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Nanci Hiebert, who is against vaccination, sits with her children at Lions Park in Aylmer, Ont. Aylmer, the town of about 7,500 southeast of London, Ont., has been the site of multiple anti-restrictions, anti-mask and anti-vaccine protests during the COVID-19 pandemic.Nick Iwanyshyn/The Globe and Mail

Canada’s high overall COVID-19 vaccination rates are concealing pockets where less than half the population has received a first dose, most of them in small towns and rural, remote parts of the country, according to a Globe and Mail analysis of provincial vaccination data.

The low rates in places such as High Level, Alta., and the Rural Municipality of Stanley in southern Manitoba – both places where just 16 per cent of the total population have gotten first shots – are leaving residents vulnerable to the fast-spreading Delta variant as provincial governments lift restrictions.

The holdouts are also making it difficult for the country to fully vaccinate 80 per cent of people 12 and over, a threshold Canada’s Chief Public Health Officer, Theresa Tam, said on Friday would be necessary to avoid overwhelming hospitals in the case of a Delta-fuelled fourth wave.

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As of Thursday, 66 per cent of eligible Canadians had received both jabs, or 58 per cent of the total population, which includes children who don’t yet qualify for a shot. And 81 per cent of eligible Canadians had received one dose, or 71 per cent of the total population. Canada has one of the highest vaccination rates in the world.

Jia Hu, a public-health physician in Calgary, said there is more reason to worry about communities where the majority isn’t inoculated against the coronavirus than there is about the odd unvaccinated person in a crowd of vaccinated people.

He likens it to measles: If a case turns up in an unvaccinated child in a highly vaccinated area, the super-contagious virus tends not to spread. If measles is introduced into an insular community that eschews vaccines, it spreads like wildfire.

“That’s why I’m a hell of a lot more worried now about rural areas than finishing the job in northeast Calgary or Brampton,” Dr. Hu said.

Canadians who have so far declined to get a shot tend to skew younger, but otherwise they don’t conform to a tidy profile.

Their misgivings range from a deep suspicion of government, to fears about short- and long-term side effects of the shot, to a belief that COVID-19 itself won’t hurt them. Some are swimming in a sea of misinformation on social media. Others are open to immunization, but can’t get time off work. Still others don’t have the technical savvy to book an online appointment or a car to drive to a vaccination centre.

A certain percentage won’t get inoculated against COVID-19 unless they have to, and most provinces have been reluctant to implement vaccine mandates. When Humber River Regional Hospital in Toronto, in partnership with online magazine The Local, surveyed 389 first-dose recipients at a mass vaccination centre in mid-July about what changed their minds, 35 per cent cited a workplace requirement. It was the top answer.

“That was an interesting finding that we hadn’t expected,” Sudha Kutty, Humber River’s vice-president of strategy and external relations, told The Globe.

Vaccination rates in select provinces

as a share of total population

Percentage of population who received

at least one dose of a COVID-19 vaccine

As of July 27*

50%

60%

70%

*Ontario’s data are as of July 18.

ALBERTA

Alberta Health Services

Local Geographic Areas

High Level

16%

Fort

McMurray

Peace River

Edmonton

Calgary

SASKATCHEWAN

Regional Health

Authorities Districts

Saskatoon

Regina

MANITOBA

Regional Health

Authorities Districts

Churchill

Thompson

Stanley

16.1%

Winnipeg

Brandon

ONTARIO

Areas based on the first three characters of a postal code

Timmins

Thunder Bay

North Bay

Ottawa

Toronto

Aylmer

44.6%

CHEN WANG AND MURAT YÜKSELIR, THE GLOBE

AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

Vaccination rates in select provinces

as a share of total population

Percentage of population who received

at least one dose of a COVID-19 vaccine

As of July 27*

50%

60%

70%

*Ontario’s data are as of July 18.

ALBERTA

Alberta Health Services

Local Geographic Areas

High Level

16%

Fort

McMurray

Peace River

Edmonton

Calgary

SASKATCHEWAN

Regional Health

Authorities Districts

Saskatoon

Regina

MANITOBA

Regional Health

Authorities Districts

Churchill

Thompson

Stanley

16.1%

Winnipeg

Brandon

ONTARIO

Areas based on the first three characters of a postal code

Timmins

Thunder Bay

North Bay

Ottawa

Aylmer

44.6%

Toronto

CHEN WANG AND MURAT YÜKSELIR, THE GLOBE

AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

Vaccination rates in select provinces as a share of total population

Percentage of population who received at least one dose of a COVID-19 vaccine

As of July 27*

50%

60%

70%

*Ontario’s data are as of July 18.

