Centre for Vaccine Preventable Diseases

Why it's important to get your 2024 flu shot – and how to get it

Christopher.Sorensen — Thu, 07 Nov 2024 14:23:42 +0000

Why it's important to get your 2024 flu shot – and how to get it

Christopher.Sorensen Thu, 11/07/2024 - 09:23

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The flu vaccine is especially important for adults aged 65 years or older, pregnant people and individuals who have medical conditions that put them at higher risk of complications from influenza infection, ��TV experts say (photo by Canva)

Ishani Nath

Topic

Our Community

Centre for Vaccine Preventable Diseases

Dalla Lana School of Public Health

Leslie Dan Faculty of Pharmacy

Subheadline

��TV experts on the flu vaccine, where it's available and when's the best time to get it

None of Jeff Kwong’s patients has asked him about the influenza vaccine yet this fall – but the family physician wants to make sure that getting vaccinated is on people’s radar.

That’s because influenza causes an estimated 12,200 hospitalizations and 3,500 deaths in Canada each year.

Moreover, public health officials are doubly concerned this season because of a strain of influenza circulating in wild birds and some agricultural animals. While the risk of avian influenza to the general population remains low, A H5N1 has nevertheless infected some humans who have close contact with sick animals.

“While current influenza vaccines don’t protect against avian influenza, they may reduce the risk of infection with human influenza viruses and therefore the possibility of both human and avian influenza viruses infecting someone at the same time,” says Kwong, an associate scientist at Sunnybrook Research Institute and professor at the University of Toronto’s Dalla Lana School of Public Health.

“These co-infections could create a new ‘version’ of influenza that might spread easily among humans and cause very severe disease.”

What is influenza?

Influenza is a respiratory disease that typically causes fever, cough and body aches. While many people recover from influenza within a week to 10 days, for some, an infection can cause severe illness.

“It’s a good idea for everyone aged six months or older to get an influenza vaccine, but it’s especially important for adults aged 65 years or older, pregnant people and individuals who have medical conditions that put them at higher risk of complications from influenza infection,” says Kwong, who is the associate director of ��TV’s Centre for Vaccine Preventable Diseases (CVPD), adding that medical conditions of concern include heart diseases, diabetes and even obesity.

The most common reason Canadians give for not getting a flu shot is because they don’t think it’s necessary – a sentiment Natalie Crown, associate professor, teaching stream, in the Leslie Dan Faculty of Pharmacy, has heard before.

“Sometimes people will tell me they don’t get vaccinated because they think they don’t need it – for example, they’ll say they are healthy and rarely get sick themselves,” says Crown, who is also a CVPD member. “The reality is getting the flu vaccine is one of most effective ways of protecting ourselves from the flu and its complications, and we are doing our part to protect the more vulnerable people around us who are at higher risk of developing complications from the flu.”

��TV’s Discovery Pharmacy's new location in the atrium of the Leslie Dan Faculty of Pharmacy building is among the places ��TV community members can get their shot across the three campuses (photo by Dana Thompson)

When to get the influenza vaccine

The flu season doesn’t have a precise start and end date. According to the National Advisory Committee on Immunizations (NACI), influenza season typically starts in December but can start as early as October or as late as February.

Influenza vaccines were first made available for high-risk individuals and then for the public, beginning in late October and early November.

Since antibodies generated by influenza vaccines gradually decrease over time, Kwong takes a strategic approach to timing his influenza vaccine – but notes that may not be the best approach for everyone.

“I tend to wait until around mid-November to get my influenza vaccine, so I will be protected in December when influenza activity often starts, and I can be fairly confident that the vaccine will still offer some protection up to May,” says Kwong. “However, for those at high risk, getting the influenza vaccine in late October is not a bad idea because occasionally influenza activity can start earlier than December.”

Where to get the influenza vaccine

Influenza vaccines are typically available at local community pharmacies, through primary care providers or at dedicated community clinics offered by public health units across the country.

Members of the ��TV community can also visit UTogether for more information on where to get influenza, as well as COVID-19, vaccines across the university’s three campuses.

Learn more about vaccines at UTogether

Do you have questions about children's vaccines? A new phone line has the answers

Christopher.Sorensen — Mon, 05 Feb 2024 14:18:11 +0000

Do you have questions about children's vaccines? A new phone line has the answers

Christopher.Sorensen Mon, 02/05/2024 - 09:18

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(photo by SDI Productions/Getty Images)

Ishani Nath

Topic

Our Community

Centre for Vaccine Preventable Diseases

Temerty Faculty of Medicine

Pediatrics

Dalla Lana School of Public Health

Hospital for Sick Children

Vaccines

Subheadline

The SickKids Vaccine Consult Service (VCS) aims to answer caregivers’ questions about all pediatric vaccinations

Canada is in the midst of respiratory illness season, yet the number of individuals getting the updated COVID-19 and flu vaccines remains low. The number of children receiving routine vaccinations has also dropped since the pandemic.

For the past few years, questions about vaccines dominated headlines and internet searches. Is this vaccine safe? Will it work? Who needs to get vaccinated?

Shaun Morris, a clinician scientist at The Hospital for Sick Children (SickKids) and an associate professor of pediatrics in the University of Toronto’s Temerty Faculty of Medicine, and Pierre-Philippe Piché-Renaud, who is pursuing a clinical and research fellowship at SickKids and graduate studies at ��TV’s Dalla Lana School of Public Health, routinely field these types of questions from parents and caregivers.

Both are members of the Centre for Vaccine Preventable Diseases (CVPD) at the Dalla Lana School of Public Health.

