Updated: February 7, 2021

THE NORTHWEST TERRITORIES COVID-19 VACCINE STRATEGY

Immunity for our Communities

For more information, please visit www.gov.nt.ca/covid-19

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If you would like this information in another official language, call us. English

Si vous voulez ces informations dans une autre langue officielle, contactez-nous.

French

Kīspin ki nitawihtīn ē nīhīyawihk ōma ācimōwin, tipwāsinān. Cree

Tłıcho yatı k’e e . Dı wegodı newo de, gots’o gonede.

Tłıcho

Ɂerıhtł’ıs Dëne Sułıne yatı t’a huts’elkër xa beyayatı theɂa ɂat’e, nuwe ts’ën yołtı. Chipewyan

Edı gondı dehgah got’ıe zhatıe k’e e edatł’eh enahddhe nıde naxets’e edahłı.

South Slavey

K’ahsho got’ıne xǝdǝ k’e hederı ɂedıhtl’e yerınıwe nıde dule. North Slavey

Jii gwandak izhii ginjik vat’atr’ijahch’uu zhit yinohthan ji’, diits’at ginohkhii.

Gwich’in

Uvanittuaq ilitchurisukupku Inuvialuktun, ququaqluta. Inuvialuktun

ᑖᒃᑯᐊ ᑎᑎᕐᒃᑲᐃᑦ ᐱᔪᒪᒍᕕᒋᑦ ᐃᓄᒃᑎᑐᓕᕐᒃᓯᒪᓗᑎᒃ, ᐅᕙᑦᑎᓐᓄᑦ ᐅᖄᓚᔪᓐᓇᖅᑐᑎᑦ.

Inuktitut

Hapkua titiqqat pijumagupkit Inuinnaqtun, uvaptinnut hivajarlutit. Inuinnaqtun

1-855-846-9601

COVID-19 in the Northwest Territories2020 has been a challenging year for all Northerners. COVID-19 has had a significant impact on our lives and communities - changing the way we work, study, gather, and travel.

As a territory, we’ve worked together to follow public health orders and guidance, and so far, those efforts have protected the Northwest Territories (NWT) from the virus. We have all made sacrifices in order to protect NWT residents from COVID-19.

At the same time, experts around the world have worked non-stop to develop safe and efficacious vaccines that will eventually move us past this pandemic. As a result of their dedicated efforts and federal support, a vaccine is now located in the NWT and we have started the delivery of a comprehensive vaccination program. As this unfolds over the coming months, we will be announcing and widely promoting the timing and locations of vaccination clinics as our vaccine supply arrives, is matched with priority groups/communities, and is ready to be delivered. The initial focus will be to ensure priority groups are vaccinated. The general population can expect to have access to the vaccine in March 2021.

This vaccine represents a light at the end of the tunnel. As we start to see vaccination rates rise and infection rates fall within the NWT, nationally, and globally, we get closer to resuming life without restrictions.

Vaccines, like other public health measures, are most effective when we all do our part. When deciding whether to get the vaccine, use of reliable and credible sources is crucial. The unity and resilience of the residents of the NWT have brought us safely to this point. We are counting on this collective response to extend to the next crucial stage of the pandemic.

Goal: To provide safe and efficacious COVID-19 vaccines to all eligible NWT residents in an effective and timely manner to reduce the overall impact of COVID-19.

The NWT COVID-19 Vaccine Strategy is built upon Canada’s COVID-19 Immunization Plan: Saving Lives and Livelihoods1

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Guiding ValuesThe Government of the Northwest Territories (GNWT) is working closely with federal, provincial, and territorial partners throughout the planning and rollout of COVID-19 vaccines in Canada. The unique characteristics of the NWT will play a key role in shaping vaccine distribution within the Northern context. We will rely on the expertise of Indigenous government and community leaders to help shape a culturally respectful response. This response will recognize the unique challenges and strengths we have in the NWT.

Our approach is grounded in five core values which will be reflected throughout the COVID-19 vaccine rollout:

1. Equity. All eligible adult residents will have access to the COVID-19 vaccine in a way that considers individual- and community-level risk factors.

