Item Open AccessCOVID-19 Vaccination and Public Health Countermeasures on Variants of Concern in Canada: Evidence From a Spatial Hierarchical Cluster Analysis(JMIR Publications Inc., 2022-05-31) Daniel A Adeyinka; Cory Neudorf; Cheryl A Camillo; Wendie N Marks; Nazeem MuhajarineBackground There is mounting evidence that the third wave of COVID-19 incidence is declining, yet variants of concern (VOCs) continue to present public health challenges in Canada. The emergence of VOCs has sparked debate on how to effectively control their impacts on the Canadian population. Objective Provincial and territorial governments have implemented a wide range of policy measures to protect residents against community transmission of COVID-19, but research examining the specific impact of policy countermeasures on the VOCs in Canada is needed. Our study objective was to identify provinces with disproportionate prevalence of VOCs relative to COVID-19 mitigation efforts in provinces and territories in Canada. Methods We analyzed publicly available provincial- and territorial-level data on the prevalence of VOCs in relation to mitigating factors, summarized in 3 measures: (1) strength of public health countermeasures (stringency index), (2) the extent to which people moved about outside their homes (mobility index), and (3) the proportion of the provincial or territorial population that was fully vaccinated (vaccine uptake). Using spatial agglomerative hierarchical cluster analysis (unsupervised machine learning), provinces and territories were grouped into clusters by stringency index, mobility index, and full vaccine uptake. The Kruskal-Wallis test was used to compare the prevalence of VOCs (Alpha, or B.1.1.7; Beta, or B.1.351; Gamma, or P.1; and Delta, or B.1.617.2 variants) across the clusters. Results We identified 3 clusters of vaccine uptake and countermeasures. Cluster 1 consisted of the 3 Canadian territories and was characterized by a higher degree of vaccine deployment and fewer countermeasures. Cluster 2 (located in Central Canada and the Atlantic region) was typified by lower levels of vaccine deployment and moderate countermeasures. The third cluster, which consisted of provinces in the Pacific region, Central Canada, and the Prairies, exhibited moderate vaccine deployment but stronger countermeasures. The overall and variant-specific prevalences were significantly different across the clusters. Conclusions This “up to the point” analysis found that implementation of COVID-19 public health measures, including the mass vaccination of populations, is key to controlling VOC prevalence rates in Canada. As of June 15, 2021, the third wave of COVID-19 in Canada is declining, and those provinces and territories that had implemented more comprehensive public health measures showed lower VOC prevalence. Public health authorities and governments need to continue to communicate the importance of sociobehavioural preventive measures, even as populations in Canada continue to receive their primary and booster doses of vaccines. Item Open AccessComparison of COVID-19 vaccination rollout approaches across Canada: Case studies of four diverse provinces(McMaster University Library Press, 2023-02-01) Fitzpatrick, Tiffany; Camillo, Cheryl, A.; Hillis, Shelby; Habbick, Marin; Mauer-Vakil, Dane; Roerig, Monika; Muhajarine, Nazeem; Allin, SaraAcross Canada, there were notable differences in the rollout of provincial/territorial COVID-19 vaccination programs, reflecting diverse sociodemographic profiles, geopolitical landscapes, health system designs, and pandemic experiences. We collected information regarding underlying principles and goals, governance and authority, transparency and diversity of communications, activities to strengthen infrastructure and workforce capacity, and entitlement and access in four diverse provinces (British Columbia, Saskatchewan, Ontario, Nova Scotia). Through cross-case analysis, we observed significant differences in provincial rollouts of the primary two-dose vaccination series in adults between December 2020 and December 2021. Nova Scotia was the only province to state explicit coverage goals and adhere to plans tying coverage to the relaxation of public health measures. Both Nova Scotia and British Columbia implemented fully centralized vaccination booking systems. In contrast, Saskatchewan's initial highly centralized approach enabled the rapid delivery of first doses; however, rollout of second doses was slower and more decentralized, occurring primarily through community pharmacies. In alignment with its decentralized health system, Ontario pursued a regionalized approach, primarily led by its existing public health unit network. Our research suggests explicit goals, centralized booking, and flexible delivery strategies improved uptake; however, ongoing learning will be crucial for informing the success of future vaccination efforts. Item Open AccessThe Impact Of Provincial Proof- Of-Vaccination Policies On Age-Specific First-Dose Uptake Of COVID-19 Vaccines In Canada(Health Affairs (Project Hope), 2023-11-01) Tiffany Fitzpatrick; Cheryl A. Camillo; Shelby Hillis; Marin Habbick; Monika Roerig; Nazeem Muhajarine; Sara AllinRequirements of proof of COVID-19 vaccination were mandated for nonessential businesses and venues by Canada’s ten provinces throughout the fall of 2021. Leveraging variations in the timing of these measures across the provinces, we applied event study regression to estimate the impact the announcement of these measures had nationally on age-specific first-dose uptake in the subsequent seven-week period. Proof-of-vaccination mandate announcements were associated with a rapid, significant increase in first-dose uptake, particularly in people younger than age fifty. However, these behavioral changes