ALBERTA

Alberta Health Services

Local Geographic Areas

High Level

16%

Fort

McMurray

Peace River

Edmonton

Calgary

SASKATCHEWAN

Regional Health

Authorities Districts

Saskatoon

Regina

MANITOBA

Regional Health

Authorities Districts

Churchill

Thompson

Stanley

16.1%

Winnipeg

Brandon

ONTARIO

Areas based on the first three characters of a postal code

Timmins

Thunder Bay

North Bay

Ottawa

Toronto

CHEN WANG AND MURAT YÜKSELIR,

THE GLOBE AND MAIL, SOURCE:

PROVINCIAL GOVERNMENTS

Aylmer

44.6%

No matter their reasons, stragglers are inherently harder to vaccinate than eager beavers, according to Phillip Anthony, manager of the East Toronto mobile vaccination strategy at Michael Garron Hospital. That explains why the number of shots Canada injects daily has fallen off a cliff, from a high of 552,900 (on a seven-day rolling average) on July 8 to an average of 288,512 a day last week.

“Now you have to be very mobile,” Mr. Anthony said. “You have to go get people.”

True as that may be, not everyone is gettable.

Open this photo in gallery:

Together, Aylmer and its neighbouring farmland they make up the least-vaccinated postal codes in Ontario, those beginning with N5H.Nick Iwanyshyn/The Globe and Mail

Nanci Hiebert, for example, says that when it comes to COVID-19 vaccines, she will “strictly be a ‘No’ – forever.”

Sitting on a towel at a splashpad in Aylmer, Ont., a town of 7,500 south of London, the 30-year-old mother of three described her opposition as flowing from a mix of personal experience, independent research and a deep-seated desire for freedom.

“I feel like it’s our God-given right to say ‘No’ to something,” she said. “I feel like naturally our bodies are capable of fighting a lot off.”

Her friend Kristi-ann Wall, another 30-year-old mother born and raised in Aylmer, was less certain, but no more vaccinated. “It’s not like, ‘No, I’m never going to get the COVID vaccine,’ ” she said. “It’s that I don’t feel comfortable being pretty much a test dummy to see where it goes.”

Although Ms. Hiebert’s firmer stance has caused a rift with some of her relatives, it is not an uncommon one among younger adults in Aylmer and the rural township that surrounds it.

Aylmer is the base of an anti-lockdown preacher, Henry Hildebrandt, who said in a speech at the end of June that he and his Church of God, which serves Mennonites, have racked up $273,500 in fines for flouting Ontario’s pandemic laws. A mailing address for Vaccine Choice Canada, a group that has been fighting compulsory vaccination since the 1980s, is located inside Aylmer’s old Imperial Tobacco plant. One of the group’s founders, who lives nearby, spoke at a “freedom” rally last November that drew 2,000 people to Aylmer.

Proportion of total population not vaccinated,

by age group and region

As of July 24, 2021

0–11

12–29

30–49

50–69

70+

0

10

20

30

40

50%

N.L.

PEI

N.S.

N.B.

Que.

Ont.

Man.

Sask.

Alta.

B.C.

Yukon

NWT

Nunavut

Note: Children under the age of 12 are not yet eligible

for COVID-19 vaccines in Canada.

CHEN WANG AND MURAT YÜKSELIR /

THE GLOBE AND MAIL, SOURCE:

GOVERNMENT OF CANADA

Proportion of total population not vaccinated,

by age group and region

As of July 24, 2021

0–11

12–29

30–49

50–69

70+

0

10

20

30

40

50%

N.L.

PEI

N.S.

N.B.

Que.

Ont.

Man.

Sask.

Alta.

B.C.

Yukon

NWT

Nunavut

Note: Children under the age of 12 are not yet eligible for

COVID-19 vaccines in Canada.

CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL,

SOURCE: GOVERNMENT OF CANADA

Proportion of total population not vaccinated, by age group and region

As of July 24, 2021

0–11

12–29

30–49

50–69

70+

0

10

20

30

40

50%

N.L.

PEI

N.S.

N.B.

Que.

Ont.

Man.

Sask.

Alta.

B.C.

Yukon

NWT

Nunavut

Note: Children under the age of 12 are not yet eligible for COVID-19 vaccines in Canada.

CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE:

GOVERNMENT OF CANADA

All this has contributed to a dubious distinction for Aylmer and its neighbouring farmland: Together, they make up the least-vaccinated postal codes in Ontario, those beginning with N5H. Only 44.57 per cent of people in N5H had received a first dose as of July 18, according to data from the Institute for Clinical Evaluative Sciences, a non-profit health research group.

“I don’t think that we’re ever going to get through COVID because people are not being vaccinated,” said Lise Jones, a 68-year-old retiree who spent 34 years working in nursing homes. “COVID is never going away.”

