public and not wanting to get sick.

Employees in long-term care homes and assisted living facilities had lower rates of COVID-19 vaccinations, which was concerning given the high COVID-19 infection and mortality rates observed in both these settings throughout the pandemic. Licensed Practical Nurses (LPNs) and Care Aides (CAs) also had lower rates of vaccine uptake compared to other healthcare sector groups, like physicians and registered nurses.

Among LPNs and CAs, reasons for remaining unvaccinated included: not believing that COVID-19 vaccines are safe, not believing that COVID-19 vaccines are beneficial, and not believing that COVID-19 vaccines would reduce risk at work.

The investigators also wanted to know how Northern Health employees felt about required vaccines. They found that 76% of respondents felt that COVID-19 vaccines should be required for healthcare professionals, and 74% felt that COVID-19 vaccines should be required for high-risk settings, while only 59% of respondents believed that COVID-19 vaccines should be required for everyone.

Finally, vaccinated respondents were asked if they would receive seasonal COVID-19 vaccine boosters if offered and available, and 83% said they would be likely to receive a seasonal booster.

With funding from the BCCDC Foundation, this local research helped to uncover important findings about vaccine hesitancy and vaccine confidence among NHA employees during the COVID-19 pandemic. The findings from the research were shared with Medical Health Officers in the region and are helping to shape future workplace vaccine campaigns to support the health of employees and the community. 

The post Researchers Examine Vaccine Confidence and Hesitancy in Healthcare Settings in Northern BC appeared first on Pacific Public Health Foundation.

Though it may feel different, as we are learning to live with SARS-CoV-2 as a circulating respiratory virus, we must understand that there remains a global health emergency of which we cannot become complacent. We must still protect those who have been made more vulnerable due to the pandemic, and we must also focus, for example, on long-term data collection for vaccine effectiveness, advancing vaccine equity, and applying lessons from the current pandemic to future threat responses.

Our work, therefore, continues.

The SPEAK Surveys data are critically important to help us understand where to focus our efforts. To date, data show negative impacts on mental health and stress and that societal impacts are inequitably distributed, with families with children, young adults, and people from lower socioeconomic backgrounds most impacted. Taking this into consideration, much of the work of public health is shifting from acute, and often real-time, response, to strategic, proactive recovery and addressing the societal consequences of the pandemic and pandemic-related measures, as well as applying lessons to help us prepare for the future. These efforts will take years.

What does this mean for us?

It means we’re actively listening, learning, engaging, and convening work to advance equity, community resiliency, the social determinants of health, and a stronger, innovative public health sector. Here’s a snapshot of some of our current solutions-focused projects and priorities, as we shift towards the future.

• As BC shifts towards pandemic recovery, there is a limited window of opportunity to learn from the experiences of those engaged in the pandemic response and identify areas for improvement to prepare for emerging pathogens and future pandemics. It is critical to learn from the public health experience of the pandemic in order to prepare for the future. We’re funding a project that aims to articulate learnings to inform a provincial pandemic preparedness and response guidance framework, which will ensure BC is ready for future threats.
• Working with Michael Smith Health Research BC, the Simon Fraser University Faculty of Health Sciences, and the Morris J. Wosk Centre for Dialogue, we convened a dialogue event to distill key lessons, strengthen partnerships among public health and research stakeholders, and identify structures and mechanisms to support evidence-based practice, policy, and decision-making, as well as community-relevant public health messaging and tools.

• We continue to fund key areas of immunization research and service, with a specific focus on advancing equity for Indigenous communities. This includes vaccine monitoring, reporting, access, and stewardship in the North to strengthen these areas to ensure that Indigenous communities receive the same access to, and supports for, vaccination.
• Evidence of Indigenous-specific racism in the health system surfaced in powerful ways during the pandemic. We’re supporting a project that will systematically look at the ways in which Indigenous-specific racism, white supremacy, and settler colonialism showed up within the public health response.

• Addressing the societal, or unintended, consequences of the pandemic and pandemic-related measures is critical to rebuilding, recovery, and resiliency. Working with the Ministry of Health and the BC Centre for Disease Control, we’re providing grants across the province focusing on equity in regional health authorities and local communities.
• One fundamental consequence of the pandemic is that youth mental health and wellbeing has been negatively impacted—data from the SPEAK surveys have demonstrated that this must be a core area of work for public health. We’re supporting provincial research to understand the needs and gaps, and build and strengthen interventions for youth.

We look forward to sharing outcomes of these and other projects in future stories and as we advance our new strategic plan to help shape public health over the coming years by focusing on equity, partnerships, innovation, and social justice, anti-racism, and truth and reconciliation. 

Together… a constant theme

In early 2020, our Executive Director wrote her first reflections blog, followed by a second reflections piece in early 2022—the theme of both was ‘together.’

In 2023, ‘together’ remains a core theme.