Shaun Morris and Pierre-Philippe Piché-Renaud (supplied images)

To help boost confidence in vaccination through easy access to reliable, evidence-based information, Morris and Piché-Renaud have launched a new pilot project running until the end of March.

The SickKids Vaccine Consult Service (VCS), part of a larger project funded by the Public Health Agency of Canada (PHAC), is offering a phone service staffed by nurses to answer caregivers’ questions about all pediatric vaccinations. The intent is to make vaccine information more accessible and, ultimately, help parents make the best, most informed decision for their child, Piché-Renaud says.

Building on previous success

The pilot project builds off the success of a COVID-19-specific VCS phone line that ran from October 2021 to March 2023. The COVID-19 VCS received more than 2,700 calls from caregivers asking about COVID-19 vaccines for children. The phone line was staffed by health-care professionals who provided information tailored to each individual circumstance, including living situation or medical history – answers that could not typically be found on the internet.

The nurses fielding calls were trained to create an open and safe environment, explains Julia Orkin, the SickKids COVID-19 VCS medical lead and an associate professor in ��TV’s department of paediatrics in the Temerty Faculty of Medicine.

“It wasn’t, you know, ‘you must do this,’ it was really a shared supportive conversation,” she says. After calling in, 83 per cent of caregivers surveyed said their questions and concerns were addressed, and more than 60 per cent said they would proceed with vaccination.

The new phone service expands beyond the COVID-19 VCS by fielding questions not only about COVID-19 vaccines but all childhood immunizations. The service is open to anyone in Ontario, with a specific focus on patients with existing medical concerns and equity-deserving populations throughout the Greater Toronto Area.

Insurance coverage and internet access aren’t required to book a VCS consultation and translation services are available.

Piché-Renaud says that the conversations are about “taking it one step at a time, meeting parents where they are, and addressing their concerns.”

Research has shown that COVID-19 vaccine uptake was lower among certain groups – for instance, certain racialized and lower income populations. To reach these communities, Morris and Piché-Renaud are working with organizations like Black Creek Community Health Centre, Taibu Community Health Centre and the Paediatric Alliance of Ontario.

“The messaging is going to come through the people that [caregivers in these communities] already know and work with,” says Piché-Renaud.

Meeting an urgent need

Providing information on the importance of childhood vaccinations is particularly urgent.

“Immunization coverage for a variety of diseases is lagging behind, leaving kids susceptible to infections and outbreaks that are completely preventable. It’s essential to provide parents with clear, individually tailored messaging from a trusted source to enable them to make informed decisions for their children,” says Shelly Bolotin, director of the Centre for Vaccine Preventable Diseases and an associate professor at the Dalla Lana School of Public Health.

During the pandemic, routine childhood immunizations for preventable diseases like meningitis, measles and polio were set back to levels not seen since 2008. The proportion of Canadians who view vaccines as important for children also dropped from 91 to 82 per cent, according to UNICEF’s 2023 State of the World’s Children report. Canada has since seen cases of pertussis (whooping cough) and other vaccine preventable diseases.

“We’re still seeing kids who show up at SickKids and other paediatric hospitals with vaccine preventable illnesses, like certain types of meningitis,” says Piché-Renaud.

The physicians hope that through the VCS phone line and a related project working with SickKids pediatricians and patients, they will be able to better understand why some children are not getting vaccinated. With this information, they can then develop resources such as educational websites, or improve access to vaccination sites.

Making trusted vaccine information more accessible

Morris and Piché-Renaud encourage Ontario parents wondering about childhood vaccines to book a consultation appointment at SickKids VCS.

For Morris, empowering patients and families to make the best health decisions for themselves is one of the most important aspects of his job. Services like the VCS phone line help achieve that goal by “enabling people to connect to trusted sources of information and navigate through the quagmire of not good information, which is probably more common in the realm of immunization than in most areas.”

BlueDot is using AI to get ahead of the next pandemic

Christopher.Sorensen — Tue, 15 Aug 2023 18:11:56 +0000

BlueDot is using AI to get ahead of the next pandemic

Christopher.Sorensen Tue, 08/15/2023 - 14:11

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Kamran Khan, founder and CEO of BlueDot, is a scientist at Unity Health Toronto and a professor in the department of medicine in the University of Toronto’s Temerty Faculty of Medicine and the Dalla Lana School of Public Health (photo by JORGE UZON/AFP via Getty Images)

Ishani Nath

Centre for Vaccine Preventable Diseases

Temerty Faculty of Medicine

Artificial Intelligence

Dalla Lana School of Public Health

Global

Subheadline

Startup's data-driven forecasts extend as far as 10 years into the future

The Toronto offices for Kamran Khan’s BlueDot, which uses artificial intelligence to flag potential infectious disease outbreaks around the world, are located at the edge of Lake Ontario – appropriate for a company that, similar to a lighthouse, signals when there’s danger ahead.

“We use the internet as a medium for surveillance to detect early signals of outbreaks anywhere in the world before they’re officially reported by public health agencies,” explains Khan, a scientist at Unity Health Toronto and a professor in the department of medicine in the University of Toronto’s Temerty Faculty of Medicine and the Dalla Lana School of Public Health.

He breaks BlueDot’s work down into three key components: identifying threats early, rapidly assessing their risks and likely trajectories, and helping organizations to turn these insights into swift action.

“The whole purpose here is to compress time, because ultimately, time is the enemy when you’re dealing with an outbreak,” says Khan, a member of ��TV’s Centre for Vaccine Preventable Diseases.

