Ontario Makes COVID-19 Vaccination Policies Mandatory for High-Risk Settings

In response to evolving data around the transmissibility of the Delta variant and based on the recent experiences of other jurisdictions, the government, in consultation with the Chief Medical Officer of Health, is taking action to increase protection for our most vulnerable, including frail seniors, immunocompromised individuals and young children who are not yet eligible for vaccination. This includes making COVID-19 vaccination policies mandatory in high-risk settings, pausing the province’s exit from the Roadmap to Reopen and providing third doses of the COVID-19 vaccine to vulnerable populations. The government is also expanding eligibility for the Pfizer vaccine to children born in 2009 or earlier.

To protect vulnerable patients and staff in settings where the risk of contracting and transmitting COVID-19 and the Delta variant is higher, the Chief Medical Officer of Health has issued a directive mandating hospitals and home and community care service providers to have a COVID-19 vaccination policy for employees, staff, contractors, students and volunteers, and for ambulance services to have a COVID-19 vaccination policy for paramedics. The vaccination policy must be effective no later than September 7, 2021, and at a minimum will require these individuals to provide proof of one of three things:

• Full vaccination against COVID-19;
• A medical reason for not being vaccinated against COVID-19; or
• Completion of a COVID-19 vaccination educational session.

Individuals who do not provide proof of full vaccination against COVID-19 will be required to undertake regular antigen testing. These settings will be required to track and report on the implementation of their policies to the provincial government. This is similar to the vaccination policy requirements currently in place for long-term care homes.

“While Ontario remains a leading jurisdiction for first and second doses administered and we have the infrastructure in place to manage outbreaks, the Delta variant is highly transmissible and the experience of other jurisdictions shows we must remain vigilant as we head into the fall,” said Christine Elliott, Deputy Premier and Minister of Health. “By taking additional measures in high-risk settings we will further protect our most vulnerable, safeguard hospital capacity, ensure a safe return to school and keep Ontario running.”

To support the return to school plan, the Ministry of Education intends to introduce a vaccination disclosure policy for all publicly-funded school board employees, and staff in private schools as well as for all staff in licensed child care settings for the 2021-22 school year, with rapid antigen testing requirements for staff who are not immunized against COVID-19. The Ontario government is also working with public health units and publicly funded school boards to run voluntary vaccination clinics in or nearby schools to make vaccines even more convenient and accessible for eligible students, their families, educators and school staff returning to school this fall.

Vaccination policies will also be implemented in other higher-risk settings such as:

• Post-secondary institutions;
• Licensed retirement homes;
• Women’s shelters; and
• Congregate group homes and day programs for adults with developmental disabilities, children’s treatment centres and other services for children with special needs, and licensed children’s residential settings.

“With the support of Ontario’s Chief Medical Officer of Health, our government is taking action to make schools as safe as possible,” said Stephen Lecce, Minister of Education. “Our plan will protect our schools, ensure rapid speed with contact tracing, all with the intention of keeping them open for the benefit of Ontario students.”

As an additional measure to continue protecting Ontario’s most vulnerable, based on the recommendation of the Chief Medical Officer of Health and other health experts, the province will begin offering third doses of the COVID-19 vaccine to those at highest-risk, providing them with an extra layer of protection against the Delta variant. This includes:

• Transplant recipients (including solid organ transplant and hematopoietic stem cell transplants);
• Patients with hematological cancers (examples include lymphoma, myeloma, leukemia) on active treatment (chemotherapy, targeted therapies, immunotherapy);
• Recipients of an anti-CD20 agent (e.g. rituximab, ocrelizumab, ofatumumab); and
• Residents of high-risk congregate settings including long-term care homes, higher-risk licensed retirement homes and First Nations elder care lodges.

Locations and timing for third doses will vary by public health unit and high-risk population based on local planning and considerations, with some beginning as early as this week where opportunities exist.

In addition, to further support a safer return to school by ensuring more children and youth can benefit from the protection offered by the vaccine, the province will extend eligibility to the Pfizer vaccine to children born in 2009. Ontario has closely monitored data from Alberta and British Columbia in making this decision, and these provinces have offered the Pfizer vaccine to youth born in 2009 for several months with no risks identified. Starting on Wednesday, August 18, 2021, all children turning 12 years old before the end of 2021 will be eligible to receive their first dose of COVID-19 vaccine and can book their appointment through the provincial booking system, through their public health unit, or pharmacies, or can walk-in to vaccination clinics across the province.

“Keeping a low rate of infection in our communities and protecting our most vulnerable is how we can keep our schools, our businesses and our social settings as safe as possible while minimizing disruption,” said Dr. Kieran Moore, Chief Medical Officer of Health. “To provide the best protection to each individual while learning to live with the virus, we are taking action by requiring individuals who work in higher-risk settings to be fully vaccinated, by providing a third dose of a COVID-19 vaccine to certain groups who have a decreased immune response and by expanding the eligibility to the children born in 2009 or earlier.”

While the province has reached the exciting milestone of more than 81 per cent of Ontarians aged 12 and over having received a first dose, and is expected to reach its target of 75 per cent vaccinated with a second dose later this month, out of an abundance of caution the government, in consultation with the Chief Medical Officer of Health, is pausing the exit from the Roadmap to Reopen. The Chief Medical Officer of Health and other health experts will continue to monitor the data to determine when it is safe to exit the Roadmap and lift the majority of public health and workplace safety measures currently in place.