2. Cultural competency. Information and vaccine delivery will respect and adapt to the needs and contexts of the diverse peoples living in the NWT. The GNWT recognizes that historical experiences and the ongoing impacts of colonization, cultural oppression, and systemic racism impact health outcomes and trust in the health care system. We will rely on existing relationships grounded in trust and mutual respect within our communities to ensure relevant, meaningful vaccine delivery and communication within the local and cultural context.

3. Evidence-based decision making. Decision-making on COVID-19 vaccine use in Canada will be based on science, independent regulatory review, and the advice of medical and other experts - including the National Advisory Committee on Immunization (NACI). This reflects the fundamental importance placed on public health expertise, the independence of scientific research, and reliance on data and evidence regarding vaccine safety and efficacy. Reporting from local and national sources will inform our processes and recommendations as we move forward.

4. Flexibility and responsiveness. New information on vaccine products, distribution, and other logistical details are expected in the coming weeks and months. The NWT COVID-19 Vaccine Strategy sets the framework by which vaccines will be distributed. At the same time, the strategy will be responsive and flexible as new information arises and the rollout unfolds.

5. Trust. Trust is a foundational component to vaccine decision-making. To support vaccine decision-making at an individual level, residents need to trust the information they are receiving, as well as the recommendations from health care professionals and the institutions delivering the vaccination program2. The need to promote public trust is an underpinning value in every action and decision of this vaccine strategy.

These core values will help guide the delivery of a successful vaccine program in a manner that is most appropriate for Northerners.

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What do we know right now?There is a lot of information available, but there are still gaps in knowledge. We continue to learn more about COVID-19 vaccines and update our approach. As more information becomes available, we will keep people informed. Right now, we know the following:

The COVID-19 vaccine will be available free of charge.

The vaccine is publicly funded, which means that all eligible adult residents 18 years of age and older will be offered the vaccine free of charge. Like other vaccines, Northerners will be able to choose whether or not they want the vaccine; however, we strongly encourage all eligible adult residents to become immunized to protect themselves and others against COVID-19. Vaccine uptake will be especially important to protect those who are at high risk of severe disease from COVID-19 and those who cannot yet receive the vaccine, which currently includes residents who are pregnant or breastfeeding, immunocompromised, under 18 years of age, or have an autoimmune condition4.

The initial vaccine that the NWT will be receiving is the Moderna COVID-19 vaccine.

The Moderna COVID-19 vaccine is the initial vaccine to be distributed in the NWT. The first shipment of the vaccine arrived in the territory on December 28, 2020. The federal, provincial, and territorial governments made this decision together to acknowledge the storage and handling complexity of the two initial vaccine candidates.

The NWT is expected to receive enough of the vaccine for 75 per cent of the eligible adult population.

The NWT is expected to receive enough vaccine to immunize 75 per cent of eligible residents 18 years of age and older within the first three months of 2021. This generous initial allocation from the federal government recognizes the territories’ limited health care system capacities and the vulnerabilities of remote Indigenous communities. If more than 75 per cent of the eligible adult population in the NWT decides to get vaccinated, more vaccine will be available later in the year. The NWT received 7,200 doses in the first of multiple vaccine shipments on December 28, 2020.

Health Canada has approved the use of the Moderna vaccine in Canada.

On December 23, 2020, Health Canada authorized the use of the COVID-19 vaccine manufactured by Moderna. After an in-depth independent review of the evidence, Health Canada determined that the Moderna vaccine meets the rigorous safety, efficacy, and quality requirements. NACI has updated the recommendations on the use of COVID-19 vaccines to further support the safe use of the Moderna vaccine in Canada3. The Moderna vaccine arrived in Canada on December 25, 2020.

What is the difference between Vaccination and Immunization? Vaccination is the process of giving a vaccine to protect against a specific disease, whereas immunization reflects the immune system’s response protecting the individual from a specific disease following vaccination.11

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At this time, the Moderna vaccine is the best option for the NWT.