Ms. Jones was among the seniors sipping beer out of plastic Bud Light cups at the Aylmer Legion this week. Like most seniors in N5H, she’s fully vaccinated against COVID-19. She regards her vaccination receipt as a badge of honour. She keeps a laminated copy in her car’s glove compartment.

Open this photo in gallery:

All of Aylmer’s age groups younger than 30 have first-dose rates below 40 per cent.Nick Iwanyshyn/The Globe and Mail

There is a stark generational divide in the vaccination rates in N5H. About 80 per cent of those over 75 have received a first dose, only a few percentage points short of the provincial average for that age group.

All of Aylmer’s age groups younger than 30 have first-dose rates below 40 per cent; those aged 12 to 15 have a first-dose coverage rate of 22.81 per cent, by far the lowest in Ontario.

Joyce Lock, the Medical Officer of Health for Southwestern Ontario, said that despite a slow start, the Aylmer area’s vaccination rates are increasing. The public-health unit is reaching out to vaccine-hesitant groups through family doctors, WhatsApp channels and pamphlets in Low German and Spanish, the languages spoken by most of the region’s Mennonites and migrant farm workers respectively.

“Health beliefs in themselves are complex,” Dr. Lock said. They are shaped by history, culture, religion and past experience with health care systems, she added. Getting at the roots of vaccine hesitancy takes patience and time.

Stanley Vollant, an Innu physician who has worked on vaccine outreach efforts in northern Quebec, echoed that. The Nunavik region of Quebec, where 14 fly-in Inuit communities hug the coastline from Hudson Bay to Ungava Bay, is in last place for vaccination in the province.

Only 43.8 per cent of the total population has received a first dose, 30 percentage points lower than Quebec’s provincial average. That rises to 61-per-cent first-dose coverage among people aged 12 and older, still 23 percentage points lower than the provincial average.

Dr. Vollant said the Inuit people in the coastal regions have a deep distrust of southern medicine, in part because of a long history of mistreatment and the extraordinary isolation they experience when they travel south for care. “Many people believe vaccination is the way white people want to control us,” he said. “It takes time to counter that misinformation.”

Nunavik has a big generation gap when it comes to vaccination. Provincial statistics say 100 per cent of people over 60 have been vaccinated, compared to 29 per cent of people aged 12 to 17 and 50.6 per cent of those 18 to 29.

In northwestern Alberta, vaccination rates are also considerably lower than the rest of the province, which already has among the lowest vaccination rates in the country.

Just 22 per cent of eligible people in the High Level area have received at least one dose of the vaccine, or just 15.8 per cent of the overall population. That low uptake even extends to seniors, with only 30 per cent of people over 75 receiving at least one dose.

The High Level health area includes not just High Level, a town of about 3,000 people, but also a number of smaller communities, a number of First Nations reserves and a huge swath of rural land that altogether have a population of roughly 24,000 people.

When members of the congregation at the High Level Christian Fellowship ask Pastor Norman Bueckert about the vaccines, he says he’s careful not to offer any advice. He estimates that just under half of the church is vaccinated against the virus and he’s careful not to tell people what they should do.

He hasn’t received a COVID-19 shot. “I’m not an anti-vaxxer, because I have all the other vaccines,” he said in an interview. “I’m personally not ready yet and don’t trust the vaccines.”

Mr. Bueckert said people in his church believe COVID-19 is real. Some have gotten sick and there are people in the community who have ended up in intensive care

But he said there has been so much conflicting information floating around about vaccines that people just don’t trust public-health officials insisting the vaccine is safe. The provincial government’s decision to fence off a handful of churches and jail pastors who refused to abide by pandemic capacity limits has only bred more suspicion, he added.

In British Columbia, health officials have pointed to lower-than-average vaccine rates in some areas to explain recent increases in infections and the province is attempting to boost those numbers with mobile vaccine clinics and other programs. But still, even the lowest vaccinated places in B.C. are above 50 per cent of the eligible population for at least one dose and slowly increasing.

The largest spikes in cases are happening in the Central Okanagan region, where mask mandates have returned, but those areas have relatively high vaccine rates of 75 per cent among those 12 and older. (B.C. doesn’t publish coverage estimates for the total population.)

The lowest vaccination rates in B.C. are in the northeastern part of the province, just across the provincial boundary from the High Level area of Alberta.

In Winkler, Man., someone sent Mayor Martin Harder a text message recently warning him that he would be dead in two years. The idea that the vaccines are a ticking time bomb that will kill recipients in the coming months or years is a common conspiracy theory among the anti-vaccine fringe.

Mr. Harder has been public about the fact that he has been vaccinated, and he said it’s not unusual for him to get 10 abusive text messages, online messages or calls a day attacking him for his support for vaccines or other public-health measures. He blames misinformation, easily accessible online, for turning the COVID-19 vaccine into a divisive issue for his town and even for his own family.