BlueDot’s intelligence platform combines a computer’s ability to understand human language, known as natural language understanding (NLU), and machine learning, a form of AI that imitates humans’ ability to learn and gradually become more accurate. The platform sorts through massive volumes of online information – ranging from news reports, social media sites, government websites, and more – from around the globe, in more than 130 languages, every 15 minutes of every day.

“We’ve basically trained a machine to pick up early clues around the world and around the clock,” explains Khan.

The clues get cross-referenced with historic data to determine what is outside of the norm, and then triaged into high, medium and low risk threats. Global data – including commercial air travel data, climate conditions, mosquito observances and population demographics – are also added to the mix to determine whether a threat could spread.

This data analytic sequence is how BlueDot accurately predicted a Zika virus outbreak in Florida six months before it occurred, and sounded the alarm about COVID-19 nearly a week before it was officially reported by public health organizations like the CDC and WHO.

As COVID-19 restrictions have eased around the world, public health experts are now shifting focus to the next set of emerging global threats – what could spark the next pandemic, and will we be ready? Writer Ishani Nath sat down with Khan to learn how BlueDot uses artificial and human intelligence to help answer these questions and more.

How does BlueDot work – is it all done by machines or do humans play a role?

Our belief is that machines should play to their strengths, and humans should play to their own. There’s a whole process of using machine learning for gathering, organizing and ingesting unstructured data that’s multilingual and creating structure out of it 24 hours a day, 365 days a year. And then there’s a series of analytics and human intelligence that helps us differentiate what threats demand our immediate attention and anticipate where, when, and how they will impact the health of populations around the globe. Recent advances in generative AI are also creating opportunities for machines to produce “intelligence briefs” – but given the vital importance of these outputs, there will always be a need for human oversight.

For example, we first have to determine whether a threat appearing somewhere in the world is unusual. It’s important to remember that machine learning is only as good as the historic data that we train it on. But when we’re dealing with newly emerging diseases, we are often dealing with threats where there is little or no historic data. For instance, if we identify an outbreak of an influenza-like illness occurring in the Northern Hemisphere in July, we know that is unusual compared with observed historic trends. But for some newly emerging threats like COVID-19 – where we don’t have historic data – we have to tap into our in-house expertise in public health sciences, clinical medicine, pediatric infectious disease and veterinary sciences, while also collaborating with experts from academia and governments around the world to rapidly characterize and assess those novel threats.

Notable Event Alert screenshot from BlueDot (supplied image)

When it comes to vaccines, how can this information improve which threats get addressed?

Well, we’re not just considering what constitutes a vaccine-preventable disease today. By working with private sector organizations like pharmaceutical companies, we’re helping support decisions about what they should be investing in in terms of R&D to develop new vaccines for diseases where the landscape is going to significantly change in the future – for example, because of climate change.

And when vaccines are in market, are they manufacturing enough in relation to forthcoming demand? Are they producing it at the right time? Are they distributing it optimally and equitably? BlueDot’s public and private sector clients are using our intelligence to support key decisions – not just about what’s happening now, but also what’s coming next.

You mentioned climate change. Do you also consider climate and environmental data?

Yes. Going back to Zika for example – what we were able to determine and publish in the Lancet is where we would expect lots of infected travellers and no local outbreak versus lots of infected travellers, as well as environmental conditions suitable for a local outbreak. What happened six months later is entirely aligned with what we anticipated.

We’re now working on taking the latest climate change models and intersecting them with ecological models for mosquitoes and insects so we can anticipate where those insects will survive and thrive in new areas. If you don’t have the mosquito that can transmit a particular virus, then there’s no possibility of a local outbreak from that virus. But these ranges are changing. In some cases, it’s actually becoming too hot and they’re not able to effectively transmit. But in other cases, conditions are becoming more hospitable.

How far into the future do these forecasts extend?

We’re doing these forecasts looking 10 years into the future. The main reason we’re looking out that far, realizing there’s more uncertainty as you go further out, is that we are working with pharmaceutical and life sciences companies that develop and manufacture vaccines, therapeutics, diagnostics, PPE, disinfectants and more. Their interests are understanding and anticipating future demand. Do they invest in a chikungunya vaccine or a vaccine for a different infectious disease? A vaccine manufacturer has to consider: What am I investing in today, how many lives could it protect and is this a sound business decision recognizing that it might take a decade or more to actually bring that vaccine to market?

What’s next for BlueDot?

Building on top of large language models (LLMs) like GPT, we’ve developed some early capabilities where you can ask our platform questions in natural language. Like, “Every day, tell me how many cases of COVID there are in my location this week and if there’s an increase of 10 per cent or more above baseline, notify me.” Or, “Tell me how many travellers on flights are coming from London to Toronto in the next three months and the likelihood of an imported case of measles showing up.” We’re still actively in R&D mode but building on top of LLMs is showing a lot of promise.

How does working in this space shape how you personally feel about the future?

I’m excited by the fact that technology can help humans in powerful ways, but understand that humans have to help themselves. I often quote the Spanish-American philosopher George Santayana who said, “Those who cannot remember the past are condemned to repeat it.” My worry is we’re quick to forget and that we will repeat the cycle of panic followed by neglect until humanity realizes we have to be proactive – because we know it’s a certainty we will be dealing with more threats in the future. What I often ask myself is, what things can I do today that will have a tangible and positive impact on the lives of others?

This interview has been edited and condensed for clarity.