While the Moderna vaccine is less challenging to transport throughout the NWT than the other available COVID-19 vaccine, it will still pose transportation and cold chain management challenges for our remote and isolated communities. Like all vaccines, the Moderna vaccine must be kept at a constant stable temperature throughout transportation, delivery, and storage until it is ready to be used. This process is called the vaccine’s cold chain. If a vaccine’s cold chain is broken, the vaccine’s integrity is compromised and will no longer be effective. Based on current information, the Moderna vaccine needs to be kept at -20°C throughout its cold chain while the other vaccine candidate which requires more extreme temperatures.

The Moderna vaccine is an mRNA vaccine, which is a new type of vaccine.

Many vaccines contain a tiny amount of weakened or dead virus that does not cause disease. Messenger RNA (mRNA) vaccines are different because they do not contain any weakened or dead virus. Instead, mRNA vaccines teach our cells how to make a protein specific to the COVID-19 virus, which turns on an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies5,6. The mRNA is active in the cell but does not enter the space where genetic material is housed. It does not contact or impact the cell DNA5.

Moderna is a two-dose vaccine.

The Moderna vaccine requires two doses given at least 28 days (about 4 weeks) apart. It is essential to receive the second dose to achieve the vaccine’s full efficacy. The greatest immunity is expected 14 days after the second dose of the vaccine4.

NACI has reported that the Moderna COVID-19 vaccine is highly efficacious.

NACI states that current mRNA vaccines (including the vaccine from Moderna) are highly efficacious in the short term against confirmed symptomatic COVID-19 disease one to two weeks after receiving the full two-dose series4. More specifically, evidence shows that the Moderna COVID-19 vaccine has 94.1 per cent efficacy in preventing any COVID-19 illness and 100% efficacy at preventing severe COVID-19 illness at least 14 days after the second injection5. Moderna studied the effect of the vaccine on 28,207 participants. In that group, 14,073 people were given a placebo, which means they did not get the vaccine. The remaining 14,134 participants received the Moderna COVID-19 vaccine. Only 11 participants who received both doses of the vaccine developed symptomatic COVID-19. None experienced serious COVID illness4. The Moderna vaccine is estimated to be 100 per cent efficacious at preventing severe disease from COVID-194.

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What is the difference between vaccine efficacy and vaccine effectiveness? Vaccine efficacy is what is known about how well a vaccine works from the controlled, clinical trial data. Vaccine effectiveness is the understanding of how well a vaccine works in a real life non-controlled setting. Moderna’s clinical trials informed the vaccine efficacy whereas ongoing vaccine monitoring and reporting following wide spread vaccine roll out will inform the vaccine effectiveness.

The Moderna vaccine is not currently recommended for certain populations.

At this time, the vaccine is only approved for adults 18 years and older. NACI recommendations advise that the COVID-19 vaccine should not be offered routinely to the following populations, who were excluded from the initial clinical trials, until further evidence is available4. This includes people who are:

• Immunosuppressed due to disease or treatment

• Individuals with an autoimmune condition

• Pregnant or breastfeeding

• Under 18 years of age

The GNWT will actively monitor the status of further approvals and will provide updated information as it is available.

The Health Canada vaccine approval process is thorough, proven, and trusted.

Vaccinations must be safe, effective, and meet the highest quality standards. Health Canada has a thorough and trusted regulatory system that authorizes all vaccines for distribution. Under normal circumstances, it takes about ten months to review vaccine submissions. However, recognizing the urgent need for COVID-19 vaccines, the federal Minister of Health signed an Interim Order to allow for more flexibility to speed up the review and authorization of drugs and vaccines for COVID-19. This quick response did not compromise safety and quality. In addition to this initial review process, Health Canada will continue to receive and review new information as it becomes available from the manufacturer. As the vaccine is rolled out, our routine vaccine reporting program will also identify and report any concerns as it continues to ensure that the vaccine is safe, effective, and of high quality.

The collaborative efforts of global partners helped speed up the development of COVID-19 vaccines.

Creating a new vaccine can take years. However, the development of vaccines for COVID-19 is progressing quickly for many reasons, including:

• Quick adaptation of existing research programs such as those focusing on RNA- and viral-vector-based technology;

• International collaboration among scientists, health professionals, researchers, industry, and governments;

• Increased dedicated funding;

• Quick recruitment of participants for clinical trials;

• Rapid set-up of clinical trials to prove efficacy of the vaccine; and

• Reduction of time lags in the vaccine approval process.