were short- lived, with uptake returning to preannouncement levels—or lower—in all age groups within six weeks, despite mandates remaining in place for at least four months; this decline occurred earlier and was more apparent among adolescents ages 12–17. We estimated that nationally, 290,168 additional people received their first dose in the seven weeks after provinces announced proof-of-vaccination policies, for a 17.5 percent increase over the number of vaccinations estimated in the absence of these policies. This study provides novel age-specific evidence showing that proof-of-vaccination mandates led to an immediate, significant increase in national first-dose uptake and were particularly effective for increasing vaccination uptake in younger to middle-aged adults. Proof-of- vaccination mandates may be effective short-term policy measures for increasing population vaccination uptake, but their impact may differ across age groups. Item Open AccessImplementation of a Pharmacy Clinical Instructor Model to Facilitate Experiential Learning within Saskatchewan’s Entry-to-Practice Doctor of Pharmacy Program(Health Reform Observer - Observatoire des Reformes de Sante, 2023-06-02) Kary, Steven; Camillo, Cheryl, A.; Gerwing, Shauna; Dumont, ZackIn response to nationally endorsed changes in pharmacy curricula, the University of Saskatchewan College of Pharmacy and Nutrition (CoPN) sought to expand experiential learning for its pharmacy program. In 2010, Canada’s faculties and deans of pharmacy committed to implementing entry-to-practice Doctor of Pharmacy (PharmD) programs in all schools by 2020. The expansion and change in credentialing of Canada’s pharmacy training from baccalaureate programs was intended to ensure graduates possess the competencies required within the modern scope of pharmacy practice. To further this transition, the Canadian Council for Accreditation of Pharmacy Programs increased the required hours of students’ experiential learning. In Saskatchewan, pre-existing operational and financial pressures on the CoPN, coinciding with the provincial health system’s amalgamation from twelve regional health authorities to a single health authority, prompted a collaborative approach. To address the growing need for practical experience within the Saskatchewan Health Authority, the CoPN implemented clinical instructor positions within tertiary care centres in Saskatoon and Regina. This unique approach among PharmD programs provided financial stability and accountability to student learning, although early student feedback identified several challenges with this model. These findings about the clinical instructor model can guide the ongoing implementation of experiential learning within PharmD and other health care professional programs. Item Open AccessUnderstanding the mechanisms of administrative burden through a within-case study of Medicaid expansion implementation(American Political Science Association, 2021-02-01) Camillo, Cheryl, A.The importance of the administrative burden problem in public programs has been apparent during the COVID-19 crisis in the United States as millions of newly unemployed people have had to wait for unemployment checks and public health insurance benefits due to paperwork requirements, agency staff shortages, and outdated information technology systems. The resulting burdens have extended financial hardship, caused the coronavirus to spread, and eroded citizen and agency morale. Administrative burdens have long been known to be costly, yet remain fixtures of public benefit programs across the world. To reduce them, we need to understand their mechanisms. Formal policy solutions per se will not reduce administrative burdens because they do not exist solely by design. This article contributes to behavioral public administration by providing a comprehensive, empirical-driven theoretical framework for understanding the complex processes through which supply-side administrative burdens are instituted, modified, and eliminated. Using a retrospective within-case study method that utilizes participant observation, documentation, and archival records, the article traces the process by which a state eliminated administrative burdens in the process of implementing an initially straightforward expansion of Medicaid eligibility, thereby creating a model for simplifying and streamlining enrollment that was incorporated into the Affordable Care Act. Item Open AccessAddressing the ethical problem of underdiagnosis in the post-pandemic Canadian healthcare system(SAGE Publications, 2023-09-15) Cheryl A. CamilloProper diagnosis is essential for effective treatment, yet in Canada health conditions are commonly underdiagnosed at all levels of the health system, meaning that they go undiagnosed or are diagnosed only after a delay. Underdiagnosis leads to inadequate treatment and potentially insufficient recovery and rehabilitation, as well as costly inefficiencies, such as repeat medical visits. Moreover, disparities in underdiagnosis in which vulnerable groups, such as women and Indigenous persons, are properly diagnosed at lower rates worsen existing inequities, which threatens the overall health of the general population. As health leaders and policy-makers seek to strengthen Canada’s strained healthcare system, it will be important to address underdiagnosis and its causes, including systematic bias. Providing timely and accurate diagnoses for all patients is an essential component of delivering high quality, efficient, ethical, and cost-effective healthcare. The Canadian College of Health Leaders’ Code of Ethics offers a framework for addressing underdiagnosis equitably. Utilizing the framework, suggestions are made for actions that can be taken at all levels of the health system to reduce underdiagnosis.