Research aims to help parents prepare for RSV immunizations for children

siddiq22 — Wed, 19 Jul 2023 18:50:09 +0000

Research aims to help parents prepare for RSV immunizations for children

siddiq22 Wed, 07/19/2023 - 14:50

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(photo by FatCamera/Getty Images)

Ishani Nath

Topic

Breaking Research

Centre for Vaccine Preventable Diseases

Pediatrics

Dalla Lana School of Public Health

Immunology

Vaccines

Two new ways to protect children from respiratory syncytial virus, better known as RSV, may soon be available in Canada – and a University of Toronto researcher aims to ensure parents can make an informed decision about vaccination.

Even though the majority of children will get infected by age 2, “most parents do not know about RSV,” says Tiffany Fitzpatrick, an assistant professor at the Dalla Lana School of Public Health and a member of the Centre for Vaccine-Preventable Diseases.

She’s heard from parents who only learned about the virus – which has a similar seasonal pattern to the flu and symptoms such as coughing, wheezing, and fever – after their child caught it. Although most cases are mild, RSV can lead to more severe illness like pneumonia, and is the leading cause of infant hospitalization in Canada and many other countries.

Tiffany Fitzpatrick (supplied image)

Health Canada is in the process of approving more immunization options to protect children against RSV – an antibody-based drug that may eventually be used to protect all newborns from severe RSV illness and a vaccine for pregnant people that would pass protection from parent to newborn. The potential impact of these new options, both for the health of Canadians and an already overburdened health-care system, is massive.

“This could be really revolutionary,” says Fitzpatrick, who is also a scientist at Public Health Ontario.

That is, as long as parents have the information necessary to make an informed decision about vaccination and understand the severity of RSV – a task that Fitzpatrick plans to address with her research, recently funded by the Canadian Immunization Research Network.

New RSV immunization options coming to Canada

The new RSV prevention drug and vaccine have been a long time coming. Despite more than 60 years of research, options for protecting vulnerable populations (such as newborns) against the virus remained limited – until now.

Currently, the only option for protecting newborns at the highest risk of hospitalization (those born very prematurely, born with heart or lung conditions, or those born in remote communities without quick access to medical care) is a monoclonal antibody therapy called palivizumab. The drug cannot treat RSV, but if injected every month during RSV season, it can help prevent severe illness.

However, palivizumab comes with a high price tag and needs to be administered every month – sometimes for up to six months – so it is typically reserved for high-risk infants. Health Canada recently approved a longer-acting antibody-based drug, nirsevimab, which would only require one injection per RSV season. Nirsevimab is expected to cost much less than palivizumab, and it may eventually be an option for all parents.

A vaccine for pregnant people to help protect newborns from infection is also in the pipeline and may be approved as soon as later this year. The vaccine, recently approved in the U.S. for older adults, offers the prospect of protection against RSV infection – not just disease – to all newborns for the first time.

This RSV vaccine, made by Pfizer and known as RSVpreF, would be given to individuals in their late second or third trimester of pregnancy. The vaccine prompts the pregnant person to makes antibodies that are transferred to their fetus, so their child is born with some protection against RSV. In a worldwide, double-blind clinical trial with pregnant women published in The New England Journal of Medicine, the RSVpreF vaccine was more than 81 per cent effective at protecting infants against serious health issues caused by RSV, like lower respiratory tract illness.

Health Canada is on the verge of approving a new drug and a vaccine to protect children from respiratory syncytial virus (RSV), shown here in an electron micrograph image (image by NIAID)

Speaking with parents about RSV and vaccination

In advance of the rollout of nirsevimab and Health Canada’s consideration of RSVpreF data, Fitzpatrick is listening to parents and learning about their understanding of RSV and potential concerns. Her research will involve conducting interviews with parents across Canada and using the information to create tailored educational materials that address questions and provide the information parents may need as they consider their future RSV immunization options.

“We need to start planning now to make sure that parents are anticipating this, and they have the information they need to be able to make that decision,” she says.

In addition to surveys and interviews, Fitzpatrick and her collaborators will be engaging with populations more vulnerable to RSV. For instance, research indicates that certain living conditions can play a role in a child’s risk for RSV.

“We know if a child is exposed to mould, or if they live in a crowded house, they’re much more likely to catch any respiratory virus and for it to become a much more severe disease,” Fitzpatrick says.

Specific regions and demographics are also disproportionately impacted by RSV. Collaborators on Fitzpatrick’s study will focus on parents in Nunavut – an area that has the highest rates of RSV hospitalization in the world.

“They’re going to be working with community partners there to understand the unique barriers and motivators for RSV immunization in Inuit communities,” she says.

Fitzpatrick is aiming to have the educational materials from her study available in time for next year’s RSV season, when nirsevimab and vaccines for pregnant people will hopefully both be available.

“I hope this research provides parents with the information that they need to make the decision that’s right for them,” she says, noting that as a public-health practitioner, she ultimately hopes people decide to get immunized “so we can prevent as much RSV disease as possible.”

��TV and Merck Canada partner to advance and share vaccine knowledge and research

lanthierj — Tue, 27 Apr 2021 20:18:33 +0000

��TV and Merck Canada partner to advance and share vaccine knowledge and research

lanthierj Tue, 04/27/2021 - 16:18

Cutline

A $3-million contribution from Merck Canada Inc. to the Dalla Lana School of Public Health’s Centre for Vaccine Preventable Diseases reinforces ��TV’s role as a leader in the advancement of immunization and vaccine science (photo by Johnny Guatto)

Topic

Global Lens

Centre for Vaccine Preventable Diseases

Industry Partnerships

Temerty Faculty of Medicine

Dalla Lana School of Public Health

Factor-Inwentash Faculty of Social Work

Lawrence S. Bloomberg Faculty of Nursing

Leslie Dan Faculty of Pharmacy

Meric Gertler

Research & Innovation

As Canada marks National Immunization Awareness Week, a new investment from Merck Canada to the University of Toronto’s Centre for Vaccine Preventable Diseases at the Dalla Lana School of Public Health (DLSPH) will support research, education and knowledge translation around vaccine science and help communicate the importance of immunization as a cornerstone of public health.