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CommunicateObjective 1: Instill confidence in the safety and efficacy of the COVID-19 vaccine, and empower NWT residents to make informed choices about getting vaccinated.

Objective 2: Provide timely, accurate, and relevant information to NWT residents on a regular basis.

DistributeObjective 5: Provide the COVID-19 vaccine to all eligible NWT residents in 2021.

PlanObjective 3: Ensure vaccines are distributed in a timely, culturally respectful, and efficient manner while maintaining vaccine integrity.

Objective 4: Prioritize those at risk for severe outcomes from COVID-19 and those at high risk of importing COVID-19 to the territory.

Monitor & ReportObjective 6: Monitor vaccine safety, effectiveness, and coverage to inform local and national decision-making.

Key Components of the NWT COVID-19 Vaccine Strategy SARS-CoV-2 is a new virus which causes COVID-19 infection. This novel coronavirus required authorities around the world to learn quickly, adapt to emerging evidence, and respond appropriately to limit spread and save lives. The NWT COVID-19 Vaccine Strategy will be no different. The COVID-19 vaccine is new and as evidence evolves, we will learn and adapt accordingly.

The COVID-19 vaccine strategy will be continuously reviewed and informed by new evidence as well as feedback from communities and providers. This information will allow the GNWT to make improvements and adjustments while remaining nimble in response. There are four components of the Strategy:

• Communicate

• Plan

• Distribute

• Monitor and Report

It is important to note that as we move through each component of the strategy that there will be continuous adjustments made to our approach as we aim to meet our objectives. For instance, there needs to be ongoing communication and updates for the public now that vaccine distribution has begun.

Within each component, the NWT aims to achieve the specific objectives shown below:

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Communicate People are at the center of any effective immunization program. Significant vaccine uptake is necessary in order to protect vulnerable residents and stop the spread of COVID-19 at the population level. To achieve this, we will need to instill confidence in the safety and efficacy of the COVID-19 vaccine, and empower residents to make informed choices about getting vaccinated. We will also need to provide timely, accurate, and relevant information to NWT residents on a regular basis.

The following actions will be required in order to realize these objectives:

1. Work with Indigenous government and community leadership to understand community needs and perspectives.

NWT residents and leaders know their needs and communities best. The NWT Chief Public Health Officer (CPHO) and other health system partners have met with, and will seek ongoing guidance and feedback from, Indigenous government and community leaders to inform a culturally respectful rollout of the vaccine. Continued collaboration with communities will allow for a deeper understanding of residents’ perspectives and how to tailor communications to meet their needs.

We are mindful that the rollout of this vaccine may bring up feelings of concern or fear associated with historical and lived experience of communicable disease, particularly for Indigenous peoples. An effective vaccine program must be informed by listening, understanding, and addressing these valid concerns. Extensive work is underway with leadership to ensure timing, communications, logistics, and ongoing support meet the needs of each community.

2. Provide information to residents that is accessible and understandable in order to help them make informed decisions about vaccination.

Accurate and understandable information is the foundation of any successful vaccine program. It forms the basis of healthy behavior and informed decision making. We are committed to delivering information in ways that are clear, easily understandable, and accessible to all residents to support informed choices about getting vaccinated.

Communication about the COVID-19 vaccine is being finalized in all 11 NWT official languages where possible. All communication materials use plain language and a variety of methods specific to Northern audiences.

3. Keep residents up to date on rollout and changes to evidence or recommendations.

Residents will be regularly informed of where and when they will be able to access vaccinations using a variety of communication methods to ensure optimum access. Any changes to vaccine evidence or recommendations, including any potential impacts to the COVID-19 vaccine strategy, will be shared with the public. We will closely monitor updates related to the delivery of COVID-19 vaccines and update our strategy as needed.

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4. Address vaccine hesitancy and barriers to vaccination.

When a vaccine is available but people delay or refuse to get vaccinated, it is often because they: are not confident in the vaccine, it is not convenient to get the vaccine, or they do not see the importance of the vaccine. This is referred to as vaccine hesitancy7.