Much of what we are learning and hearing is that public health needs to do a better job of incorporating your voices. The SPEAK Surveys are a vital tool, and one example. Public engagement is important to us, as it brings us together and ensures public health is working for you.

Our work has been, and will continue to be, accomplished together through collaboration and partnerships. This also means our donor community and we’re continuing to advance efforts through Your Health, Our Commitment — a way for you to get involved and help too—gifts to Your Health, Our Commitment will advance the projects above and other critical initiatives.

National COVID-19 Awareness Day was March 11th, to commemorate the day the WHO declared a global pandemic in 2020, offering a day to both remember and to look ahead, and bring people and communities together. As we focus on learning from the pandemic, supporting recovery efforts, and addressing the societal consequences, let’s not forget we still have work to do, together. 

The post New Pandemic Recovery Projects Helping BC Advance Equity and Community Resiliency appeared first on Pacific Public Health Foundation.

Time frame: 2020-2022

Overview:
Not long after the World Health Organization declared COVID-19 a pandemic, Dr Natalie Prystajecky and Dr Melissa Glier, who had already been studying viruses in wastewater since 2018, were able to quickly leverage an existing collaboration, methods, and equipment for testing enteric viruses in wastewater to be able to test for SARS-CoV-2, the virus that causes COVID-19. Recently adopting an alternative sampling method that allows to test wastewater from an entire community, their team is also working on a method to test wastewater as it exits a building, thus providing key information on how COVID-19 is being spread throughout and among BC communities.

Results:
Funding for their work allowed Drs Prystajecky and Glier’s team to optimize their methods and test for SARS-CoV-2 in five wastewater treatment plants in Metro Vancouver, covering nearly 50% of BC’s population, along two regional health authorities. Weekly reports are shared with medical health officers and epidemiologists within regional health authorities, BC Centre for Disease Control staff, and Metro Vancouver.

Their collaborations have extended to the development of a three-day rapid sequencing method to effectively track COVID-19 variants of concern within a region, and key findings from their studies have been published in the Journal of Environmental Sciences and the American Society for Microbiology, with more to come. With the Omicron variant, wastewater testing has become a critical and necessary component of SARS-CoV-2 monitoring and surveillance.

Rapid SARS-CoV-2 Vaccine Research Initiative in BC

Time frame: 2021-2022

Overview:
In a new and unique partnership with Genome BC and Michael Smith Health Research BC (formerly the Michael Smith Foundation for Health Research), we funded nine new rapid-response vaccine research projects addressing COVID-19 vaccine research priorities and knowledge gaps. This funding program was developed and implemented in real-time, enabling us to get funding to critical research projects rapidly in order to have high-impact on vaccination roll-out for BC. Collective funding of around $1.3M is allowing for vaccine research that ultimately focuses on public health response and ensuring access to, and confidence in, vaccination programs for everyone in BC.

More specifically, the projects funded address areas such as:

• vaccine breakthrough infections;
• vaccine effectiveness in the context of Variants of Concern and in immune response;
• viral transmission;
• equitable distribution;
• vaccine acceptance and attitudes towards vaccines; and
• vaccine literacy and hesitancy among people who are pregnant or breastfeeding, people who are incarcerated, people who work in long-term care homes and a variety of multicultural communities in the Lower Mainland.

For a summary of the projects, go here.

Results:
We’ll continue to share outcomes of this research as these projects progress. You can stay connected on project updates by visiting this page and subscribing to our newsletter.

The post COVID-19 Response: From Monitoring to Vaccination appeared first on Pacific Public Health Foundation.

Last summer, Dr Natalie Prystajecky (Principal Investigator) and Dr Melissa Glier (lead researcher) provided an introduction to wastewater testing for SARS-CoV-2. Here, Drs Glier and Prystajecky provide an update on research progress and how wastewater data continues to be used in the pandemic response.         

Soon after the World Health Organization declared the global outbreak of COVID-19 a pandemic, the BC Centre for Disease Control (BCCDC) Public Health Laboratory (PHL) and Metro Vancouver began working together to test wastewater for SARS-CoV-2.

We quickly leveraged an existing collaboration, methods, and equipment for testing enteric viruses in wastewater to be able to test for SARS-CoV-2, the virus that causes COVID-19. But we weren’t the only lab in Canada doing this work–across the nation, researchers like us were developing and optimizing methods. To ensure that the methods used across Canada were robust and that the data were comparable, the Canadian Water Network’s COVID-19 Wastewater Coalition conducted an Inter-Laboratory Study, hosted by Canada’s National Microbiology Laboratory.

The goal of this study was to better understand the variability associated with methods that are being used in Canada, with a focus on method optimization. This study set the stage for sharing methods and data amongst Canadian experts to achieve the collective goal of rapid development of methods that can support public health. The study’s key finding and recommendations have been captured in an outcomes report and a publication where Dr Glier is the second author.