Merck Canada’s $3-million investment will help the centre’s diverse mix of public health researchers to better understand the decision-making of individuals and communities around whether and when to receive immunizations. With expertise in vaccine science, social and behavioural health, equity and health systems, the centre’s faculty members will produce scientific research to aid the Ontario government, policy-makers and public health advocates around the world in increasing public knowledge of and access to immunizations.

“As two historic leaders in the research, development and advancement of vaccines, the University of Toronto and Merck Canada understand how immunization has contributed significantly to the prevention and control of infectious diseases in Canada and internationally, particularly for our most vulnerable citizens,” said ��TV President Meric Gertler. “While the world turns to widescale immunization as a key tool in bringing the COVID-19 pandemic to an end, Merck Canada’s investment will help to ensure that the Centre for Vaccine Preventable Diseases becomes a major hub for innovative research in vaccine education.”

The Hon. Christine Elliott, deputy premier of Ontario and minister of health, joined President Gertler, Merck Canada President Anna Van Acker and DLSPH leaders to announce the funding in a virtual ceremony.

“The COVID-19 pandemic has reinforced the critical role vaccine research and education play in protecting the health and safety of Ontarians now and in the future,” said Elliott. “Merck Canada’s generous contribution to the University of Toronto’s Centre for Vaccine Preventable Diseases will have a tremendous impact on the Centre’s work, ensuring that it continues to be a global leader in innovative vaccine science.”

(photo by Nick Iwanyshyn)

Established at the DLSPH at ��TV in 2020, the Centre for Vaccine Preventable Diseases contributes locally and globally to healthy communities through excellence in interdisciplinary vaccine-preventable disease and immunization research and education. The centre’s vision is to catalyze cutting-edge research and education that maximizes the health benefits of immunization for everyone. A collaboration between the Dalla Lana School of Public Health, the Factor-Inwentash Faculty of Social Work, the Lawrence S. Bloomberg Faculty of Nursing, the Leslie Dan Faculty of Pharmacy and the Temerty Faculty of Medicine, the centre also addresses knowledge gaps not just in public understanding of vaccine science but among the many health science fields whose members deal with vaccination.

“The COVID-19 pandemic has shone a light on the critical importance of immunization and innovative collaborations such as this one,” said Anna Van Acker, president and managing director at Merck Canada. “As a science-based company with a long-standing legacy in vaccines, we are very pleased to be teaming up with the Dalla Lana School of Public Health to support our common goal of advancing vaccine science. We are confident that this invaluable collaboration with an institution that is driven by principles of equity and engaging in top-quality research made freely available to the world, will help strengthen the city, province and country’s standing as a world-leading home to scientific innovation.”

Already, the centre has become a hub for continuing education training to help health providers improve their understanding of the science behind vaccines. The centre’s membership spans basic, social and applied sciences, creating cross-pollination in the fields of public health, pharmacy, medical science, nursing, sociology and social work. Given the built-in interdisciplinarity of public health, and its century-long history developing vaccine science, the DLSPH is the centre’s ideal home.

“The University of Toronto and the Dalla Lana School of Public Health have played a major role in the development and distribution of vaccines that rid the world of terrible diseases such as smallpox, polio and diphtheria,” said DLSPH Dean Adalsteinn (Steini) Brown. “Merck Canada’s funding allows us to pursue critical research and education that will strengthen this legacy and improve public health.”

��TV and Merck share a historic legacy in vaccine development, research and knowledge advancement. The university traces its work in vaccine research to Dr. John G. Fitzgerald, who led the world in the development of diphtheria and tetanus anti-toxins and established Connaught Laboratories. Today, many ��TV and DLSPH faculty members are part of World Health Organization (WHO) Collaborating Units, including the Joint Centre for Bioethics, as well as working with the Global Alliance on Vaccination and Immunization (GAVI) on issues ranging from ethics and Ebola, measles and rubella elimination to reducing pain from immunization.

Merck has been a leader in health innovation for the past 130 years, bringing forward medicines and vaccines for many of the world’s most challenging diseases in pursuit of the mission to save and improve lives. Today, Merck continues to be at the forefront of research to prevent and treat diseases that threaten people and animals, including cancer, infectious diseases, such as HIV and Ebola, and emerging animal diseases.

David Palmer, ��TV’s vice-president, advancement, said: “We are pleased to thank and welcome Merck Canada as a major partner, helping advance ��TV’s global leadership in the development and advancement of cutting-edge vaccine science and disease prevention, critical to ensuring the health and well-being of people in Ontario, Canada and around the world.”

Learn more about industry partnerships at ��TV

Better, but far from over: ��TV experts share their COVID-19 outlooks for the year ahead

Christopher.Sorensen — Tue, 19 Jan 2021 18:53:56 +0000

Better, but far from over: ��TV experts share their COVID-19 outlooks for the year ahead

Christopher.Sorensen Tue, 01/19/2021 - 13:53

Cutline

The pandemic's end may finally be in sight as front-line staff receive vaccines, but ��TV researchers who have been studying the virus and its impact say there remain many hurdles to clear in 2021 (photo by Rick Madonik/Toronto Star via Getty Images)

Paul Fraumeni

Topic

Global Lens

Centre for Vaccine Preventable Diseases

Coronavirus

Sunnybrook Health Sciences

Temerty Faculty of Medicine

Dalla Lana School of Public Health

Factor-Inwentash Faculty of Social Work

Faculty of Arts & Science

Global

Laboratory Medicine and Pathobiology

Mount Sinai Hospital

Research & Innovation

Sociology

University Health Network

Vaccines

Allison McGeer is unequivocal when she is asked about the vaccines that are now being administered to fight the spread of COVID-19.