Vaccine hesitancy is complex and can stem from a variety of factors. This can include, but is not limited to: past experience, knowledge, perceived importance of vaccination, trust, and risk perception2 as well as geographic barriers, cost, and mistrust of the healthcare system7. It is important to acknowledge and understand the different reasons or barriers that may contribute to vaccine hesitancy. This understanding will allow for issues to be mitigated throughout the planning and rollout of the COVID-19 vaccine.

Plan The rollout of the COVID-19 vaccine is one of the most complex in Canada’s history. Successful distribution across the NWT hinges on the quality of planning and practice that takes place both initially and on an ongoing basis. There are a number of areas in which the GNWT Department of Health and Social Services (HSS), in partnership with health and social services authorities and federal partners, are focusing their planning efforts. These include transportation and delivery logistics, safety and security, education and training, data collection, reporting, and monitoring. The objective is to ensure that vaccines are distributed in a timely, appropriate, and efficient way while maintaining vaccine integrity. We are committed to the following actions:

1. Build on existing partnerships with communities and governments.

Successfully importing, shipping, and distributing COVID-19 vaccines requires several unique considerations. To ensure safe handling requirements are met, the GNWT is working closely with the federal government to ramp up its capacity to meet the logistical challenges of receiving and distributing the vaccine across the territory.

Logistical planning is a collaborative effort primarily between the territorial health and social services system and federal partners. The Immunization National Operation Centre (NOC) for COVID-19, in collaboration with provinces and territories, acts as the federal coordinating center for managing vaccine distribution across Canada. NOC and Joint Task Force North (JTFN) are supporting logistics planning and project management for vaccine rollout in the NWT.

Interdepartmental collaborations as well as partnerships with local health care providers and community leadership are being leveraged to ensure planning is relevant to the realities of each community. This approach includes identifying local barriers and strengths, including the availability of infrastructure and resources to support mobile vaccine clinics and effective communications.

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2. Building on existing vaccine delivery expertise.

Thousands of vaccines are delivered and administered each year in the NWT. This includes annual flu clinics, as well as routine and specialized vaccines. Vaccine delivery and standing up vaccine clinics is not new. We have local staff with lots of experience to lead this work across the territory.

The NWT will use lessons learned from the H1N1 pandemic vaccine rollout where 63 per cent of the NWT population was vaccinated in less than two months. Though uncontrollable variables exist which may prolong the time it takes to administer the vaccine, we aim to achieve a high overall uptake of the COVID-19 vaccine.

3. Recruit and train additional staff.

The Northwest Territories Health and Social Services Authority (NTHSSA) will deploy small mobile vaccine teams, made up of up to eight health care providers and support staff, into communities. These teams will help the local health care staff who are considered the experts in their communities. This approach requires recruitment of additional staff to assist, as local health care providers may not have the capacity to participate given ongoing local operational demands.

If anyone on these vaccine teams has travelled outside of the NWT, they must self-isolate for two weeks before they are allowed to travel to any of our communities.

All healthcare staff in the NWT are required to complete a specialized immunization program called Education Program for Immunization Competencies (EPIC) before they can deliver vaccines. Many of the providers already have this training; however, the Moderna vaccine is a new type of vaccine and additional training is required to ensure appropriate storage and handling.

Prior to vaccine delivery, health care providers will participate in a learning session about past Indigenous experiences with illness and disease in the NWT as well as strategies for delivering culturally safe care to support appropriate vaccine delivery. This training recognizes that historical experiences with systemic racism and negative experiences associated with communicable diseases have occurred in the past and aims to ensure that they are not perpetuated.

4. Maintain the safety and security of residents, workers, and the vaccine product.

Teams are working to ensure the mobile clinics follow public health order requirements laid out in the Emerging Wisely plan, and that appropriate mitigation measures are in place to protect residents and health care providers from spreading COVID-19 infection.

Additionally, teams are working with the NOC to ensure that threats to vaccine safety, such as breaks in its cold chain, are minimized.

