Editorial

One of the tenets of harm reduction is to “meet people where they’re at.”

One of the tenets of harm reduction is to "meet people where they’re at."

Simply put, it’s about removing barriers to care — be they physical, emotional or geographical — and relating to people without judgment, regardless of where they are in their journey.

While it’s a phrase often used in the context of addiction and substance abuse, "meet people where they’re at" can be an instructive way to think about vaccination.

Manitoba’s pandemic reopening plan and eventual return to normal are pinned on meeting vaccine targets. The province’s Labour Day goal is for 80 per cent of eligible Manitobans to have received one dose, and more than 75 per cent of eligible Manitobans to be fully vaccinated.

Vaccine implementation task force co-lead Johanu Botha. (Mike Deal / Winnipeg Free Press files)

Vaccine implementation task force co-lead Johanu Botha. (Mike Deal / Winnipeg Free Press files)

But the province’s vaccination rate is losing steam, at precisely the time it should be gaining speed in the home stretch. As of Wednesday, about 85,000 people who have received their first shot still need a second dose to reach that goal.

This week, Manitoba’s super sites opened to walk-ins as part of a daylong "vax-a-thon" to help reach those targets. Johanu Botha, operations lead for the Manitoba vaccine task force, noted that "...the only way we can get needles into arms is when the arms arrive for immunizations, and at this stage of the game, we can only go as fast as Manitobans are willing to be vaccinated."

Instead of waiting for the arms to arrive for immunizations, what if the needles came to the arms?

The last push on vaccinations ought to be taking the vaccine directly to people, rather than expecting them to travel to a super site. That might mean more pop-up clinics at workplaces and community centres. It could involve mobile immunization vans that reach out to people experiencing homelessness. Drive-thrus might also be an option.

It could also involve, literally, going door to door.

In the U.S., where vaccination rates have plummeted, President Joe Biden called for door-to-door outreach, though in a mostly informational capacity, to remind people how and where to get their shot. In North Carolina, Mecklenburg County took things a step further and launched Doses to Doors, a program in which health department officials team up with community outreach so people can get their shots right on their front steps if they choose.

Providing information is good first step, but vaccination is the goal. Having shots at the ready could bridge the gap.

In Manitoba, we have seen such community-led efforts in The Pas and Thompson, where targeting low-income neighbourhoods ultimately got shots into arms. In June, the province also announced 25 community grants for outreach efforts in low-uptake communities.

Instead of waiting for the arms to arrive for immunizations, what if the needles came to the arms?

Door-to-door vaccination administration is not a new concept: the World Health Organization still operates the Global Polio Eradication Initiative in developing countries — one of the largest public-health undertakings in history.

There are many reasons people can’t or won’t go to a super site, including access to transportation, location and other factors. The people most inclined to access super sites are likely now fully vaccinated, or have received at least one dose.

With some reports indicating the province is moving the super sites into wind-down mode, the question is how to reach those people who, for whatever reason, have yet to get their first shot.

Incentives can be useful tools in encouraging vaccination, but they are only one tool — one that hasn’t proved very effective for dismantling barriers. The next best answer to the vaccination-uptake question might be in meeting people where they’re at.