“It’s a miracle that the vaccines have come so quickly,” says McGeer, director of the Infectious Diseases Epidemiology Research Unit at Mount Sinai Hospital and a professor in the department laboratory medicine and pathobiology in the Temerty Faculty of Medicine. “We’ve been saying for many months that the only way out of this pandemic is the vaccine. If we had to continue without the vaccine, it would have been very difficult.”

But McGeer, who is cross-appointed to the department of medicine and ��TV’s Dalla Lana School of Public Health, and who has several COVID-19 projects funded by the Canadian Institutes of Health Research, adds that while the vaccine is helping to ease global society out of the pandemic, “it’s a qualified miracle because it’s going to take months for us to deliver vaccines and because COVID is just not going to end fast – it’s not going away.”

Many questions have yet to be answered. Will people need to be re-vaccinated? How much is the virus going to mutate? How many people will roll up their sleeves?

“It’s a long list we need to answer to determine how we move from what I think of as acute COVID, which is what we have now, to chronic COVID, which is what we’ll have at the end of this year.”

Allison McGeer is the director of infection control at Mount Sinai Hospital and a professor at ��TV’s Dalla Lana School of Public Health with cross-appointments in the Temerty Faculty of Medicine (photo courtesy of Allison McGeer)

McGeer’s questions about how Canada will fare in 2021 are echoed by a number of ��TV scientists and scholars who have been focused on understanding the coronavirus and its effect on society since the outbreak took hold in North America early in 2020.

Jeff Kwong, an associate professor at Dalla Lana and in the department of family and community medicine at the Temerty Faculty of Medicine, is the interim director of ��TV’s Centre for Vaccine Preventable Diseases. He welcomes the vaccine but agrees there is much more to consider.

“Now, it’s all about the supply. How many doses can we get and how quickly and how fast can we get it into as many people’s arms as possible? That’s going to be the story for 2021.”

The first few months will be tough.

“On the negative side, the first part of 2021, as we’re seeing now, is going to be hard,” says Isaac Bogoch, associate professor of medicine in the Temerty Faculty of Medicine and an infectious diseases consultant at the University Health Network. “We have record-high cases of COVID across Canada now and, unfortunately, those numbers will go higher because of social gatherings over the holiday season.”

Yet, despite the challenges, Bogoch, a member of the Ontario Ministers’ COVID-19 Vaccine Distribution Task Force who has become well-known to Canadians for his almost-daily appearances on TV and radio newscasts, says the vaccines are already beginning to make a positive difference.

“We are now vaccinating some of the most vulnerable populations in Canada and will continue to do so throughout the first two to three months of 2021,” he says. “That will do a lot of good. Long before we achieve herd immunity, vaccinating workers and residents of long-term care settings, seniors and Canadians with compromised immune systems will protect some of the most vulnerable populations in the country, alleviate death and suffering and take some pressure off of our health-care system.

“It won’t solve all of our problems, but it will certainly solve several of the issues we are facing.”

Bogoch adds that life in Canada should continue to normalize as we move further into 2021.

“As 2021 rolls on and vaccine programs continue to expand across the country, I really think things are going to get better,” he says. “We’ll probably start to see a lifting of several of the public health measures that we have, like larger gatherings permitted in indoor and outdoor settings, and we’ll start to see mask mandates lifted, greater travel and transportation allowed and a softening of border measures.

“I think that it’s going to be a period of rapid change – and change in the right direction.”

McGeer, Kwong and Bogoch are just three of the hundreds of ��TV researchers and scholars who shifted their focus over the past year as part of a massive, university-wide effort to better understand the virus and its myriad impacts, work on new treatments and vaccines, and figure out ways to help the city, province and country engineer a strong and socially equitable recovery.

There are more than 110 federally funded COVID-19 research initiatives at ��TV and its hospital network. ��TV, meanwhile, has contributed more than $10 million through the Toronto COVID-19 Action Fund.

“Across so many fields and in so many different ways, the University of Toronto community is applying its expertise and experience to help Canada and the world resolve this unprecedented global crisis,” said ��TV President Meric Gertler in a recent report focused on ��TV’s response to the pandemic.

The report, titled “Demonstrating Resilience in a Pandemic: Scientists as First Responders,” chronicles the work of researchers from across of the university’s three campuses, as well as its nine partner hospitals and numerous industry partners.

It also recognizes the support of the federal government, which contributed $1.1 billion in funding to COVID-19-related research. Also of note was the historic donation of $250 million from James and Louise Temerty and the Temerty Foundation to the Temerty Faculty of Medicine. The foundation advanced $10 million of that donation to expand ��TV’s Containment Level 3 facility and enable other urgent COVID-19 efforts.

��TV scientists were among the first in the world to begin investigating the virus. Kamran Khan, a faculty member at the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health, started BlueDot in the wake of the 2003 SARS crisis in a bid to develop an early warning system for virulent diseases. In early January, the company pushed out an alert to its users about an unusual cluster of pneumonia cases arising from a market in Wuhan, China – days before the U.S. Centres for Disease Control and Prevention and World Health Organization issued their own alerts.