5. Procurement and strategic positioning of resources.

In partnership with the NOC, we have procured the appropriate supplies (specialized freezers and coolers) to maintain the vaccine cold chain, and related supplies (syringes, sharps containers, alcohol swabs, and personal protective equipment) required for vaccine administration.

We are working with centralized points of distribution to ensure accessibility to regions and efficient transportation within the NWT.

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! Prioritization The NWT is in a fortunate position to expect enough vaccine to vaccinate 75 per cent of the eligible adult population in the first three months of 2021. Doses for the whole population will not arrive at the same time. Therefore, a phased approach is being prepared for vaccine delivery starting in January 2021 that prioritizes residents who are at highest risk. As vaccine supply increases, vaccination will be expanded to the entire eligible population starting in March 2021.

NACI has provided independent expert advice regarding priority populations for the early vaccinations. NACI’s recommendations have been incorporated into NWT priorities while still reflecting the unique phase of the pandemic, geography, and population of the NWT. This approach will remain flexible and will be adapted based on evolving transmission patterns.

Two guiding principles which informed the NWT COVID-19 vaccine prioritization include:

1. Risk of severe disease from COVID-19; and,

2. Risk of importation of COVID-19.

The risk factors of initial consideration for immunization include:

• Advanced age: the risk of COVID-19 severity starts to increase after age 60. Most vulnerable in this category are those who live in long-term care facilities or in shared living environments.

• Existing chronic disease and comorbidities: residents with conditions like chronic lung, kidney, or heart disease are at greater risk for experiencing severe form of COVID-19 and its complications. Those who travel outside the NWT regularly for medical care are at even greater risk.

• Likelihood of transmitting COVID-19 to those at high risk of severe illness and death is another important consideration. This risk group may include frontline health care workers, or those who provide care to high risk vulnerable populations.

• Resident workers who live in NWT but work regularly out of territory or at work camps with out-of-territory workers are at elevated risk of acquiring COVID-19 and transmitting to family, household members, or those in the community.

• Living in a remote community, including Indigenous communities, with limited health infrastructure in comparison to larger centers.

What will this look like?Residents who fit within the identified priority groups will receive the vaccine first. We expect this to take place between January and February 2021. The general population can expect to have the opportunity to be vaccinated starting in March 2021. While information and resources about the vaccine itself will be hosted at www.gov.nt.ca, specific dates and times of vaccine clinics will be updated as information is available at www.nthssa.ca.

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DistributeTo ensure a successful roll out, the GNWT will take a phased approach to vaccine distribution. The first shipment arrived on December 28, 2020. The timing of subsequent vaccine arrival in the NWT is still being determined. A phased approach allows the GNWT to remain flexible to respond to variables such as the timing and quantity of vaccine shipments, as well as other logistics while working towards the goal of ensuring priority recipients are among the first to get access to the vaccine. We will be required to be flexible in our operational plans. These plans will ensure effective storage, distribution, administration and reporting based on manufacturer and Health Canada requirements. We will continue to engage with communities and Indigenous governments as details about vaccine delivery and quantities are confirmed. All eligible NWT residents who would like to be vaccinated will have access to the COVID-19 vaccine in 2021.

To ensure that all residents have this access, we are committed to the following actions:

1. Deploy mobile vaccine clinics to all communities in the NWT.

To make vaccines as accessible as possible, the health and social services authorities are creating multiple mobile teams who will coordinate vaccine delivery to all 33 communities. They will support local health care staff in the immunization program. Mobile teams will be equipped to stand up vaccine clinics and administer vaccines in a safe and efficient manner. Teams will stay in the community as long as required to ensure all those eligible have to opportunity to be vaccinated. This approach will vary based on community needs. Given that the Moderna COVID-19 vaccine requires two doses, mobile teams will return to communities roughly 28 days later to administer the second vaccine. All members of the mobile teams will be from within the territory or will have completed the mandatory 14 day self-isolation period prior to travelling to communities as per public health orders.

Vaccine clinics will be set up and carried out based on Emerging Wisely requirements to effectively mitigate risk of COVID-19 transmission. This includes monitoring gathering size, appropriate spacing, and ensuring that enhanced cleaning requirements are met.