“The further we go, the more entrenched they become,” he said. “We have a very hard-working community and a very caring community and the fact that this has been so divisive is very, very hard to swallow.”

About 30 per cent of total population in Winkler has received at least one dose of a COVID-19 vaccine – well below the 69-per-cent average across the province. The rate for the Rural Municipality of Stanley, which surrounds Winkler and extends south to the U.S. border, is even lower at 16 per cent.

Open this photo in gallery:

Melissa Nadeau prepares before administering a dose of the Pfizer vaccine at a COVID-19 immunization clinic, hosted by East Toronto Health Partners, at Shoppers World Danforth in Toronto, on July 28, 2021.Tijana Martin/The Globe and Mail

Overall vaccination figures from Canada’s urban centres, which are generally high, can also disguise pockets with lower vaccination rates.

In Toronto, the municipal government, hospitals and a slew of community ambassadors led by hyperlocal social-service agencies have made a Herculean effort to vaccinate people in such neighbourhoods, which are often poor and racialized.

The lessons they’ve learned – including making vaccination as convenient as possible and leaving outreach to trusted locals who share the language and faith of the target audience – could apply in rural parts of Canada as well.

A prime example is the immunization blitz taking place during the August long weekend in the high-rise neighbourhood of Taylor-Massey, a landing pad for new immigrants located on the boundary of Scarborough and the old city of Toronto. Known to locals as Crescent Town, the area had a first-dose vaccination rate of 53.4 per of the total population, among the lowest rates in a city where just over 71 per cent of residents have received a first shot.

Open this photo in gallery:

Zuner Unia stands outside the convenience store where he works on July 28, 2021. Mr. Unia was overdue for his second shot, but unable to leave his post, so a nurse from the nearby immunization clinic at Shoppers World Danforth came and injected him inside the store.Tijana Martin/The Globe and Mail

During the August long weekend, a “home stretch” vaccine push in Taylor-Massey featured microtargeted pop-up clinics in nine locations, including two grocery stores, a local elementary school and the Shoppers World Danforth plaza.

The Shoppers World location, overseen by Michael Garron Hospital, was already up and running last week inside a former GNC vitamin store sandwiched between a laundromat and an LA Fitness.

Every day, Karen King, a volunteer screener at the clinic, roamed from store to store, encouraging cashiers at the Dollarama and the Subway sandwich shop to pop in for a jab.

When she discovered that Mini Variety worker Zuner Unia, 43, was overdue for his second shot but unable to leave his post, she arranged for a nurse to inject him inside the convenience store on Tuesday. “It was a no-brainer,” Ms. King said. “We were just trying to help him out because he wanted it.”

Alice Gillis, 65, stumbled on the clinic and walked in for a second shot of Pfizer after doing her banking at the plaza. She received her first dose of Pfizer three months earlier, but turned down a second-dose appointment offering Moderna because she didn’t want to mix vaccine brands. “I put it off and put it off,” Ms. Gillis said from her red wheelchair scooter. “But if I don’t get it, I can’t go anywhere. I want to go home to Nova Scotia.”

Convenience is an often-overlooked way to combat vaccine complacency, said Laura Desveaux, a behavioural scientist at Mississauga’s Trillium Health Partners hospital network. “It’s actually not about convincing people,” she said. “It’s about making it as easy as possible to get vaccinated.”

The vast majority of people who trickled into the Shoppers World site on Wednesday were there for second doses, which provide crucial protection against the Delta variant.

Open this photo in gallery:

Camille Rojas with her mother, Martha, who just received her first dose of the Pfizer vaccine.Tijana Martin/The Globe and Mail

Martha Rojas was a rare first-dose candidate. The 61-year-old, who had been eligible since the spring, was terrified at the thought of having debilitating side effects or a dangerous allergic reaction. Her daughter, Camille Rojas, 27, rubbed her back and urged her mother to say ‘Yes’ as they spoke to a worker outside the clinic.

The elder Ms. Rojas wasn’t ready. “Do you want to take a walk, Mommy?” said Camille, who was already double-vaccinated.

Twenty minutes later, the pair returned and asked to speak with the physician on site, Nicole Kim.

“I’m glad you’re here,” Dr. Kim said. “That’s a big step.” Dr. Kim answered her questions about side effects and allergies and told the Rojas’s about the severely ill COVID-19 patients she had cared for in hospital. “Anything is better than getting COVID, right?” she said.

Continuing to rub her mother’s shoulder, Camille added, “I think you should get it. You’ll be fine, Mommy. I’m here. The doctors are here. It’s going to be okay.”

At last, Ms. Rojas agreed. Afterward, she said her daughter had been a role model, helping her to overcome her fear of getting vaccinated. “She’s been so brave.”

With reports from Chen Wang, Les Perreaux and Marieke Walsh

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