Urban centres across Canada are home to many vulnerable populations who are more at risk of acquiring SARS-CoV-2 and developing serious complications from COVID-19. The Government of Canada, through the COVID-19 Immunity Task Force (CITF) and the Vaccine Surveillance Reference Group (VSRG), is investing approximately $770,000 in a new study that will investigate the uptake, effectiveness, and side effects of COVID-19 vaccines among members of vulnerable urban populations in Canada.
The individuals to be included in this study experience risk factors such as homelessness and poverty, may live in congregate settings such as social housing or correctional facilities, may use drugs intensively or have additional health conditions due to compromised immune systems, or may have poor nutrition, hygiene or inadequate living conditions. Adding to these risks are the barriers to vaccination, ranging from stigma to discrimination, which they already often face when trying to access healthcare.
Researchers will recruit more than 250 people who use drugs from three community-recruited cohorts in Vancouver, British Columbia. Participants will be asked to provide a blood sample and complete a survey at their first (baseline) visit and then do three follow-up visits (one every two months) until March 31, 2022. Following their first visit, researchers aim to assess vaccine uptake, adherence to vaccination protocols, as well as monitor and investigate potential side effects of the vaccines. It is anticipated that the results from this study, combined with data from other relevant COVID-19 studies across Canada, will contribute to a better understanding of vaccines and Canada’s vulnerable population.
“There are multiple factors that may impact a person’s ability or willingness to get vaccinated. Some might not have access to a computer, phone or transportation, or they may distrust the healthcare system because of poor and harmful experiences in the past,” says Dr. Brittany Barker, study co-lead, a research scientist with the British Columbia Centre for Substance Use (BCCSU) and a postdoctoral fellow at the University of British Columbia (UBC) whose past research has focused on street-involved youth who use drugs. “For example, Indigenous people were subject to government-sanctioned medical experiments in Indian hospitals and residential schools and continue to experience racism and discrimination in the BC health care system today. These harms are compounded for those who use drugs and this may result in vaccine hesitancy. With this study, we are working with community members to identify strategies that might address these concerns and improve vaccine confidence and access in ways that are safe and person-centered.”
“B.C. is in the middle of dual overdose and COVID-19 public health emergencies. There is a feeling from many of our community members who use drugs and are living in Vancouver’s Downtown Eastside, that they were excluded from pandemic response measures and were only prioritized for fear of infecting others, due to their lack of housing and drug use needs,” says Erica Thomson, Executive Director of the BC/Yukon Association of Drug War Survivors and co-investigator on the study. “There is already a strong distrust of the healthcare system and now there is a lot of misinformation about the pandemic and vaccines, particularly among the most marginalized because they may be unable to access accurate information. As someone who uses drugs, I joined the research team to demystify information about COVID-19 and vaccines. My hope is to produce evidence so that people can make informed choices about their health, including vaccinations.”
In addition to addressing knowledge gaps related to vaccine hesitancy, the blood samples taken at each visit will allow researchers to investigate the effects of vaccines on participants’ immune systems, including the durability of immunity over the study period. Researchers will also analyze the effectiveness of the SARS-CoV-2 vaccines and compare their effectiveness among subgroups of vulnerable populations.
“These coronavirus vaccines have not been specifically tested among people who use drugs,” notes Dr. Hudson Reddon, the other study co-lead and a postdoctoral fellow at UBC. “While we do not expect to find evidence that these vaccines do not work equally well among people who use drugs, documenting their side effects and effectiveness will help reassure people in vulnerable urban populations who are contending with dual public health emergencies of drug overdose and COVID-19.”
“Due to a variety of reasons, we know that access to medical care is a challenge for our vulnerable urban populations,” says Dr. Scott Halperin, Co-Chair of the VSRG. “With this research, the VSRG aims to generate evidence that will guide public health in how to tailor their strategies in a way that will increase vaccine confidence and uptake, and ultimately better care for and protect our vulnerable urban populations.”