2. Communities are locally engaged prior to mobile vaccine team arrival.

In order to support residents to make informed decisions about vaccination and increase confidence in the vaccine, we will ensure residents have enough time to have their questions and concerns addressed. Opportunities to engage residents before the mobile clinic staff arrive to the community will be prioritized.

In most communities, local health staff will be available to provide information before immunization clinics begin. Prior to the mobile team’s arrival, a health care provider will engage with community leadership to address any misconceptions, hesitancy, and answer any questions. Translators and interpreters will be used whenever possible to ensure that information is written in plain language and available in Indigenous languages using a variety of communication methods specific to northern audiences.

The goal is to support relationship building and trust by providing time and space for residents to make informed decisions.

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3. Vaccines are delivered in an accessible, inclusive, and culturally respectful manner.

In order to support vaccine uptake, all potential barriers that may prevent vaccination must be addressed. This includes, but is not limited to: cost, convenient access to vaccine clinics, language barriers, and potential fear of contracting COVID-19.

To ensure that each resident has access to the COVID-19 vaccine, the GNWT will be offering the vaccine free of charge to all residents with support from the Government of Canada.

In cooperation with local community governments and organizations, the GNWT will ensure that residents with accessibility concerns will be supported to have access to vaccination.

Finally, to further ensure residents are making informed decisions, the GNWT will make an effort to ensure that Indigenous language interpreters are present at the vaccine clinics where possible.

Additional barriers may be relevant to a specific community. To this end, vaccine clinics will be designed in consultation with local health care staff and community leaders who understand the needs of their communities best. Therefore, vaccine clinics will be locally informed to meet the unique needs of each community.

Monitor & ReportStrong immunization surveillance systems are essential to monitor the safety and effectiveness of COVID-19 vaccines. Ongoing surveillance of real-world vaccine use is a well-established part of Canada’s vaccine system and is made up of three main streams:

• Safety – monitor if the vaccine causes any new adverse reactions or if adverse reactions are more severe or present more often8.

• Coverage – monitor the percentage of residents that have been vaccinated7,9.

• Effectiveness – monitor how well the vaccine works to slow disease transmission and reduce illness, death and hospitalization1 in uncontrolled (non-clinical trial), real-life circumstances10.

Canada’s vaccine surveillance involves health care professionals, vaccine manufacturers, all provinces and territories, the Public Health Agency of Canada (PHAC), and Health Canada to alert public health authorities of changing trends or unusual adverse events that were not previously reported.

Surveillance data provides the required information to adjust vaccination programs, and to achieve a level of vaccine coverage that will slow disease transmission and ultimately decrease rates of illness, hospitalizations, and deaths. The objective is to monitor vaccine safety, effectiveness, and coverage to inform local and national decision making.

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This objective will be met through the following actions:

1. Leverage existing territorial and national reporting systems.

The GNWT and PHAC have well-established reporting systems already used for other vaccine reporting. Reporting is initiated at the front line reflecting each vaccine administered. This information is submitted to the CPHO, which is then used to create a territory-wide ‘picture’ of vaccine uptake and experience. This data is then sent to PHAC using existing channels to inform a broader, national understanding of vaccine coverage, safety, and effectiveness.

We will continue to use existing vaccine reporting to monitor vaccine coverage and to help us understand how many residents have been vaccinated and how many are required to achieve herd immunity. Herd immunity means that enough people have been immunized, making the spread of the specific disease between people less likely12.

Additional reporting systems will be established as required to ensure consistent and effective reporting on vaccine data.

2. Timely reporting on Adverse Events Following Immunization (AEFI) and vaccine administration.

Vaccines are closely monitored once distributed and can be quickly removed if safety concerns are identified. Notwithstanding the rigour of clinical trials and excellence in vaccine delivery, a small number of Canadians may experience an adverse event following vaccination. Like any medication, vaccines can cause side effects and adverse reactions. After being vaccinated, it’s common to have mild and harmless side effects. This is the body’s natural response as it works to build immunity against a disease. It is also possible – but very rare – for someone to have a serious adverse reaction to a vaccine.