Kamran Khan’s BlueDot was among the first organizations to flag an unusual cluster of pneumonia cases arising from a market in Wuhan, China (photo by Jorge Uzon/AFP via Getty Images)

By March, ��TV researchers and Sunnybrook Health Sciences Centre microbiologists Samira Mubareka and Robert Kozak, in collaboration with McMaster virologist Arinjay Banerjee, were among the first to isolate the virus, using specimens collected at Sunnybrook from Canada’s first infected patient. Their work gave researchers across Canada a ready supply of virus on which to test treatments. Kozak is now developing a vaccine as part of a national collaboration with Université Laval.

Robert Kozak and Samira Mubareka, both in ��TV’s Temerty Faculty of Medicine and at Sunnybrook Health Sciences Centre, were among the first to isolate the coronavirus (photo by Nick Iwanyshyn)

As vital as that work was in 2020, Christine Allen, who helped steer the university’s Toronto COVID-19 Action Initiative as ��TV’s associate vice-president and vice-provost, strategic initiatives, emphasizes that there is a huge amount of work still needed in the upcoming year.

“Last year confirmed the power and impact of our scholars and interdisciplinary teams in tackling the world’s most important challenges,” she says. “In 2021, we will need to redouble our efforts, ensuring that the basic research and the applied and translational – and the links between them – are further strengthened as ��TV’s research and scholarly community continue to contribute to social justice, economic progress and health security.”

Carmen Logie, an associate professor at the Factor-Inwentash Faculty of Social Work, says the vaccines are lifesavers but notes that getting them to developing countries and then into the arms of people is much more challenging than in Canada. That’s why she is focusing her efforts on the pandemic’s outsized impact on people in low-income countries. In particular, she is studying how COVID-19 is affecting adolescents and young people who are refugees in Uganda’s capital, Kampala – many of whom fled violence in the Democratic Republic of the Congo. She and her research colleagues have been using a mobile phone app to help these young people receive information about preventing COVID-19 – and to express their feelings and concerns.

The challenges experienced by these young people and other refugees were severe in July – and Logie notes that the situation hasn’t improved much since.

“This is a low-income country and the pandemic is striking Uganda and the refugees in an extremely hard way that is much different than in Canada,” she says. “I read a report in mid-December that said in one refugee camp a lack of face masks, water and soap is pushing COVID-19 infection rates higher. The refugees are being given one mask and they are supposed to wash it daily and reuse it, but there isn’t enough water and soap to enable them to do that. This is typical of what’s happening there.”

“While we do need to take care of one another in Canada, and we need to address the inequalities within Canada, we also need to keep an eye on larger global inequalities. The fact is that there are low-income people in the world won’t get a vaccine until 2022. We should all be concerned about that.”

Bogoch, too, is concerned about the international picture. His background as an infectious disease specialist includes many years on the ground in Africa – mostly in Ghana and Cote d’Ivoire – treating people with parasitic infections.

“We know this is a very contagious virus and how it can rip through communities and spread around the world quickly,” he says. “So, we’re in a global situation where no one is safe anywhere unless everyone is safe. This is especially true for countries that are not as well-resourced as countries like Canada.”

Helping in that effort, he says, is COVAX, an initiative launched by the World Health Organization, the European Commission and France to provide equitable access to the COVID-19 vaccine for low- and middle-income countries. Canada is a participant.

Even in developed countries, the spread of COVID-19 among vulnerable populations continues to be a major problem. Bogoch is particularly concerned with “congregate settings” – operations such as hospitals, factories and grocery stores – where people must work in person and are often in close proximity to each other.

“We really need to get these people vaccinated,” he says. “And I would extend that urgency to shelter populations. This is a vulnerable group and there’s already evidence in Canada that COVID can just tear through homeless shelters and refugee shelters. We have to protect people in those settings.

“This need is reflected in the provincial approaches to vaccine priorities this coming year and that is a good thing.”

And then there is the deadly situation in long-term care homes, which has become one of the most troubling aspects of Canada’s COVID-19 response.

“I spent a long time in January of 2020 looking at respiratory infections in a variety of health-care institutions and it was clear to me that we were going to have a disaster in long-term care (LTC),” says McGeer.

While she is thankful the vaccine is beginning to be injected into the arms of LTC workers and residents, she also notes that we shouldn’t be surprised at how hard COVID-19 hit the LTC sector.

“Pandemics tend to lay bare where you are having trouble already,” McGeer says. “The issues in LTC existed pre-pandemic. For example, we got out of having four patients in a room in most hospitals in this country years ago. But that hasn’t changed in LTC. If I said to you ‘When you are in a hotel, would you share a room with three other people who you don’t know and share a bathroom with eight other people?’ You’d think I was crazy, right? But we require people to do that in LTC all the time. That’s why the virus has spread the way it has in these facilities. And this crowding is just one problem.”

Nevertheless, McGeer hopes the LTC experience over the past year has been a wakeup call.

“The challenges are enormous and you can’t fix them during a pandemic,” she says. “But at some level, and maybe this is magical thinking, I’m hoping we will as a society be able to look at the impact of inequities and do something longer term to reduce them in Canada. But it’s going to be very hard.”

The pandemic has also had a notable disproportionate impact on racialized populations in Canada.

Eileen de Villa, Toronto’s chief medical officer of health, revealed data in a July CBC article showing that Black people accounted for 21 per cent of reported cases of COVID in the city even though they made up only nine per cent of the overall population. The disparity was similar for people of Arab, Middle Eastern and West Asian descent, de Villa noted.

Tanya Sharpe encountered the same phenomenon last year as she was conducting research on the sociocultural factors that influence coping strategies of Black family members and friends of homicide victims.

