How One of Canada’s Poorest Neighbourhoods Avoided a COVID Crisis

From $5 incentives to on-the-street vaccines, Vancouver’s public health authority created a tailored approach to vaccinating the Downtown Eastside.
Downtown eastside vaccine clinic
Hayley Devine receives a COVID-19 vaccine at a pop-up clinic in Vancouver's Downtown Eastside. All photos by Jackie Dives 

On a recent afternoon in April, Sharon Janzen and Wendy Stevens walked along Vancouver’s East Hastings Street carrying a basket filled with alcohol swabs, bandaids, hand sanitizer, and dozens of pre-drawn syringes containing the Pfizer-BioNTech COVID-19 vaccine. 

As they canvassed Vancouver's Downtown Eastside, an inner-city neighbourhood in the grips of a deadly overdose crisis, Janzen, a nurse with public health authority Vancouver Coastal Health, and Stevens, a peer operations coordinator, asked residents if they’d had a dose of the vaccine. Stevens would explain she had been vaccinated, and allay any concerns, while Janzen would administer the vaccine to those interested. 

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The unconventional tactic is one of many strategies the public health authority has been using since January to try and achieve herd immunity in the Downtown Eastside. As a result, of the 10,000 people living in the neighbourhood, around 9,000 have received at least one dose—in addition to 2,500 people who work in the area. 

“That’s huge. It’s so significant; we haven’t seen that uptick in cases, we’re not seeing hospitalizations in the same way,” said Elizabeth Holliday, director of Overdose Emergency Response and Harm Reduction for Vancouver Coastal Health.

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Elizabeth Holliday oversees harm reduction for Vancouver Coastal Health.

Due to underlying health conditions, Downtown Eastside residents who contract COVID-19 are four times more likely to be hospitalized and four times more likely to die than people in the general population. In addition, living in shelters, Single Room Occupancy hotels (a form of low-income housing with shared bathrooms and kitchens), and other congregate settings can make it difficult to isolate when someone does get COVID. 

The virus has pitted the community against duelling public health crises, as thousands of British Columbians die of fatal drug overdoses, most often linked to the synthetic opioid fentanyl. 

While VICE World News was on site at a pop-up vaccine clinic set up inside an overdose prevention site in the Downtown Eastside Thursday, two people overdosed in the alley and were quickly tended to by support staff and paramedics. 

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For months, COVID cases in the Downtown Eastside were low, until an outbreak in late August resulted in around 50 cases; in February the area hit a high of 80 cases. 

“We were sort of sitting at a high simmer of cases,” said Holliday, “so what we would expect I think is the continuation of that trajectory and a possible escalation exponentially potentially if it went unchecked.”   

In addition to four days of mass vaccination sites specifically for Downtown Eastside residents, mobile clinics have been dispatched to the streets, tents, and into SROs. The public health authority offered newly vaccinated residents $5 or a coffee card—to make sure they stuck around for 15 minutes afterwards so they could be monitored for side effects. 

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The health authority’s contract tracing and isolation strategy for Downtown Eastside residents included using hotels used to help people with the virus isolate, and providing them food, water, cigarettes, as well as a safe supply of drugs to help them stay in place. 

“Supports were provided to them where they lived and where they wanted to be, which could even be in a tent or shelter,” said Vancouver Coastal Health spokesperson Deana Lancaster. 

Brian O’Donnell, a board member with the Vancouver Area Network of Drug Users, said initially there was a lot of paranoia about why the neighbourhood was being prioritized in the vaccine rollout.

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“People were afraid of getting microchipped or being given the virus,” he said, noting members of the community are naturally distrusting of authority figures. 

But he said those fears subsided as more people got vaccinated. He said the $5 was a good incentive. 

To combat vaccine hesitancy, peer ambassadors—people who’d lived in the Downtown Eastside—were recruited to do community outreach. 

“The (question) we often heard is, ‘Why us first? We’re not prioritized for anything else so why all of a sudden are you prioritizing vaccines in this community?’” Holliday said. “Regardless of how I present myself, I come in with a different level of privilege and power and that is always a complicated thing in this neighbourhood.” 

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Guy Felicella does peer outreach in the Downtown Eastside, where he used to live.

Peer clinical advisor Guy Felicella, who lived in the Downtown Eastside from 1993 to 2013 and is now in recovery, said there were some residents who waited until they saw enough other people receive a dose before getting their own. 

“One of the main questions I’d always gotten is, ‘Did you get vaccinated, Guy?’ and I’m like ‘I sure did, pal,’” he said. “For people who knew me from my past, if I did it, they felt comfortable to get it as well.”

On Thursday, the B.C. Coroner’s Service said 158 people died from overdoses—about five a day. More than 7,000 British Columbians have died of a fatal overdose since the province declared it a public health emergency in 2016. 

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Holliday said overdoses are increasing in part due to people following “stay home” public health advice—and no longer visiting safe consumption sites. Additionally, many SROs put “no guest” policies into place. 

“People who maybe would use together were using alone in their home or on the street, so we saw an uptick in people dying in their homes but then also outside,” she said. 

She wants people to know that it’s safe to come back to safe consumption sites and overdose prevention sites. 

“With the reduction in COVID in this neighbourhood, these services are here, they’re safe. We all want people to be welcomed back in.” 

Follow Manisha Krishnan on Twitter.