The Canadian Vaccine Monitoring System includes federal, provincial, and territorial partners that can rapidly share and disseminate information to appropriate stakeholders regarding vaccine safety signals or other relevant issues8. Regulations within the NWT Public Health Act require timely reporting of any adverse events following vaccinations from all health care providers. Information is reported directly to PHAC from the NWT Office of the CPHO and contributes to national and international vaccines safety monitoring efforts.

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What happens next?The availability and rollout of a COVID-19 vaccine is a turning point in this pandemic. Emerging Wisely stated that all public health measures may be lifted once a vaccine for COVID-19 has been approved, produced, and distributed to vulnerable populations. Before any measures can be safely lifted, the vaccine needs to be delivered and the rate of infection needs to be reduced territorially, nationally and globally. The NWT is deeply interconnected with other Canadian jurisdictions. This means that national vaccine rollout as well as the ongoing status of the pandemic across the country is factored into the decisions made about territorial public health restrictions.

Over the coming weeks and months, as more research is completed and more COVID-19 vaccines come on the market, recommendations may support vaccination for a greater proportion of the population. Changes to recommendations will happen once there is strong evidence on vaccine safety and efficacy. Until that time, it is important to remember that there are a number of residents who will not be able to receive the vaccine. This includes residents who are pregnant or breastfeeding, immunocompromised, have an autoimmune condition, and those under the age of 18.

Finally, public health measures like travel restrictions, self-isolation requirements, and rules for gatherings and businesses have been put into place to mitigate the health impacts of COVID-19. These measures have been instrumental in the protection of the public but have taken a toll on residents of the NWT. The goal has always been to return to our normal way of life and remove these measures. The successful rollout of a vaccine will be a major step in getting back to a “normal” way of life, but it will take time and perseverance. Following vaccine delivery, the restrictions will be reviewed and adjusted to reflect the risk level. It will be important to maintain these protective measures and continue the behaviours we have successfully adopted, including physical distancing, enhanced cleaning and disinfection, staying home when you are sick, keeping your circle small, healthy respiratory practices, and wearing a mask. We truly appreciate the dedication NWT residents have shown throughout the course of this pandemic and are counting on these efforts as we enter this next crucial stage.

References1. Public Health Agency of Canada (PHAC). (2020, December 8). Canada’s COVID-19 Immunization Plan: Saving Lives

and Livelihoods. Government of Canada. Retrieved from: https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases/2019-novel-coronavirus-infection/canadas-reponse/canadas-covid-19-immunization-plan-en.pdf

2. Dube, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J. A. (2013). Vaccine hesitancy: An overview. Human Vaccines & Immunotherapeutics. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906279/

3. Government of Canada. (2020, December 23). Health Canada authorizes Moderna COVID-19 vaccine. [press release]. Retrieved from: https://www.canada.ca/en/health-canada/news/2020/12/health-canada-authorizes-moderna-covid-19-vaccine.html

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5. Centre for Disease Control and Prevention (CDC). (2020, December 18). Understanding mRNA COVID-19 Vaccines. Covid-19. Retrieved online: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html

6. Government of Canada. (2020, December). Moderna COVID-19 Vaccine: What you should know. Retrieved from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/moderna.html

7. World Health Organization (WHO). (2015, August 18). Vaccine hesitancy: A growing challenge for immunization programmes. World Health Organization. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes

8. Government of Canada. (2019, December). Vaccine safety and pharma-covigilance: Canadian Immunization Guide. Retrieved at: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-2-vaccine-safety/page-2-vaccine-safety.html

9. Government of Canada. (2020, November 12). Vaccine coverage in Canada. Retrieved from: https://www.canada.ca/en/public-health/services/immunization-vaccines/vaccination-coverage.html#a2

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11. Centre for Disease Control and Prevention (CDC). (2018, May 16). Immunization: The basics. Vaccines and Immunizations. Retrieved from: https://www.cdc.gov/vaccines/vac-gen/imz-basics.htm

12. Centre for Disease Control and Prevention (CDC). (2020, July 30). Glossary. Vaccines and Immunizations. Retrieved from: https://www.cdc.gov/vaccines/terms/glossary.html#commimmunity

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