On Friday afternoon, Ontario‘s Ministry of Long-Term Care released first and second dose vaccination rates for all of Ontario’s 626 long-term care homes. The numbers are quite interesting. Figure 1 ranks the 34 public health units by the average of the second dose vaccination rates for their long-term care homes. At the top at 91 percent is Ottawa Public Health followed closely by York Region and Toronto Public Health at 90 percent. At the bottom are Chatham-Kent, Haldimand-Norfolk, and Timiskaming at 81, 80 and 79 percent respectively.
While this does not seem like a substantial range, the range
is more marked when the individual homes are ranked from highest to lowest as
illustrated in Figure 2. Of Ontario’s 626 LTC homes, 5 have 100 percent second
does vaccination rates - North Shore Health Network - Eldcap Unit (Algoma PHU),
Dundas Manor Nursing Home (Eastern Ontario PHU), The Fordwich Village Nursing
Home (Huron-Perth PHU), William A. 'Bill' George Extended Care Facility
(Northwestern PHU) and Morriston Park Nursing Home (Wellington-Dufferin
PHU). Of Ontario’s 626 LTC homes, only
13 percent of them have second dose vaccination rates at 95 percent or
greater. About 17 percent of these homes
have less than 80 percent of their staff vaccinated with some below 60 percent. Indeed, the drop off after 70 percent is quite steep.
For those that are interested, the northern Ontario public health units are all over the range of vaccination with Northwestern Health Unit at the top and Temiskaming at the bottom. Thunder Bay District Health Unit, which is at the top of performance for vaccination rates in the general population is near the bottom third when it comes to second does for its LTC home staff. The rates range from 97 percent for Nipigon District Memorial Hospital to 77 percent for Hogarth Riverview. Southbridge Roseview – the site of Thunder Bay’s major LTC pandemic outbreak is 9th out the ten district LTC homes coming in surprisingly at only 78 percent with a second doses. There is substantial room for improvement when it comes to some of the LTC homes in Thunder Bay District given that only one of the ten is over 95 percent for second vaccination status rates.
The more interest question is why such variation exists across the province. There seems to be no obvious regional pattern to the vaccination rates as the dispersion simply in northern Ontario alone would attest. Indeed, when the second does vaccination rates are ranked by averages for Ontario economic region, they range from highs of 88 percent for Ottawa (510) and the GTA (530), followed by 87 percent for Stratford-Bruce (580) and the Northwest (595) with the Northeast (590), London (560) and Windsor-Sarnia (570) at 85, 84 and 82 percent. A regression of vaccination rates by LTC on a constant and economic region dummy variable (eleven but with the GTA omitted as the reference variable) finds a very low r-squared (5 percent) but four regions have statistically significantly lower vaccination rates relative to the GTA. They are Hamilton-Niagara at 4 percent lower second dose rates relative to the GTA homes, London at 5 percent lower, Windsor Sarnia at 7 percent lower and the Northeast at 4 percent lower.
Even for those that were statistically significant, they are quantitatively not large differences, So, what explains 95 percent of the variation in vaccination rates across LTC care homes? Good question. One suspects a lot has to do with home specific factors including local management, staff culture and unique local environmental conditions. There is room for improvement and the requirement for mandatory COVID-19 vaccination for Ontario long-term care workers by November 15th is probably the best way to close these gaps.