“This was early on in the pandemic in 2020,” says Sharpe, an associate professor at the Factor-Inwentash Faculty of Social Work. “The U.S. began to capture data by race, which is a standard practice in the U.S., but not so much in Canada. They began to show that many of the same neighbourhoods that experienced the highest rates of homicide violence and victimization – neighbourhoods that are disproportionately Black and Latino in the U.S. – were also experiencing the highest rates of COVID-19.”

She and her team then examined determinants that often lead to health issues in racialized populations – inadequate housing, education and low-paying jobs that don’t include paid leave.

“When you consider these factors, you make this fundamental connection about the impact of structural inequities on some of our most vulnerable populations,” says Sharpe, who joined ��TV in 2018 after 11 years at the University of Maryland in Baltimore and is the founder and director for The Centre for Research and Innovation for Black Survivors of Homicide Victims (The CRIB).

“In Canada, vulnerable populations impacted by structural inequities are disproportionately Black and Indigenous people who often do not have the luxury of social distancing from family members when there are five or six people in one household, or don’t have access to clean drinking water to wash their hands to protect themselves from the virus.

Tanya Sharpe, an associate professor at the Factor-Inwentash Faculty of Social Work, says the pandemic forced society to see what it had previously chosen to ignore: structural inequity, which resulted in Black and other racialized communities bearing the brunt of COVID-19’s deadly impact (photo courtesy of Tanya Sharpe)

She adds that racialized Canadians “are so often the front-line workers, the nurses and personal support workers in nursing homes and the cashiers in the grocery store who are taking care of everyone else and exposing themselves day-to-day, putting themselves at risk to simply survive.”

Sharpe emphasizes that the disproportionate number of COVID-19 cases among racialized communities is simply the latest chapter in a long history of systemic racism.

“The pandemic has forced all of society to see what I think people purposely choose not to see: structural inequity that is in fact inherently violent and can no longer be ignored.”

She welcomes the vaccine but is leery of the oft-used expression “getting back to normal.”

“I don’t think we should ever go back to normal,” she says. “The unearthing of the structural inequities suggests that, yes, we need to make sure everyone is vaccinated, but what are we going to do about the systemic racism of inequities that continue to plague Black and Indigenous communities?”

Sharpe says it’s essential to address the lack and accessibility of race-based data collected by Canadian governments.

Ultimately, it’s data, she says, that enables policy-makers to make change that can help to address structural inequities.

“They need the information. Because in the absence of data, if you don’t count it, it doesn’t count.”

For all Canadians, how work and employees will recover from the pandemic remains an open question.

��TV’s Scott Schieman, a professor of sociology in the Faculty of Arts & Science who is known for his research on work – and the stress that often comes from work – launched a study in September 2019 to document the experiences of 3,000 Canadians. His original plan was to replicate the study annually to track changes over the next decade. But COVID-19 caused Schieman to pivot so the study could map the short- and longer-term impacts of the pandemic, including job disruptions, financial strains, and the shift (for some) towards remote work – all of which are expected to have consequences for physical and mental health.

Eight months later, Schieman and his team are seeing those COVID-19 stressors come alive.

He notes that those who have been able to keep their jobs and work from home have fared relatively well. This is especially true if those workers have not had to take care of children while on the job at home. But add children to the mix – especially when they are attending school virtually – and Schieman says the stress on parents has become much greater. The patterns are particularly strong for those with younger children at home.

One of his main concerns is workers who have lost their jobs, either temporarily or permanently, because a business has been forced to close.

“Everyone is experiencing significant and often very different impacts on quality of life, and their sense of optimism, loss of control over their lives and feelings of uncertainty about the future,” he says. “But certain job sectors or industries are more compromised. Accommodation and food services, for example, got slammed, especially during the early months of the pandemic. If you want to see a line on a graph that looks like nothing you’ve seen before, you look at the job disruption for that group.”

His research shows workers experienced a simultaneous spike in the sense of powerlessness and distress – mostly because of a sharp rise in financial strain.

“The question now,” Schieman says, “is whether that sector will come back and how it will rebound. Once the vaccine is administered, will the rebound be smooth or uneven? And what will it mean for their well-being?”

Scott Schieman, a professor of sociology in the Faculty of Arts & Science, is mapping the short- and longer-term impacts of the pandemic, including job disruptions, financial strains, and the shift to remote work (photo by Brian Summers)

Schieman has also noted increases and dips in the loneliness and social isolation pandemic that lockdowns and job losses have caused.

“The loneliness spiked early in the pandemic, but then summer came, the lockdowns eased, many businesses re-opened and people could socialize in person more. But in the latest data from our study that we’ve looked at, loneliness is spiking again as we go back into lockdowns.”

Social isolation, he adds, can have a profound effect on mental health, resulting in severe psychological distress. He says recent data shows older study participants are feeling that loneliness the most sharply.

“I’m speculating at this point, but I have to wonder if that is partly because younger people more easily engage in social media technology and that helps them stay connected to their friends,” he says.

So, when will we be free of COVID-19 for good?

Kwong, at the Centre for Vaccine Preventable Diseases, says the holy grail is herd immunity, when enough people have been vaccinated or developed natural immunity that the virus no longer spreads like crazy.

“Winter and spring in Canada won’t be normal,” predicts Kwong. “And I don’t think people should be making huge travel plans for the summer. But I heard the prime minister say that every Canadian who wants the vaccine will be able to get it by September.

“That’s fantastic if that can happen, because that means by next year at this time we’ll have the majority of the population protected and we can, hopefully, have a normal December holiday season.”

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