Ontario so far does not allow most adults under 60 to receive a fourth dose of the COVID-19 vaccine, putting it at odds with the United States and Quebec, and this has driven doctors in Ontario to prepare legal actions to make the province expand eligibility.

Since the mRNA vaccine’s ability to prevent infection after three or four months of injection is considered weak, alongside the increased transmissibility of the currently dominant BA.5, ordinary Ontarians are currently not eligible for a fourth dose, especially healthcare workers seeking another opportunity.

Family doctor in Ottawa, Dr. Nelly Kaplan-Myrth, said she registered 730 people to come to her office for a fourth dose of COVID-19 last week.

She added, “But then I received a call from Public Health in Ottawa on Friday, stating that the Ministry of Health asked them not to expand eligibility for the fourth dose, unless they are Indigenous, immunocompromised, or live in a community setting, so I had to cancel.”

She said many of her patients travel to Quebec, where anyone 18 or older can get a fourth dose as long as three months have passed since the last one.

In a letter she sent to the Ford government this week, the province was urged to lower the eligible age to under 60.

“People will get COVID-19 two or three times, and many of our patients work in the community and have children, and this vaccine we gave them in December or January 1, we can give them another vaccine until October.”

October is approaching, the date when Canada’s Chief Medical Officers and the National Advisory Committee on Immunization ask provinces to launch booster dose campaigns before the expected wave of COVID-19 transmission.

Dr. Fahad Razak, from Ontario’s COVID-19 Scientific Advisory Table, said there is evidence supporting immediate expansion of vaccine eligibility, but there is also much evidence indicating the province should wait until fall.

“I understand and respect voices on both sides here, but I really think we are in a period of scientific uncertainty.”

He said officials are likely in a waiting era, analyzing trends – some of which indicate a recent increase in COVID-19 transmission in Ontario – to determine the right time to make fourth doses available to all adults.

“You want protection when cases are more widespread. Ideally, you won’t get an additional vaccine for three to six months, and we have the next generation of vaccines in the fall.”

If Ontario does not expand eligibility, Kaplan Myrth says she and her lawyer Mark Boury will file a complaint to the Ontario Human Rights Tribunal this week.

Boury said, “It’s madness to let these things go to waste, Ontarians have already paid for these things.” “It would be a shame to restrict people and prevent them from taking the vaccine.”

Since December 2020, Ontario received 2.4 million doses of COVID-19.

It is unclear how many of these doses are still applicable, but most provinces asked the federal government to stop sending the vaccine again in 2021, because they have more doses than they can use.

Ontario’s Ministry of Health has been repeatedly asked how many of these 2.4 million doses were wasted during the pandemic or expired in freezers over the past six months.

Each time, the ministry refuses to answer.

The Ministry of Health declined to say if there is an imminent plan to expand COVID-19 vaccine eligibility for fourth doses, but Premier Doug Ford told reporters Thursday morning, “You will hear more about our rollout (of the fourth dose) shortly.”

For Dr. Doris Greenspon, CEO of the Registered Nurses’ Association of Ontario, there isn’t much time to wait.

She said, “Nurses are asking us, they want a fourth booster dose and don’t want it to depend on age.” “We must expand vaccine eligibility before we get deeper into this situation with more people getting infected.”

So far, Ontario nurses are heading to Michigan or New York or Quebec for a fourth dose.

“It’s terrible – how many can go to Quebec and Michigan – it’s terrible for them and terrible for patients, and that’s why it should be open.”

Kaplan Myrth says she has more than 80 patients and other advocates behind her efforts to expand eligibility.

Some suffer from immunodeficiency, others work in healthcare, and there are more in essential personal workplaces where they meet hundreds of people daily.

Razak said if the data were better and clearer, every jurisdiction in the world with vaccine stock would accelerate giving fourth doses to everyone.

He added, “Let’s say there was a final paper in the New England Journal of Medicine about the benefits of the fourth dose – we would all do this immediately.”

Meanwhile, Razak said people should make sure they get all the COVID-19 vaccine doses they are currently eligible for, and wear masks indoors and at outdoor gatherings.

“All these things provide you protection regardless of vaccination status.”

Edited by: Dima Abu Khair