By participating in the inter-laboratory study, our team was able to optimize our methods and apply them to testing for SARS-CoV-2 in five wastewater treatment plants in Metro Vancouver, which cover nearly 50% of BC’s population and located within two regional health authorities.

The SARS-CoV-2 wastewater data is compared to trends in the incidence of community cases by BCCDC’s public health physician Dr David McVae, medical geographer Sunny Mak, and data analyst Michael Kuo. Weekly reports are shared with medical health officers and epidemiologists at the regional health authorities, staff at the BCCDC and Metro Vancouver. In addition, Metro Vancouver launched an online tool which allows residents to track the SARS-CoV-2 viral load in wastewater at each of the region’s five treatment plants. The results (wastewater data graphed with the case data over time) are also available online within the bi-weekly BC COVID-19 Data Summaries.

Furthermore, last year we collaborated with UBC’s assistant professor Dr Ryan Ziels and PhD student Xuan Lin to develop methods to detect SARS-CoV-2 variants of concern in positive wastewater samples. This project led to the development of a rapid sequencing method (3-day) to effectively track COVID-19 variants of concern within a region. More details pertaining to this study can be found on the UBC News website and in this publication.

Our team continues to work on method development and recently adopted an alternative sampling method. For the work to date, we have focused on sampling from wastewater influent (as the wastewater enters the wastewater treatment plant). This allows us to test wastewater from an entire community.

We are now evaluating a method to test wastewater as it exits a building; this allows us to test the wastewater for a specific community. Wastewater samples are collected by placing a testing device called the COVID-19 sewer cage (COSCa) into a manhole as wastewater exits a building.

The COSCa device, which is 3D printed, was created by PhD student Emalie Hayes at Dalhousie University and emphasizes the role of innovation in responding to the pandemic. We are using the COSCa sampling method, in collaboration with the Ziels laboratory, to investigate SARS-CoV-2 and the variants of concern in wastewater discharged from UBC residences. By the end of the project, we will have developed a robust wastewater testing program to support public health decision makers respond to the COVID-19 pandemic in BC.

We are already starting to plan for wastewater testing beyond COVID-19, with an aim to build a comprehensive enhanced wastewater surveillance system for BC. This includes adding additional testing targets of public health concern, such as for surveillance of flu, foodborne pathogens or organisms carrying antimicrobial resistance. We anticipate the wastewater-based testing will have an important role in surveillance systems of the future.

We’d like to recognize our funders: the BCCDC Foundation for Public Health, NSERC, Metro Vancouver, and Health Canada.

We also recognize the enormous contribution of our team and collaborators, including the team that processes and tests the samples: Liam Byrne and Tina Lee (current coops), Tenysha RossVanMierlo, Matthias Krushel, Ziwen Ran (previous co-ops), and Jennifer Kopetzky (technician). We recognize the contributions of the following as well; Christine Tchao, Daisy Yu, Tracy Chan, Dr John Tyson (BCCDC PHL); Dr Ryan Ziels, Xuan Lin, Kevin Kuchinski, (UBC); Dr David McVea, Sunny Mak, Michael Kuo (BCCDC) Farida Bishay, Alvin Louie, Daisy Espinosa, Dr Andjela Knezevic-Stevanovic (Metro Vancouver), Dr. Chand Mangat, Dr. Michael Mulvey, Dr. Anil Nichani (NML/PHAC); Dr. Alex Chik, Bernadette Conant, and Dr. Steve Hrudey (CWN).

The post Project Update: BCCDC’s COVID-19 Wastewater Surveillance in Metro Vancouver Communities appeared first on Pacific Public Health Foundation.

People in prisons across Canada have disclosed that the health care system behind bars is failing, and they fear they will not leave prison alive. Segregation is being used for medical isolation or quarantine during COVID-19 as prisons have few other options available to them, and Canadian prison advocates and watchdogs have called the overuse of segregation during the COVID-19 pandemic ‘atrocious’ and potentially a Charter rights violation.

In person educational and rehabilitative programs, as well as family visits, have been suspended in most prisons in Canada for 12 months now, casting doubts on the correctional system’s ability to function as a place of rehabilitation during pandemics. While efforts to de-carcerate were made early in the first COVID-19 wave, daily prison counts began to creep up across Canada in the second half of 2020 and researchers and advocates are calling on governments to focus on this action again.

The spread of COVID-19 behind bars is not inevitable—with appropriate actions, the cycle of Concentration, Amplification, Deterioration, then Dissemination can be broken. Prison health is an essential component of public health, and responses to COVID-19 in prisons are a vital component of effectively controlling the virus to protect all of us.

Interesting in reading Dr Bartlett’s guest post “Addressing Barriers to Sexually Transmitted and Blood Borne Infection (STTBI) Screening and Care in Prisons”? Go here to read her article.

The post Uncovering SARS-CoV-2 Behind Bars: Understanding the Impact of the COVID-19 Pandemic in Correctional Settings appeared first on Pacific Public Health Foundation.