“The COVID-19 pandemic has not impacted everyone in the same way. People in Canada living in urban centres who face risk factors such as problematic substance use, homelessness, and poverty have experienced disproportionate negative health consequences,” says Canada’s Chief Public Health Officer, Dr. Theresa Tam. “This study will support the development of more effective vaccination and public health strategies to reach those who are most vulnerable to harms and severe outcomes from COVID-19 in urban areas.”
The study is being conducted with investigators from the BC Centre on Substance Use, BC/Yukon Association of Drug War Survivors, BC Centre for Disease Control and Vancouver Coastal Health.
List of investigators:
- M-J Milloy, PhD. Research scientist, BCCSU; Canopy Growth Professor of Cannabis Science, Department of Medicine, UBC;
- Brittany Barker, PhD. Research scientist, BCCSU; post-doctoral fellow, Department of Medicine, UBC;
- Hudson Reddon, PhD. Research associate, BCCSU; post-doctoral fellow, Department of Medicine, UBC;
- Erica Thomson, Executive Director, BC/Yukon Association of Drug War Survivors
- Sofia Bartlett, PhD. Post-doctoral fellow, BC Centre for Disease Control & Department of Medicine, UBC
- Agatha Jassem, PhD, Clinical Microbiologist, BC Centre for Disease Control Public Health Laboratory; Clinical Assistant Professor, Department of Pathology and Laboratory Medicine, UBC
- Muhammad Morshed, PhD, Clinical Microbiologist, BC Centre for Disease Control Public Health Laboratory; Clinical Professor, Department of Pathology and Laboratory Medicine, UBC
- Inna Sekirov, MD, PhD, Medical Microbiologist, BC Center for Disease Control Public Health Laboratory
- Eugenia Socias, Research scientist, BCCSU; Assistant Professor, Department of Medicine, UBC
About the Vaccine Surveillance Reference Group
The Vaccine Surveillance Reference Group (VSRG) supports the monitoring of the safety and effectiveness of COVID-19 vaccines in Canada. It is a consortium of Canadian organizations – the Public Health Agency of Canada (PHAC), the Canadian Research Immunization Network (CIRN), the National Advisory Committee on Immunization (NACI), and the COVID-19 Immunity Task Force (CITF) – working collaboratively to pool expertise on vaccine surveillance. The VSRG reports to PHAC and is supported by the CITF Secretariat. It is co-chaired by the leader of CIRN and the former chair of NACI. Among its responsibilities, the VSRG, through the CITF Executive Committee, makes recommendations to PHAC on funding research teams that can address important aspects of the immune response, safety, and effectiveness of COVID-19 vaccines with public health relevance and with attention to all priority groups. For more information visit: www.covid19immunitytaskforce.ca/vaccine-surveillance-reference-group-vsrg/
About the COVID-19 Immunity Task Force
The Government of Canada established the COVID-19 Immunity Task Force (CITF) in late April 2020. The Task Force is overseen by a Leadership Group of volunteers that includes leading Canadian scientists and experts from universities and healthcare facilities across Canada who are focused on understanding the nature of immunity arising from the novel coronavirus that causes COVID-19. To that end, the CITF is supporting numerous studies to determine the extent of SARS-CoV-2 infection in Canada (in the general population as well as in specific communities and priority populations), understand the nature of immunity following infection, develop improved antibody testing methods, and help monitor the effectiveness and safety of vaccines as they are rolled out across Canada. The Task Force and its Secretariat work closely with a range of partners, including governments, public health agencies, institutions, health organizations, research teams, other task forces, and engages communities and stakeholders. Most recently, the Task Force has been asked to support vaccine surveillance, effectiveness and safety as part of its overall objective to generate data and ideas that inform interventions aimed at slowing—and ultimately stopping—the spread of SARS-CoV-2 in Canada. For more information visit: www.covid19immunitytaskforce.ca
BC Centre on Substance Use
COVID-19 Immunity Task Force: