Welcome to the sixth in a series of webinars as part of the Empowering Temporary Foreign Workers Project. This project from Pyros Canada is funded by the Government of Canada's Temporary Foreign Worker Program. My name is David Ivany and I'm part of the Empowering Temporary Foreign Workers Team and I'm honored to facilitate this webinar today. Also joining me from the micro justice team at Kyros are Shannon, Cheryl, and Alfredo. So hello everyone. And if you want more information about the project you can go to the Kyros Canada website. So, I would like to acknowledge that the land we are meeting on today is the traditional territories of indigenous peoples across Turtle Island. We thank them for allowing us to meet and learn together on their territories. To the original caretakers of this land which we stand. I acknowledge the traditional territory of many nations including the Mississaugas of the Credit, the Anishinaabeg, the Chippewa, the Haudenosaunee, and the Wendat peoples where I am right now. I was here for thousands of years before us across Turtle Island. We honor the struggles and the lives of those who gave themselves for it. For all those here today we acknowledge the ancestors beneath our feet and the land on which we stand. With our ears to the ground we can hear them. The Cree Nation, the Métis, the Diné, the Anishinaabe, the Dakota and the Kota Nations, the Inuit, the Blackfoot, the Inu, and all nations that came before us and those yet to become. An infinity of footsteps of those who long called this land home, the unfolding of bundles, the undoing of colonization, and the opening of this land to allow treaty to come alive. We affirm our relationship to each other and to the land. We acknowledge and pay respects to the indigenous nations and ancestors of this land. Once again, I acknowledge the traditional territory of many nations, including the Mississaugas of the Credit, the Anishinaabeg, the Chippewa, the Haudenosaunee, and the Wendat peoples where I am right now. This webinar, Vaccines and Migrant Workers, Accessibility, Concerns, Mints and Facts, Protection and Prevention, Staying Healthy in Times of COVID-19. We'll explore how we can help migrant workers have accurate information they need to make informed decisions about vaccinations. First, we will go through a review of vaccines and vaccine information with a question period with doctors afterwards. Then we will look at key issues around vaccination and migrant workers. And finally, we'll hear from people with experience in vaccination clinics in Ontario. The agenda is quite full. So I would say let's get started. So first, to talk about the vaccines and vaccine information, we have Dr. Catherine Yew and Dr. Willem Bunn-Heinegen. Dr. Catherine Yew is a family physician and medical director of Health Access, Thorncliffe Park, as well as an assistant professor in the Department of Family and Community Medicine at the University of Toronto. She was an emergency physician for 10 years and is now a passionate advocate for her family practice patients, becoming a recipient of the 2019 Ontario College of Family Physicians Award of Excellence for her leadership in supporting vulnerable populations. In her role as medical director, physician engagement in health systems designs at HATP, Dr. Yew has been establishing strong collaborative relationships between the health, social and educational neighbourhood agencies in order to implement intersectional and seamless delivery of care to patients. Dr. Yew is also chair of the board of directors for the East Toronto Family Practice Network, a network of family physicians with a mission to create equitable access to interprofessional care for all family practices. And Dr. Willem Bunn-Heinegen, Dr. Will, works as a family doctor at Woolwich County Community Health Centre in Wellesley, Ontario. He has also worked for over the past decade as an occasional physician with migrant worker health clinics with various initiatives, particularly OCOW and the Grand River Community Health Centre. Dr. Will first gained an interest in supporting migrant workers after visiting them in rural Ontario, as well as communities in both Mexico and Jamaica with his wife and migrant worker scholar, Janet McLaughlin. So with that, I give it over to the doctors. Thank you so much for being here today. Hi, thank you for this opportunity. I just wanted to say that a shout out to those of you who work in the CHC, I certainly work for Flemington Community Health Centre and I think we are here with a lot of knowledge together and I'm actually here to learn as well. I'm pleased to have the opportunity to speak at a high level around the COVID-19 vaccination, but I certainly won't come. I'm not here as an expert. I'm here as a colleague. I'm happy to share what we've been doing from the perspective of working within East Toronto and from the urban perspective. I gather there's our audience includes many from outside of the city, of course, and I'm grateful that Will is here with me to do the presentation and who also brings that lens. I hope that folks can see the slides that Will and I had put together. Can I get a thumbs up if you're actually seeing the slides? So we were asked to give a little bit of an overview of COVID vaccination in Canada and Eduardo kindly gave us a number of sort of, I guess, common questions that have come up in his experience with migrant worker support groups. I guess the first sort of question was around the status of vaccination in Canada and as most of you are probably well aware it's ramped up significantly. Thank you. And globally at this point there's been over a billion vaccine doses that have been administered. In Canada as of April 23, we've had about 10 million people who have received a single dose of COVID vaccine and that amounts to about 25% of the population. And around, well, just under one million who have received two doses so would have been fully vaccinated and as you know that's in part due to the the emphasis on getting a first dose in to provide some partial immunity, as opposed to getting everyone quickly vaccinated with the two doses. In Ontario at this point there have been almost five million doses administered and about 360,000 people who are fully vaccinated. So globally, I guess we were asked just to comment about that. As you can see from this map, there is significant sort of, you know, vaccine inequity. We can see in the United States so it's color coded the darker colors would indicate higher vaccination rates and the lighter colors lower. In Canada, we're sort of near the near the top, the United States it's, you know, almost 50% from what I understand here in Canada we're at about, I said 25 to 30% by comparison here on the map they show Ghana which only has 2.8% that have been vaccinated. And of course with the communities that you would be dealing with the migrant workers tend to come from, you know, Mexico, Jamaica, and Trinidad and Tobago. So, in those countries, Mexico, my understanding is it's maybe around 10% vaccination rates right now with the with the first dose. And in Jamaica, I believe it's, it's lower, maybe about 5%. So significantly fewer people have been vaccinated in those communities. I think in Trinidad it's even a bit lower yet. We've been asked to speak a little bit about the Ontario's COVID vaccination rollout plan and I come at this from the perspective of a community family physician who has been involved in systems planning in the local neighborhood level, as well as an advocate for the communities that I serve in terms of getting more supplies to those at high risk. It is a complicated rollout plan, but I hope that in the next few slides I can provide a bit of an overview that can help us navigate our migrant workers and our patients to the, to the right place to access the vaccines. I recognize that in the audience we've also got somebody from Winnipeg, welcome. I have been asked to speak about Ontario and I actually am curious as to how the rest of Canada is faring on this. As folks know, the vaccination rollout plan is a collective effort. There's the federal government who secures the vaccines for us from outside of the country. As you know, the supply is not coming from internally so we don't have production of vaccines in our country. And Ontario's vaccination plan is specifically rolled out according to the following phases, where phase one is high risk populations that are being served initially and then there's phase two. Since early April, vaccines have been offered to migrant agricultural workers as part of phase two of the vaccination rollout. Phase two of the vaccination rollout in general has focused on older adults, people in high risk settings, frontline essential workers and other populations that are at greatest risk of illness. The migrant workers are prioritized under quote, the employer provided living accommodations for temporary foreign agricultural workers in the top prioritization during phase two. So they should have been at this point in time, depending on which public health unit you are in, eligible to get vaccines. As we will hear a bit about today, the vaccination offering to migrant agricultural workers has taken place through pilot clinics, as well as now ongoing vaccination rollout clinics. These clinics have been regional, happening with workers traveling to centralized community clinic locations, or to mobile clinics or on farm clinics that are set up, as well as through an airport vaccination clinic initiative at Pearson airport in Toronto. So there are a number of factors that affect access to vaccines. The number one factor that has really been impacting our distribution and rollout of the vaccine is the supply. I mentioned earlier vaccines are not produced locally in Canada and we are certainly basically having to work with our other partners around the world to bring vaccines to us. Different public health units vary with regards to its distribution plan. As mentioned earlier, I know in East Toronto, what we've been tasked to do is to try and distribute our vaccinations through mass vaccination centres, primarily the City of Toronto sponsored mass vaccination centres. We've understood that these mass vaccination clinics over the course of the first few weeks of implementing this type of rollout distribution are not the best places for many of our newcomers and patients with navigation challenges to access vaccines in. So we've moved towards a much more hands-on approach in getting into the community. I know that the neighborhood organization has been a strong partner in our Thorncliffe neighborhood approach. For example, we've been moving more towards mobile unit clinics, specifically in pop-up formats where we, without as much long term notice to the community, have pop-ups that as vaccine supply suddenly because of Covid, as vaccine supply suddenly becomes available, as well as as data comes in around hotspots in terms of all of Toronto. So what hotspots are are those high-risk neighborhoods and the high-risk neighborhoods are identified based on the most recent Covid prevalence data, which of course changes every day. The idea is that as we quickly get the data on where the highest prevalence is that we would quickly respond to that by doing the race against Covid with vaccination strategies that are particularly targeting the hotspot neighborhoods. Vaccination for workers are strongly recommended but not mandatory. This is even the same as for healthcare providers. Vaccination is based on a personal choice and workers should not phase reprisals if they don't get vaccinated or choose not to get vaccinated. Do you know that vaccination is not the end of it all? We actually continue to encourage and must encourage all of those who get vaccinated to continue following Covid-19 safety practices and precautions. In my position myself, this is one thing that I really would say to all of my patients is that it is your personal choice. Let's look at the particular nuances that you consider in terms of making that decision for yourself. I am a big vaccine advocate, I think given the risks and the tragedy that I've seen in terms of number of deaths around Covid cases, I am really pushing hard for my patients to really consider vaccination. However, I do sit down with them and go over what it is that means more to them and their particular situation that would help them make the decision that they feel comfortable with. I was asked to talk I guess a little bit about the vaccines that have been approved in Canada so far and the mechanisms they employ. A caveat is that I am not a pharmacist or an expert at biochemistry so it will be more just a family doctor kind of perspective on these. Currently in Canada there are four vaccines approved for use and they broadly work based on two sort of mechanisms. The first one is mRNA vaccines and the Pfizer, BioNTech and Moderna vaccines use that mechanism. Just broadly how they work is mRNA is a single stranded molecule that basically is instructions for coding proteins. So synthetic mRNA is generated and put into a vaccine. It's coated in a little lipid molecule in order to protect it and that is injected and the mRNA goes into the after injection, protects your cells and basically teaches, tells cells how to make the spike protein and the spike protein is the protein that is on the coronavirus and it uses that protein to get into cells. So it's an ideal target for vaccines because once your body produces antibodies to it, it could neutralize the actual COVID virus if you were to become infected. A couple things I guess that just in terms of misconceptions around the mRNA so it is not a live virus, it's just instructions on how to make one particular protein on the COVID virus. There's no effect or interaction with DNA in any way. The virus in fact never, nothing enters the nucleus which is where DNA is. And once the cell produces the spike protein, it essentially gets neutralized by your immune system and your immune system thereby learns how to recognize that spike protein and if you were to get infected, you could immediately neutralize and thereby prevent severe infection. So the mRNA vaccines have been shown to be quite effective. The both are about 95% effective at preventing infection two weeks after the second dose. There is of course partial protection after the first dose. Which is why we're promoting that as a starting point. And it's been shown to be actually also very effective at preventing severe disease so even if you are in the small percentage who could still get COVID infections, you're much less likely to need hospitalization. The other class of vaccines are known as viral vector vaccines and that would be the Oxford AstraZeneca or the Johnson and Johnson products. So in those products, they actually, the vaccine uses a, it's called an adenovirus, which is a type of virus that's typically linked to, you know, for instance, the common cold, a fairly harmless virus. And that virus has been genetically engineered to not be able to replicate. So normally a virus, you know, enters your body and replicates and produce an infection. In this case, the virus cannot replicate. So, and they've also further engineered the, the, this adenovirus to produce that same spike protein that I mentioned in the previous slide. So in this case, the, the viral vector vaccine would be injected and the adenovirus gets essentially enter cells and then the DNA within the adenovirus gets pushed into the nucleus and they use the, the cells, I guess, the cells protein making mechanism to then produce that spike protein. And at that point, it's kind of the same as the RNA vaccines where the protein is produced, it gets presented on the cell and recognized by the immune system. And the immune system then is able to recognize that spike protein for any future infections with actual coronavirus. Thanks, Will. I mean, the, the explanation to the science behind the mRNA and the viral vector vaccines is a very difficult one. And Will, that was an amazing explanation. I would just like to share as part of the workforce vaccination hesitancy that I've been involved with over the past couple of months. I've been surprised to be seeing so much misinformation as I'm sure many of you already know of. And they're through different social media channels, WhatsApp, Facebook, what have you. And I think that it's one of those important aspects that we need to support our patients and our clients with in terms of just muddling through what information to actually take in and understand and believe in. And so that was sort of our thought around the attempt to kind of explain the mechanisms behind the mRNA vaccine as well as the viral vector vaccine. It's very complicated, but it's absolutely an amazing advancement in science and I myself have had the, been lucky to actually receive the mRNA vaccines and both of them. And not going with and have been wearing proper PPE and have been working the past year since the pandemic began with as a frontline worker with patients and have been have stayed well. I wanted to comment a little bit about the clinical trials and racial or ethnic diversity among participants and to just share and probably something that our community of patients would be very interested in hearing about is that there is good clinical data on the inclusion of racially diverse participants in clinical trials. Before a vaccine is approved for use it is tested on a large number of people to confirm that it works and is safe. These are called clinical trials scientists who tested the COVID-19 vaccines included thousands of people in their trials, including racially and ethnically diverse populations. For example, the study for the Moderna vaccine included about 30,000 people, although conducted mainly in the United States, there was a focus on including people of diverse racial and ethnic groups in the study. And it included approximately 11,000 people from communities of diverse backgrounds to ensure its safety across different populations. The Pfizer vaccine with the study was conducted in the USA, Argentina, Brazil, Germany, South Africa and Turkey. The Janssen or Johnson and Johnson vaccine study took place in the USA, Brazil, South Africa, as well as five other countries in Latin America, including Argentina, Chile, Colombia, Peru and Mexico. The analysis of the AstraZeneca vaccine combined two studies that took place in Brazil and the United Kingdom. So based on clinical trial data these vaccines have been noted to prevent disease very effectively. These vaccines of course had passed the Health Canada rigorous process to be approved in our country. However, I must say we do not have long term data to be definitive about how long the effect of these vaccines are going to last. I wonder if this is a personal thought as a medical and scientific background that certainly the evidence is yet to come for this, is whether we will be expecting booster vaccinations over time in the next several years, much as we have flu vaccines and a booster shot of that every year. So as a provider that's given lots and lots of vaccines and seen many patients who've been vaccinated, some of the common side effects that we've seen and are well documented are soreness at the site of the injection, body chills, chills, feeling tired and feeling feverish. By far most of those who I vaccinated or have I spoken to and have been documented to have been vaccinated will report some of these side effects. They're quite, they're minor for and and they usually last around 48 hours or so sometimes a little longer. I think it's very important for us to guide our clients to get vaccinated to understand whether they're having a serious reaction or a common side effect. Common side effects will will not cause any harm. But of course the serious side effects are the ones that we need to look out for. When do we know that it's serious? Well, if the side effects such as fever, for example, last more than a couple of days, they should really be seeking medical attention. Sometimes for some of our patients, it's the first time they've had out to actually be in outside their apartments or their buildings. Unfortunately, there are some rare stories where I've heard that they've actually, this is where their first outing and that's when they actually pick up COVID before their vaccination has actually become effective. So very important for folks to actually understand that if they're having a fever for more than a couple of days, shortly after their vaccination to seek medical attention. As mentioned earlier, the serious side effects are extremely rare. As part as vaccination continues this clinical studies do continue and as part of this public health agencies in different countries may pause and reassess certain vaccines, adjust their use we've certainly seen this in Canada. As part of ensuring the vaccines are safe and effective. I think it's worth discussing briefly what anaphylaxis is. Anaphylaxis is rare. It is a serious allergic reaction to the vaccination. By far majority of anaphylactic reactions occur within the first 15 minutes after the vaccination is given. So, the vaccination centers are have usual protocols that involve an observation period after a vaccine is given, so that if an anaphylactic reaction happens there are care providers and healthcare professionals around the receiver as a vaccine to help right away. While it is a serious side effect, as mentioned rare, it is something that we are well burst in as healthcare providers to respond to, often with an epinephrine injection to much like when somebody has a peanut allergy, for example. It's usually manifested as swelling shortness of breath, maybe a drop in blood pressure and feeling faint. And really, if there's any concern, seeking medical attention is very important. Now, in my experience with hundreds and hundreds, maybe thousands of patients that have already fortunately been vaccinated in thorn cliffs. Thankfully, I haven't, I have yet to see an anaphylactic reaction. So I'm just stressing how rare it is, but how important it is for us to be looking out for this. Thank you, Dr. So, I was asked to speak, I guess a little bit about rare side effects that maybe people have been reading about in the news. I think this might be actually also an opportunity to get if anybody has specific questions, but I think I would address one of the newsworthy items that probably people have been hearing a lot about which would be the AstraZeneca complications that we've seen in some rare cases. So I guess one other thing I should mention is my understanding is that the migrant workers are getting the Moderna vaccination when they are being offered the Moderna vaccination when they do come. So the AstraZeneca, this may not even be necessarily an issue that you would have to address when you're talking to migrant workers, but nevertheless, it's good to know about it. So the main thing, there's a rare complication that can occur. It seems to be happening in about maybe one in 100,000 to one in 250,000 cases where the immune response to the vaccine is quite strong and you can get some rare complications of certain blood clots and decreased, decreased platelets which are like cells involved in the blood clotting process. It's important to kind of look at I guess the how common this side effect can occur versus the complications and that we would see from COVID infection. So that's an important I guess discussion to have with anybody who is kind of asking questions about this. The particular blood clot that we do see with this is a type of blood clot that can occur in the brain. It's venous sinus thrombosis. So what would, you know, if somebody were to get the AstraZeneca vaccine, we would typically warn them that if they were to have severe headaches lasting, you know, beyond three days or other unusual side effects like bruising or bleeding that they should seek immediate medical care so that they can get tested to make sure this is not occurring. So, yeah, so I guess the, like I said, the risk, the risk seems to be quite low. And the given the risks and benefits, of course, of the vaccination, I think generally the public health agencies would say that the benefits far outweigh the risk and AstraZeneca is still recommended as a vaccine to prevent COVID infection. Yeah, and I guess this, this is just to say that if there are any questions about it that, you know, one of the my the my workers might may have that it's always, you know, advisable to connect with a primary care provider so that they can discuss their specific situation. Right. So it's different. Everybody has their own circumstances and risks, risk of complications, if they were to get COVID. And obviously the migrant worker population is at an increased risk because of the congregate living and the rapid spread that can occur in those settings. And so all of these things would have to be taken into account and then also the health, the personal health issues that a migrant worker may have so it's best to discuss those with a primary care provider if possible which of course I know is tricky because of the nature of their employment and getting health care is not always straightforward but if possible, that would always be advisable if there are any questions. That's great. I just wanted to, we'd love to answer questions and open it up for discussion but I did want to just add one thing around our experience with AstraZeneca. You know, I think that it's quite unfortunate that it's gotten such bad press in terms of a vaccine in itself. And when we look at the numbers, one in 250,000 is a very small number risk compared to the high rates in some areas of our hotspot neighborhoods, up to 20% prevalence of COVID vaccination when we screen certain populations in certain neighborhoods. And the risks of blood clots if you do contract COVID is also quite high. So, you know, I guess it's all about weighing the risks and the benefits and what one is willing to take and what isn't and certainly I'd be very respectful of the personal choices of all of my patients but I do worry about some of them. And I know that there are a higher risk and this is the only available vaccine. You know, I would say that if this is the only vaccine available to you I would absolutely jump on this and get it. You know, I could share some stories of some of my patients that have unfortunately gotten COVID and I wasn't able to provide a vaccine to them because there was no supply. And it's just it's one of those very hard discussions to have and I could imagine that as we support as many of you in the call support migrant workers themselves and we have a personal relationship with them that it's even harder to watch them get sick. You know, it's not just a number or a population that we're serving right it's a one to one relationship that we have. And I have been in that situation where I've seen somebody get sick and wish that I've been able to provide a vaccine. Thank you so much for all of that information. I've learned quite a bit. I have a few questions already in the chat so loose was wondering, like, they're both mRNA vaccines. Like, is the Pfizer and are the Pfizer Moderna vaccines the same or Yes, or is there a difference. So I guess I can speak to that a little bit is I don't know if I'm am I still, I'm not muted right now. I can hear me okay. Yeah, so they are very similar in terms of how their underlying mechanism works but they are different vaccines produced by different companies. They at this point are, you know, for instance, not interchangeable. It's not that you can get one and then get a your second dose of another. In fact, the time frames or recommended time frames are a little bit different for the second dose anyway. But the way they work, the efficacy like how well they work, the side effect profile are all actually quite, quite similar. I can't say that I've run into any major differences between the two. Okay, thanks. And before I get to the next question to let you to let everyone know. If you want to raise your hand, you can click on reactions and raise your hand and we will get to and then whatever questions are put in the chat, I will move into the conversation. So I have a hand from Christina Gomez and then we'll get to the next chat question. Yeah, my question is. Okay, we had the vaccine and the doctor says it's going to be. I can say 90% of protection for the person who has the vaccine. What happened? And what will be the percent of protection when you have to wait. Eight weeks after you get the second doses, because I believe that the percent of the effect, I can say the percent of cover for that person is going to get down. So we see that that we, we don't have covering the third or four. The lowest percent of cover for the second doses is going to affect the person that means that that person had to get the third shot because the percent of the cover is going to be down after he wait for weeks of six weeks after he get the second dose. Very good question. It's a question that I've been asked a few times before and I appreciate the question being asked if I, if we had, you know, unlimited supply and had the control over that. Ideally, we would get the vaccinations as soon as they're meant to be given in terms of the studies and the available information that we have. I don't know that we will know exactly what the answer to that question is for a little while yet because the studies haven't been completed. You know, it is unfortunate that we don't have enough that we have to space things out. However, we do know that when you have at least one vaccination and more of us are vaccinated than collectively, we are protecting each other from getting COVID. The other piece that I would want to share, and this is again take this information with a bit of caution without as much evidence available, but certainly from many of my colleagues in the front line, those who work in the emergency department and my infectious disease colleagues locally. We have noted that when patients come in sick with COVID, one of our main questions that we asked them is, have you had a vaccination yet? And if they've had one vaccine, we've noticed that they tend to get less sick patients who at least had one vaccination. So I wish I had a more concise answer for you for such a good question. It is not up to us in terms of, as a family doctor, as a small frontline providers in terms of determining who gets vaccine, who gets the vaccination at what time we have to follow the guidance that's given to us. And we hope that we just get more supply in the next several months and that we can shorten the interval between the first and the second dose. Thank you. I'm going to get to Aswani's question in a second, but Jerry is wondering, were workers who received a dose of the vaccine in Canada, given proof of vaccination, and the name of the vaccine that was administered. So I can comment on my experience with COVAXON, which is the portal that we use to enter the information once we've given vaccinations. Every time we give a vaccination, there is a receipt that's produced, whether it's printed and given to the individual, some patients actually say I don't need a receipt, but it's in the system. I'm not sure if anyone in the audience and the panelists can comment on that based on their direct experience with our migrant healthcare workers, migrant workers. I can comment, pardon me. So anybody who is registered to receive their vaccine from our perspective, we obviously have them in the COVAX system so they get that information. The email address that is provided or the phone number where they could receive messaging is where that information goes, so it's dependent on those things. We offered, because of the sensitivity for some of the workers that did not want the email of the farm HR person, which was often the person helping to manage these large groups for us. So we offered to have an email address for COVAX community health center to be able to utilize that email address as well if they didn't have one to use. So we tried to be as sensitive as possible to the needs of the workers. So I think this is a very important question and just one I think to bring to in terms of my experience at a table is that some of our patients with perhaps health conditions like dementia or issues with navigation health literacy, for example, that they, we have had patients who asked for the vaccine when they've already received the vaccine and one important step to undertake if we're helping navigate patients to get vaccinated is to look in the COVAX on system to see if they've already had the vaccine and which one and these and this information should be in there. Now having said that I recognize that there are patients who are undocumented who are also eligible for the vaccine and may not have had their names in the system for a specific reason.  So just something to think about if we're navigating our clients to get a vaccination. Did you want to ask your question? Yes. One of my questions was already answered and it was about the time between the one dose and the second dose. But then that I am already here and I would like to ask that I have heard to that the AstraZeneca yes it can produce blood clots. But if you recognize the symptoms they are very easy to treat. Is that correct? Yes, I think the challenge for us is actually recognizing the symptoms because it is rare and we're not seeing a lot of them. But for my colleagues who work in the hospital who have seen one or two of them perhaps we do have protocols in terms of how to address it once we know and it does involve a blood test. As part of the diagnostic work up we can easily actually see a blood test that shows the platelet counts going down as a marker for this condition. And we have our hematologist specialist colleagues to help us right away and blood thinners can be given if needed and diagnosed. So really I think it's very important for us as the main points of contact initially of patients to just be vigilant about asking patients to receive the vaccine who got symptoms that don't sound like the common side effects to check in with a family doctor. And to have that especially if it's an AstraZeneca vaccine that they're getting to just evaluate if this is a common side effect or the extremely infinitimally small rare likelihood of getting a blood clot. So I guess I'm continuing with that. So, like I know it's hard for migrant farm workers to reach out primary health. What would be the advice for them? Like, what would be the advice in that situation called 911 even though it's not an emergency where they should direct their concerns if they are feeling odd side effects. Yeah, that's a tough one to answer for me. You know what 911 is probably not the best option I'm going to guess. I'm not sure that our emergency or EMS colleagues. I can't speak for them I have high respects for them but I'm not sure that that's a great way to actually find a diagnosis because again the challenge is diagnosing. And I, you know, primary care is some is a space that I'm very, very committed to. And I hope that our migrant workers have good access to primary care. Can I ask this question from my CHC colleagues what are your, what's your advice and getting access to our services. Stay tuned for the presentation. Great. Awesome. Glad somebody has a good answer for this. Okay. I guess, maybe one thing I would add is for. Sorry, my phone ringing. It depends on whether or not they should call 911 it would depend largely really on their symptoms I suppose I mean if they were truly unwell and they had neurologic symptoms you know unusual stuff like weakness on one side of their body slurred speech. You know, of course 911 would be very appropriate in those scenarios. If they had a persistent headache right beyond four days after their vaccine, then it would probably make more sense if they were able to to go eat they could go to the hospital, because you need some blood work in that case, or seek go to an urgent care clinic if sometimes outreach work outreach clinics are available I know with limited time frames but if they happen to be have access to one that would be an option. And then there's always telehealth as well right in terms of, they could call telehealth and maybe talk about their symptoms and at least get get an opinion. The answer may just be go to the hospital but it is at least you'll get to talk through some of your symptoms with someone to help triage the situation a little bit in terms of, you know, should be calling 911 or taking away till tomorrow, or should you go see, you know, go to the hospital. So, we do have some of the other questions that are coming up in the chat are going to be part of the other presentations that are coming up I know we're running short on time with Dr you. And we have plenty of questions and I, I hope some of them will be answered as we move through the other panels but I'm going to take one more from Fanny, because I saw her hand up just under the wire. And to let you know lose, we are going to be talking about that through the talking about the issue raised through the panels as well. So, I'm going to have a quick question. We have a few workers in some hotels in this area, Haldeman County. There is one also in Branford or two that came in March had the vaccine and they they they have covered right now. So they are in quarantine. Also, there is some that are coming. There is one in the area of single that was in quarantine, got the vaccine at the airport. He has not been out of quarantine, but tested positive. So, is there any information given out to the workers at the airport or wherever. Because some of them think that they are getting the virus from the vaccine. So I think it will be very important to probably give out information in Spanish. I don't know if there is anything in Spanish, but they get very anxious thinking that they have the virus and that's why they are getting sick. One of them has not even been out of the hotel, but yet he has covered. So, so the anxiety level is really high. And my question is, do we have any information to give the workers about reaction or COVID-19 or with the vaccine. So, that's my question. I can answer that. David. So, I was part of a pilot project. And as money could also answer to this as well, where we were at the airport, you know, just providing information to my workers. And I was just coming questions about the vaccine, you know, which vaccine they're getting side effects and that kind of stuff. So they are being provided with the information in regards to, you know, the vaccine that they're going to be receiving. And whatever questions they have, we try to answer the questions as well. Yes, and I would like to add that. So, they are receiving these bulletin or these resources that were developed through with OCCAO collaboration of OCCAO and other organizations. These resources were, I think in my opinion, I helped with them too and they were really well made because they were like, they are easy to understand. They are very specific and they are like very cultural like center. So, they receive these and they receive a small conversation or like vaccination.  So thank you so much to Dr. Will and to Dr. Yu for coming in and speaking with us. I've learned quite a bit and I know that there are more questions to answer and hopefully through the process of the next few speakers we can get to. And we will have a question and answer period at the end, but yes, overall, thank you so much to Dr. Will and Dr. Yu. And we're going to move on to our next presenters who are going to be talking about some key issues around vaccinations that have arisen through this process. So, we have Eduardo Huesca who's going to be talking about ensuring vaccine related information reaches workers. Eduardo Huesca is an outreach worker and program coordinator with the Occupational Health Clinics for Ontario workers. He has worked directly with migrant agricultural worker communities for over 15 years presenting occupational health and safety workshops on farms and in the communities at health and information fairs. Since January, Eduardo has focused on helping to get vaccine information to agricultural workers across Ontario. So take it away. Thank you very much, David and thank you everybody. So yes, thank you so much. I'm Eduardo Huesca. I work for the Occupational Health Clinics for Ontario workers and I have the pleasure to work with a lot of folks that are on this on this call. So I'm just going to be basically sharing a bit of information around vaccine information for agricultural workers, international agricultural workers or migrant workers. In no means are the resources I'm talking about the only resources in town there's a lot more now available, a really great, you know, initiatives of video use and just really engaging and good materials. A little bit of an overview of what exists and kind of this, this focus around just making sure we're getting good, you know, well sourced information to workers to help them make an informed choice. So, just next slide. Oops, okay. So yeah, you know, the biggest focus for us has been, you know, as as agricultural workers continue to be offered vaccines is to ensure that they have access to well sourced information. So that, you know, they can make a confident and informed decision. As we know, there's a lot of misinformation going around across all communities. So it's been really important to try to really try to really address that. There's been a lot of, you know, worries, questions, concerns I know from my family, from friends I know, again, across all communities. And, you know, a lot of communities have different experiences with a vaccination, you know, in some in some communities, some folks have experienced vaccination, you know, throughout their whole life or versions of vaccination other folks haven't. So it's definitely important to recognize that and really work with communities from where they're at, in terms of the vaccine and vaccination kind of understanding. And though, again, as folks are mentioning, you know, vaccination goes back quite a long time and it saved a lot of lives globally in terms of different vaccines and now the COVID vaccines. Definitely it makes sense there's a bit of an ease there's a bit of concern because you know we haven't necessarily seen something in a lot of our time, you know, lives in terms of the scale and context of what's going on with COVID vaccines but it makes sense that, you know, folks are nervous and we're, you know, hoping to support them in that. So another part that we kind of based some of our work around this on is, you know, recognizing again that the vaccines are strongly recommended as an important part of beating this pandemic, and as an important part of protecting ourselves and those around us from serious illness with COVID-19, recognizing, however, that it is a personal choice and that no, nobody including agricultural workers should be forced or pressured to vaccinate. And again, that makes the aim of all of this to really just support communities with good information so that they can make a confident informed choice. We're an occupational health clinic or a network of occupational health clinic so it's very important for us to always talk about the other safety, you know, precautions and practices that are still very important to protect and stop the spread of COVID-19. And, you know, as was mentioned by Dr. Yu, regardless of vaccination, if somebody chooses vaccination or not, it's still very important to follow all of those COVID-19 safety precautions. As we continue to hear more about the risk of shared air and smaller particles of the virus, so, you know, it's just really important to be in the know to update, be updated with science-based information around keeping safe in addition to the vaccines. And as mentioned, you know, this comes a bit about us still not being completely sure about, you know, the duration of the vaccines in terms of their protection and as well as some, you know, some data looking at, you know, the vaccines protecting from illness versus how effective they are actually protecting from infection and transmission, right? And so it seems like early data is showing that the vaccines are protecting folks from actually getting it or spreading and other experts can kind of maybe speak a bit more to that. But that's still a bit unknown, so it's still a focus on following precautions. I just had one slide here just to talk a little bit about how we jumped in onto this topic, a bit of a timeline. So around December, we started kind of hearing a bit of talk from communities around worrying that a lot of the agriculture worker communities, you know, had hesitancy around vaccination, had questions, had concerns. Some of this actually came from some colleagues at Ontario Health West who had in December and earlier than that had been offering the flu shot to farms. And they noted that there was a pretty low uptake in some cases that they were outreaching to farms. And so that kind of got them, you know, thinking and asking questions about that. I know that other vaccine flu vaccine clinics had a more positive experience during those months, but that definitely was something that was flagged. In January, it became kind of more, you know, the issue started becoming more raised that we started hearing from other community members that, you know, in speaking to two workers, they were, you know, hearing again misinformation or myths or were just had questions that were circulating, you know, here as well as in the home countries as well. In January, that kind of spurred us to connect with some stakeholders to form a little bit of a vaccine information working group. And so we had various stakeholders join, including folks from Windsor Essex, the health unit, the public health, sorry, the CHC there, OMAFRA, the Alliance for Healthier Communities, different organizations that were just trying to get together to say, how can we start preparing for, you know, information and getting it ready, you know, to start addressing or having this reach workers. And the idea was really to avoid this having to happen very quickly, right? Avoid having to then start struggling with getting key information workers so short of a timeline when they're being offered. And so that was kind of the attempt to start this as early as possible in January. And I put the little square above because it was, so vaccination phase one, this was all happening while obviously vaccines in Ontario are already being offered and taken up. So we kind of had that looming a little bit that vaccination started, but, you know, it didn't feel like a lot of workers had a lot of information at that point. And I'm just going to quickly mention, so Oak how we collaborated on a project with the Ontario Food and Vegetable Growers Association. And the project focused on COVID-19 resources. So we were really focused on trying to identify what COVID-19 safety information workers had received and what information they hadn't received or what information they still felt like they needed to receive. And we asked other questions too, but that was kind of the gist of it. So as part of this research project, we ended up doing some worker interviews. So we didn't interview a lot of workers, the total number of workers we interviewed was 27, but they were pretty in-depth interviews each interview lasted about an hour. And some folks that actually conducted the interviews are here today as well. But we interviewed 10 workers from the Caribbean community, 10 workers from the Latinx community, and seven workers from the Thai community. And the interviews took place from February 21st to March 22nd, 27th, sorry. And I just put really quickly here because this is something that jumped out to us during those interviews that, you know, a large percentage of folks noted that they had not received, I'm sorry, had not received information regarding vaccines. So that was kind of a bit, you know, a bit of an alarm to us. Again, the numbers are small and it's not representative of everybody. And this was also during early on in the process of vaccination. But it was something that we definitely took note of. Similarly, we also got some data around whether workers felt that they had received enough information around vaccines. And so 26 out of 27 workers that were interviewed noted that they didn't feel like they had received enough information. So again, that's kind of similarly got us, you know, identifying that this was an important issue to look into. Again, the numbers are low, but it was definitely important. So we also asked as part of the survey, or the question, the interview, sorry, this these additional five questions. So what do you know about the COVID-19 vaccines? Whether what information would be helpful? Sorry, I'm having a little bit of trouble with this. Is there anything that you want to know about the vaccines? Do you have any concerns about these vaccines? So what are your concerns? So we got a lot of responses from workers about these. I'm not going to share going to them too much here due to time. But a lot of them were generally what we're hearing from a lot of other communities, you know, in terms of misconceptions around fear, side effects, whether again they can get the vaccine, sorry, the virus from the vaccine. Will it affect fertility, things like that? But it gave us a good basis to start trying to really figure out maybe what were some key points of information to look at. But again, it's very similar to a lot of the misconceptions or concerns that are among everybody basically that we hear. So early on we tried to look around for examples of different organizations kind of also trying to figure out how to best communicate vaccine information to different communities, especially communities that have language barriers that speak different languages. Because a lot of, you know, the information initially was coming out mostly in English, but there are a lot of transition has happened now and a lot of transition happened quickly, but definitely we're looking for best practices. So we connected to a group of great organizations working with newcomer communities. So Refugee 613, Okasi, Taibu Community Health Center in Scarborough in Toronto, who works with the black community, the Chinese and South Asian legal clinic. And so they had quickly partnered with some doctors from the University of Toronto, and they started very quickly putting together these bulletins, these vaccine information bulletins. And they were really meant to try to really get at some key information. The doctors, it was a great kind of collaboration between the groups that really know their communities, you know, know what the communities need, know how, you know, best to communicate with communities with healthcare, you know, providers and who have that expertise around the vaccines and everything. So it was, you know, that connection that was really great to see. So it kind of inspired us to start putting together some materials ourselves. This one was based on that bulletin of the other group, and so this is among some of one of the resources that Donna and Suani mentioned that has been circulating a bit. So this is just a general bulletin. We were able to produce it in English, Spanish and Thai. And again, as you can kind of see, and I'm going to share, I can share this whole PowerPoint with anybody's interested in, I can put links in so you can get access to all of these resources as well. But it was just really meant to be a basic run through of, you know, a bit of introduction to, you know, key messages around vaccination, a bit about the vaccines, as mentioned the difference between the mRNA vaccines and the viral vector vaccines, but just keeping it kind of general to help promote a bit of an understanding among workers. We made it into a video as well. So the video is also available. It's about five minutes and shares that information as well. We then also made this resource that looked at busting myths or addressing myths with facts. And this kind of came again from those interviews that we did with workers around some of the misconceptions or myths that workers had heard. So the idea was to try to make this, you know, interesting in these short kind of, you know, messaging. And the person who really put this together for the project was Maverick Maher, who I think is also on the call as well. So it was a lot of work around trying to see the myths and then, you know, source, well sourced answers to these to share with communities as well. And these are, this was also made to a video and the videos are available as well. The last resource we put together was a vaccine aftercare resource. So this also felt important for us. And as is kind of coming out of the conversation is to have, you know, workers understand maybe what are the normal things that they might experience, you know, that that seems to be kind of a general experience for folks having a vaccination. And as but then to also be aware of, again, the rare cases of more serious reactions, but to be clear about what these reactions could look like so that, you know, they have a piece of mind to to know what they're looking out for, and, and kind of at least have some guidance around what to do. And even to provide a little bit of assurance that you know when they get the vaccine again there's that period that they're going to and I think more people are going to talk about that who are actually, you know, ran the clinics and worked at the clinics but that you know time that they spend waiting after they get the vaccine to to be taken care of from by medical professionals. So that sorry that resources also available in the video. So here I just wanted to quickly share a landing page so the Windsor Essex Health Unit wasn't able to join us they're quite swamped as like as everybody is. And in the middle of their community vaccinations but I wanted to share, and this type of page, I think exists in a lot of the regions. So just that I've been working a bit with care and Windsor Essex so we've kind of had a bit of experience more with with the Windsor Essex Health Unit. So this is the landing page that they've put together that I really, you know suggest checking out it has a lot of resources. Again, each region, it might be doing things a bit different so it makes sense for for each for each person to connect their public health unit and their local clinics, but this just gives you some general information they've, they've put some information that's general not necessarily regional specific around, you know, you know information for workers and whatnot. A big part as well as here you can see the FAQs or the facts or the, you know, kind of questions. And these actually seem to have come from workers themselves who went through the vaccination clinic at Windsor Essex, and the staff made note of some questions that they were asked. And then now they've included it here to kind of re re engage that to the community right so it's kind of this continually understanding what concerns and questions community still have and and getting the answers and kind of relaying them back to the community so it's it's kind of trying to create a dialogue even though really this is it's more a resource a bit of a static resource but it's that this is a good component I've seen as well in terms of a passage. This, the health unit has kind of put a focus on informing employers what their roles are. So it in very clear language talks about employers role, you know, to provide information around vaccines in worker preferred language and, you know, they support in terms of actually coordinating the worker or the travel to the vaccination clinic but they make it clear that no way an employer pressure or or reprise a worker for choosing not to to that. And interestingly here they also note that it's in the employer's responsibility to support the worker ensuring they have access to primary health care services which touches on what we've mentioned but I know colleagues soon we'll talk a bit more about that. So much more these are because I think I'm probably already pretty over my time but these are just other resources the Windsor Essex Health Unit did a walk through video so they actually took a video going into the space of their community vaccine clinic. And I think that you know all of the spaces and they had narration in multiple languages so the work you know so this was spread across worker communities channels on so that the workers could kind of even get a sense of the community could get a sense of what that run through of that space would even look like. I'm not going to touch too much about this because I know my colleague from the Mexican Council it's going to talk more about this but the Windsor, you know again this partnership between the health unit and the community was so important. And so I know that the health unit for international workers and Windsor Essex really took all the information the health unit was putting together and started really passing it through all of their, their community channels. And so I know that the health unit mentioned that it was, you know, integral to to having this information reach workers. Again there's more resources that I think are good to to now consider and I can share these afterwards so you know again here viral vector vaccines. And I did it. In terms of this here so you know, I would just say, there's been examples of folks getting really creative so Jane Andres who's part of the Kairos network, you know put together this really this video with the local musician, you know talking about in using music, which you know I know has been greatly received among the Caribbean community. And it's just to kind of continue to partner with your local health care providers and health units to continue to identify what concerns what vaccine related concerns and information gaps workers still have, and trying to then you know troubleshoot getting getting the answers and also to kind of really support the building of confidence among workers to ask questions. So this line is from the Windsor Essex resource but it says you know, just getting workers to feel comfortable asking questions or even pausing a situation to say I still might not be getting it yet. I have some questions and I know it gets tricky in terms of the role of the of the vaccinating staff to answer too many questions or how deep that history is going to get and maybe we'll get into that but but that's definitely something. And then the last thing actually that we have. Okay, yeah, it's just these yeah sorry these 911 videos just around again concerns around workers and and well the unfortunate deaths that have happened during isolation. I know we've talked about that 911 might not be necessarily but as we unpack that it does really become very important to have workers know what to do an emergency if they're being left alone and know who to call whether it's somebody directly or 911 because it can really make that difference and these materials were put together by a colleague of mine who's who's up next as well. And yeah, so I'll leave it there sorry about that. Thank you, Eduardo, we're going to move right into the next presenters who are Michelle to and Stephanie my own so Michelle is a certified occupational health nurse with the background in administration, research, education, consulting and clinical work. Michelle has focused on the health and working environments of workers for the past 21 years and since 2006 a large part of her work has been concentrated on migrant agricultural workers in Ontario, and Canada as a clinician educator, researcher and advocate Stephanie mail is a PhD candidate in the medical anthropology program at the University of Toronto, where her research investigates the ways annual temporary employment under Canadian Canada's seasonal agricultural worker program influences the health and the well being of Jamaican migrant workers, and is also a project coordinator with TNO is empowering migrant workers in Ontario project. So, thank you so much for contributing and take it away. Thank you so much, David and to everyone at Kairos thanks very much for inviting us to speak here today as members of the migrant worker health expert working group, Michelle and I and our colleagues Eduardo included, aimed to keep abreast of advances and issues on the ground facing migrant agricultural workers in Ontario. And most recently, the vaccination process has become a leading concern and issue among international agricultural workers in Ontario. The migrant worker health expert working group is a team of community based health researchers and clinicians and we formed in April of last year to provide timely evidence based recommendations to various levels of government related to the health and safety of international agricultural workers across Canada during the pandemic and beyond. I want to start by acknowledging the tremendous efforts by public health units to keep us all safe during these unprecedented times. We appreciate the efforts that they and other stakeholders have taken to prioritize vulnerable populations, such as international agricultural workers, because many of our worker friends from Latin America, the Caribbean, Asia and other countries, certainly do have questions and concerns about the vaccine that require accessible information delivery from health professionals, as we've touched on, and in some cases, one on one communication prior to making an informed choice. And further, we also want to draw attention to the power imbalance between employers and migrant workers in Ontario, and note that this presents unique challenges to obtaining informed consent from migrant agricultural workers. Since the inception of the various vaccination program rollouts for migrant workers in March, we have noted a number of key issues that have emerged across regions of the province. And we clarified these issues, and we formulated a series of recommendations that we then distributed via a letter to various public health units across Ontario, as well as community health centers which have emerged in this discussion as an important stakeholder and partner. This letter that we sent went out on March 29 of 2021, and I'm just going to touch on the four issues that we in the early stages of the vaccine pilot rollouts heard from workers and other stakeholders on the ground. And so the first of that was there was very little notice regarding the vaccine being provided to workers and little to no opportunity for questions or a process to ensure informed consent. And then the third issue was that workers were not provided a copy of the vaccine consent form or little if any time to read it before being asked to sign. Some did not know which vaccine brand they were receiving. We also noted that workers with chronic health conditions or other health issues which may be affected by the vaccine were not given an opportunity to consult with a medical practitioner, as is the recommendation regarding the appropriateness of vaccine. They were not asked to sign. Some did not know which vaccine brand they were receiving when they were being asked to sign the form. And then the fourth issue that we noted was that in some cases, workers were being threatened by employers that if they did not take the vaccine their employment would be affected that is they would not be called back next year, and threats of reprisals emerged as a big issue. And then sort of into the vaccination efforts we continued to hear reports on the ground and we were continued to be very happy to see some new, you know, pilot initiatives emerge in various regions, as well as the airport project to emerge. And so this also prompted a follow up letter month later which I'm going to turn over to my colleague Michelle to the occupational health clinics to talk a little bit more about. Thanks, Steph. The first point that we've noted in the follow up letter is that that certainly the vaccine portfolios in the sending countries are not the same as the vaccines that are being offered in Canada. And in Mexico, for example, I think that there's at least five different vaccines that have been approved, most of which have not been approved in Canada. So therefore not available to the sources. The one is not used in Mexico that we know of. And in the Caribbean country that present it seems that AstraZeneca is the primary vaccine that's available. But the question remains for the workers who already received an initial vaccine in their home country, whether they'll be able to get a second dose of that vaccine or something similar in Canada. And at this point in time, as we heard already that the mixing of vaccines is not done and studied and is certainly not recommended. The second point Steph already mentioned, but concerned that we continue to hear from workers threats of reprisals if they do not get the vaccines, which is not being invited back the next year. And the workers who receive the vaccination at the airport are being transported to all populations of the province. And at this point in time, it's not clear what the follow up will look like for those workers to ensure that they have their second dose in a timely manner. Workers who receive a first dose for the vaccine in Ontario have been scheduled to receive or will be scheduled to receive a second dose four months later, regardless of the duration of their time in Canada. And most contacts are somewhere in the neighborhood of six months. There are some workers who are here for less than four months and therefore trying to sort out how to ensure that they get a second dose will be a challenge, but hopefully that will be worked on. We've also heard several reports continue as Stefan had mentioned that workers weren't given the opportunity to have the questions answered about the vaccine. There's lots of information that has been made available for workers that was identified by Eduardo, etc. But we all know that if we're going to get the vaccine and we have questions about it, that we really, in some instances really need to have a conversation with a clinician in terms of whether that's going to have a negative outcome on them. And so we came up with a series of recommendations which are detailed on our website regarding the pre-vaccination period, vaccination scheduling for the first dose, vaccination scheduling for the second dose, and some particular considerations about vaccine locations and the vaccine process, particularly trying to ensure that workers would be able to ask questions about the vaccine and its appropriateness for them at the vaccination clinics. I've talked to one public health unit and they were trying to coordinate that they had primary care clinicians at all of the vaccination clinics that they were running from like a farm workers so that workers could have the opportunity to ask a clinician specific questions about their healthcare and also specific recommendations about reprisal considerations because workers, the main message is that the vaccine is a choice and if workers choose not to have a vaccine, which is different from refusing a vaccine, that they should not have negative consequences in relation to that. So I just wanted to end this section by saying thank you to Kairos and all the speakers today and especially a very big thank you to the public health professionals and community partners who are working so hard to keep everyone in Ontario safe and healthy. It is a tough go out there right now for them and we really appreciate all the efforts. If you'd like any further information about the my work, the my network or health expert working group, it's a long, long name and the specifics about the recommendations please visit our website. Thank you. Thank you so much Michelle and stuff. I'm going to be moving into a section on experiences from vaccine clinics across Ontario. So, I have a presentation from Nancy Garner. I have Nancy Garner Alejandro Noriega Donna Brown, Elizabeth Espinosa and as one of the kind of giving sort of updates from across the regions. So Nancy Garner is the executive director of Quest Community Health Center and St. Catherine's prior to this role and Nancy was the chief operating officer at Good Shepherd nonprofit homes in Hamilton and Toronto which provides support and housing for homeless individuals living with mental health and addiction challenges. So if you want to go ahead Nancy. We are going to try to have time for questions at the, at the end of this as well but we're just looking for some context across the different regions that the project is operating within. So, here is Nancy. Thanks David. So, yeah, I'm also here with Amy Fischli. Amy has a very, very, very long title she's the primary care and stakeholder engagement advisor with the Niagara region public health. And so we will be sharing this presentation with you. So this is an initiative that Quest Community Health Center and Niagara region public health and Niagara health services undertook to begin vaccinating seasonal agricultural workers in Niagara. And we thought we just do some quick introductions and I don't know if Amy if you wanted to say anything before I moved on. Just to put some context so just want to tell you a little bit about Quest Community Health Center and our seasonal agricultural worker health program. We get about 3500 seasonal agricultural workers in Niagara each year. Most are from Mexico, the Caribbean and Latin America. The majority identify as male and the average age that we see at Quest is 46 years of age but I understand the average age in the region is about 36 years of age. Some of the issues that we see it for primary care are top issues are muscular skeletal as you can imagine due to the physical nature of the work. There's chronic disease, lots of diabetes and hypertension environmental allergies and dermatological issues, often again related to the environment that they work in. Quest has been providing primary care to seasonal agricultural workers in Niagara for about 10 years. We have received some funding a number initially we were doing this on a voluntary basis, and then later received some funding from the Lynn to hire a community health worker, a half time nurse and a 0.06 of an FDA physician. Since its inception we've grown from 50 clients to over 600 and increasing every year. We see clients about three times a year so we've seen we typically have about 1800 visits with our clients. And we do this with a number of ways we provide our services at lunchtime evenings and Sundays primarily to be available to workers when they have their time off work. And we actually have two community partners in Virgil and Vineland, where we have clinics within two churches. Virgil is Cornerstone Community Church and Vineland is Southridge Community Church and we have a group of volunteers that help with that we have. I can just show you some of our partners so we have learners from McMaster University, we have nurses who nursing students from Brock. And we have also a number of community service providers that assist in volunteering with those clinics. As part of the clinics we have dieticians and counselors, we've noticed in the last couple of years that our need for counseling has increased as a result of the pandemic. And so we've ensured that there are increased resources available to the workers. We also found out last year that a number of people didn't have access to phones so we were able to. It's great having some young staff on young people on staff so you know they always want the greatest and latest phones so they've got a bunch of phones in their in their drawers at home so we're able to get SIM cards and get phones out to people that didn't have access to a phone to connect with us. Maybe I'll pass this over now to Amy just to talk a little bit about our stakeholder group and then we can talk about our vaccine clinics. This is just kind of a neat kind of intro into the the true partnership and collaboration that the vaccination clinics were in Niagara so I get the great pleasure of being the migrant agricultural worker stakeholder group chair. I just stepped into the role in this in December and I am in all of the group of people around the table and their passion and their drive so really this group came together to strengthen communication and connections with those in the community who are working with this population and really in response to the large amount of COVID-19 outbreaks that we are actually experiencing on farms. So this group really utilizes a collaborative approach to support migrant farm workers in Niagara. And as you can see probably from the next slide Nancy I'll pull up around the membership. There are individuals from various sectors represented at the table including primary care social service organizations and spiritual groups, and so many more that probably aren't listed but yeah we're extremely grateful for all of those folks and what they do for our community on the regular basis outside of the pandemic to have meaningful impact on this community. So I'm, as I'm sure you can attest to the pandemic has really brought to light many health inequities that migrant workers experience.  I'm always in rhythm with each other. With this in mind the group really set the goals of supporting access to primary care for this population and supporting and influencing social determinants of health of this population we know this is an ongoing issue. So from there the groups split into subgroups and got to work. As you can see on the screen. They did. There was a covert action planning and coordinated reach group. This group really looked at developing proactive and reactive response process maps to respond to covert 19 issues but in a really coordinated kind of way. These maps not only included primary care pieces such as testing and health checks but also connective workers to social services. And these maps truly hinged on very strong communication between members and Nancy and quest were just phenomenal when it came to this and their patients with us and trying to drive and you know break through some barriers that sometimes can exist at government levels. So and then the community, the coordinated reach piece really focused on connecting primary care with socially and culturally appropriate connects in the communities to support workers really as a more holistic kind of approach. And then there was the education and resources subgroup which is ongoing so they're developing a repository of culturally appropriate resources to support migrant workers. Which essentially is a living document on a Google Doc site we have for the group so we can update it as needed so everybody has the most up to date information. We also had the little advocacy subgroup as well which saw some agencies kind of rally around the federal government's housing consultation so there was a few submissions around that piece to. I'll end with just kind of the beyond piece so I'm again some real strengths of this group are identified and the improved connection and communication has really allowed us to respond to outbreaks promptly and really really get to workers quicker which is really what we want. So this the work of this group in the collaborations ongoing and is allowed for networking sharing information resources and opportunities which really in turn will only serve to benefit our migrant farm worker community. So yeah Eduardo hit on it earlier around the importance of connecting with community and public health so yeah I encourage you to do so if you have the opportunity within your own communities and I think with that I'll toss her back to Nancy so she can get into the good stuff. Yes, thank you Amy and I would say that it says certainly the collaboration with Niagara region public health has been phenomenal. And so this is just a photo here of the vaccine center in St. Catherine's which is the main vaccination center for the region. Niagara community Niagara's Community Coordination Task Force for COVID-19 vaccination really prioritized agricultural and farm workers, including international agriculture workers for vaccination based on a number of risk factors. So the group was identified in the context of planning for congregate living settings. I happen to have the pleasure of sitting on that task force so I was involved right at the start of these discussions. And some of those risk factors were the risk of exposure to infection with just the ongoing inflow of new arrivals, risk of transmission within congregate settings both within their living situations and also their work environments within greenhouses. The risk of severe illness or death due to increased prevalence of chronic health conditions within the migrant worker population and then just the risk to disruption to critical food supply chains in the local economy. So we felt that this was a really important group of individuals to to prioritize for vaccines. Since last spring, Niagara has seen several COVID-19 outbreaks on farms, which really has placed a fair bit of pressure on local health and public health services. So it just made sense to vaccinate this population if they were interested in receiving the vaccine to really ensure ongoing capacity to focus the resources on the roll out of the vaccine and contact tracing and managing outbreaks and really providing care to people in hospital. So the more obviously the more people that get vaccines, the less pressures on some of those parts of the system. So to be eligible for a vaccine. Let me just go through here. Let me just backtrack a bit. So, when the provincial mandate for the 80 plus individuals, age 80 plus individuals was rolled out to to receive vaccines in the community. Before the next cohort age cohort was announced there were spaces at the vaccine center to to be filled. So the task force decided to launch a pilot to see if seasonal agricultural workers were interested in in receiving the vaccines to fill some of those spaces. And so a pilot was launched. I have to say that it was quite an incredible effort on behalf of the region and Niagara health services and, and my own health center to quickly connect with farms that were identified at high risk. So those were farms that already had a number of a large number of seasonal agricultural workers on site, and we're primarily greenhouse workers. So, I spent a weekend reaching out to those farms and speaking with the farm operators and providing information in both English and Spanish, so that they could disseminate that information to their workers. So that would be who would be interested in receiving the vaccines. As a result of that, we had 316 workers who had received their vaccine, and just to talk about the logistics of some of these things. Workers have to be transported in their cohorts so so the, we really had to rely on the farm operators to work with us to ensure that their cohorts were arriving separately and that people were were provided the information in in their preferred language and had that opportunity to understand what the vaccine was and what it would entail. As well, just the logistics of all of having interpreters and physicians and parent care practitioners who spoke Spanish at the vaccine center as well to ensure that people were receiving the information in a culturally appropriate way. Also, so the pilot seemed to be fairly successful and as a result we were receiving a number of calls saying that there was interest on farms to increase the number of people to be able to receive the vaccines. So, we were able to work together. So public health, not your health services and quest worked very closely together to have two days. It was a Saturday and Sunday in April, where workers were able to receive their vaccines. So, information again went out to all farms to the various associations affiliated with farming in the region, and to let them know that this was an option. So we had over two days we had over 3000 individuals come through to receive their vaccines. And again, they had to come in their cohorts and were provided information in in their language of choice. So it happened to be at the front registration and was able to see people coming in. And I'll say that there was one fellow who just looked stood there and was looking out and and I asked him if he was okay and he just said that he just, it was just so so surreal for him to see such a large vaccine center and just he just wanted to take it all in before he got his vaccine. So he was very excited to be there. And, you know, we heard many, many comments of that regard, people could receive their vaccine if they were an international agricultural worker. If they were a Canadian worker who worked a shoulder to shoulder with the with the international workers, or any Canadian workers in the agriculture and farming sector who couldn't who can't work from home. So, that was the criteria, they did not have to have a health card if they had a health card that was great if they had an expired health card that was okay if they had a passport that was fine. So, they all understood that they were receiving the Pfizer vaccine and were provided to information about about after care as well. This community health center prior to this went out to farms and was doing educational sessions for farm owners and operators and and workers, just to answer any questions that they may have about the vaccine and how to do that preliminary work. Obviously we couldn't get to all of the farms that we went to some of the larger farms to be able to to answer their questions, as well as from the pilot, and we were able to develop a number of questions that farm operators were were asking us and we ended up having a FAQ document that went out to farm operators answering their questions pertaining to the vaccine as well so in moving forward with the larger vaccine initiative. As some people were still in quarantine, they're 14 day quarantine they were unable to get their vaccine within those two days. And so we've seen since another 670 people and plus receiving their vaccines after that weekend vaccine initiative, just because they were now eligible to receive their vaccine. And they're still trickling in. And again, we're still providing interpretation services there. So we can speak about this forever but I'll wrap it up in the last couple of slides. I just wanted to put this out here because I was very cute so at the vaccine center everybody gets a poster note and they can put it on the wall and put their comments on and I wanted to put this one because it says, you know, gracias, muchas gracias que Dios siga bendiciendo a Canadá y todo su gente. Gracias, gracias, gracias, gracias, gracias. So it's basically this individual was saying thank you very much thank you thank you thank you thank you. And that God continue to bless Canada and all of its people. It's just so sweet to see that up there. And then some comments just from the farm operators thanking thanking us, all of us who were involved in this initiative, and how grateful they were. So, I think we can end it at that point. Thank you so much Nancy. To keep moving through the regions. We have Alejandro Noriega, who is currently the acting console at the Consulate of Mexico in Leamington. Today he participates in his capacity as a member of care for international workers. Thank you very much. Good afternoon everyone. Thank you for the invitation. Today, I am participating just as a member of a community partnership, and then we have in Windsor Essex, basically providing my individual, my personal, not personal but my individual point of view on how the vaccination effort is rolling out in the Windsor Essex County.  Then the conversations that we engaged with the Windsor Essex Health Unit, which is the organization, the agency in charge of the vaccination effort in this county. And then the on-site personal experience at the vaccination center in Leamington. Care, it is basically a community association, a community partnership made up of nine agencies. We are also settled in the Windsor Essex County, but some of our activities or some of the activities of the members extend beyond in some other areas of southwestern Ontario. Care stands basically for community assistance resources and education. Our main goal is to support international workers or workers in their cultural sectors coming from abroad in different ways, providing different resources. Care was created in 2016 at the Consulate of Mexico in Leamington joint in 2018, and some other agencies have been joining care over the years. This is the list of the current members. As you may see, the members, the partners in this group provide different various services from the legal guidance of the bilingual legal clinic, the founding member, so to speak. The OCOW, as Eduardo already explained very well there, his activities within OCOW. All the way, we have various activities all the way up to meditation and spiritual support, and the Consulate I may say is the only chief organization with a different purpose with a different nature here because we are the only foreigners here. But all of us join us the common goal to take care to look after a temporary foreign workers in their cultural sector. And with this purpose, we approach the local health unit, Wichita, to see how the efforts were developing towards the vaccination, specifically for this sector for the temporary foreign workers. We engage at individual level, different organizations, different members of care with Wichita, but also collectively, at a certain point, we decided to participate collectively in this dialogue with Wichita. These conversations, I mean started, we will say from since last year, have been permanent, on a very regular basis. But talking specifically about vaccination, since last March or maybe February. As a result of these conversations, we were invited by the health unit to join the efforts, first of all, in the preparations of the actual vaccination rollout. First, delivering or trying to deliver, delivering more information to the workers in order that they have the opportunity to make a well informed decision about receiving or not the vaccination. Okay, so we develop, they develop, and we should develop several materials. Some other agencies, like HOKAU, already have some other materials that in Spanish, and we help, for example, from the consulate and the other partners in care. We help to spread the work, to try to promote this information campaign in our social media and all the possible means at our reach. Coincidentally, I mean, it is not an accident that many of the information, it was the same of very similar information that the workers were receiving since coming from Mexico. In this case I speak from the Mexican experience, because I know, I mean, I am closer to this experience. What are the main messages that the vaccination was safe, that it goes, it went through a formal process of approval for its use. Very important that the vaccination was not mandatory, it is not mandatory, but it is highly recommended. It is the best way to protect oneself and the co-workers and the community in general, also the loved ones. At the end of the day, the code was, again, to try to provide information in order to take an informed, well-informed decision. The final, or the last one of this campaign was the avidia and Eduardo already mentioned, and basically guide you through what to expect on the vaccination day, what was the path to follow at the vaccination center. The vaccination center was set in Lamington, you know, between the municipality of Lamington and Kingsville. It is, these are two areas of high concentration of foreign workers. The vaccination center was set at the recreation complex in town. It is a very proper location for these purposes. It can receive a large number of people. And the main purpose for the care partners to be there was double. First of all, to continue with our efforts of supporting temporary foreign workers on site, providing more than providing information, comparing that information in their language, being sensitive on the cultural side of things, on the cultural hesitancy, on the information that they were receiving from home. And the other thing, the purpose that we tried to achieve was to take advantage of the opportunity and offer our services, the very services we provide in a short flyer. I would say, well, first of all, the experience was very, the experience of the vaccination was very positive. The vaccination started on April 18. It continues until this week. A change of the original criteria for receiving the vaccination was to offer the vaccine to those workers living in congregate living settings. On that day, on April 18, we learned that we should widen this criteria to all the staff, farm staff in close interaction with temporary foreign workers or close interaction with those living in congregate settings. Which, again, here my personal point of view is this decision was very positive. It builds on the immunity of the community. Also, again, a personal point of view, it was very positive that the employers were engaged in a way that they provided support to the temporary foreign workers for the registration process, all the way to the transportation, and also through their supervisors on-site support also with languages and filling out the consent form and answering questions. Of course, there are things that can be improved. Of course, there are these structural imbalance that we all know is a risk. Sometimes that we put too much confidence on the employer who has an advantage in several ways. But as far as I could witness in this experience of the vaccination center, this support provided by employers has been very, very constructive. All the process for the vaccination can command which efforts. Everything is well organized. From the reception, actually going with the nurse to receive the vaccine and the waiting period for any negative secondary effect. All the process takes around 30 minutes maximum and roughly, and I think it works very well. Here, this is one of our partners on-site. On-site, when we enter in this dialogue with the workers, we have very different... Sorry for that. We have very positive feedback in general. There are some hesitancy still. There are some misguided, there are some myths, but nothing really impeding the possibility to take the vaccine. Actually, most of them being there willingly and knowing that it was also an opportunity because back home, only grandparents normally have received the vaccine. And according with... I mean, this is not a survey at all, but according with some conversations with employer, up to 90% of the foreign workers are willing to accept the vaccine. In conclusion, I would say that the experience in this dialogue and this partnership with the Windsor-Essex Health Unit has been very, very positive. In the sense that it has been an opportunity to provide support and information to the workers. We only can hope to continue with and work to continue with this collaboration in order to provide more support in the future. Of course, there are things that we can improve that needs to be improved, but in general, the experience so far has been very positive with a very constructive approach by all the parties involved. Regarding the challenges, my personal opinion, the one in the short run is to make sure or how we make sure that those workers are scheduled to crowd it back home before receiving the second shot. How do they actually receive it? In order that they have the two doses, the full manipulation, and also because it's a health issue, it is important to try to prevent to get the disease, but also because these individuals are coming back next year, hopefully, and it is important for all of us and they complete the immunization. There are other things, but so far, again, I cannot stress that this has been a very positive experience in the Windsor-Essex County. Thank you very much. Thank you so much, Alejandro. Hello, everyone. My name is Elisabeth, the outreach coordinator for the Durand region area. Here, we have been working very close with the workers, giving them information as much as we can with the vaccine, or in general, any information we can give them. The first problem we encountered was that the workers, most of them, they are in areas where they didn't have access to the internet. So obviously, we could not deliver to them through WhatsApp or emails. So we did came, our team came with the idea to make these folders and give to the workers. Either if the workers they were getting, they were getting to Canada to the quarantine in the hotel, so we were going the days before to the hotels and delivering this folder with any information we could find. And some of the information was the one Eduardo just shared before. It was the Meet and Facts, so we include whatever we could gather from the partners or resources that we have. In general, here in Durand, most of the workers are being receiving the vaccine, at least from the farms that we have more contact with. All of the things they were, before even we asked them if they were thinking what they think about the vaccine, they were just a step forward and they were asking, when are we getting the vaccine? How can we get it? How can we register? So the farm owners, they are being very engaging with the workers and making them the appointments and taking them to get the vaccine. And one of the main questions that the workers have is that some of them they did arrive in January, so they're supposed to live in the very first days of July. And it's been bringing them a lot of anxiety and they are very worried because the days that they give them to get the second shot of vaccine is into the days in August. So we have been working with the public health units here in Durand to see what we can do regarding that because even for some of the workers, they know that in the areas that they live back home, they are not receiving the same vaccines that they got here. So that even yesterday I have a conversation with some workers that they call me, did you find any information what is going to happen with us because they are very worried what is going to happen? I did get my first dose of vaccine, what is going to happen with my second one? So it's the main thing that is happening in the region with those workers that they arrive in early January, beginning of February, and they are living in the month of July if their flies and everything goes in the way that's supposed to be. And then their days for the vaccination is into the August. The other thing is that for those workers that are arriving and getting the vaccines in the airport, they do have the car where it says the vaccine that they got, the lot number and so on information, but they don't know, they don't have a day on when are they going to get the second shot or where. So this is another team that the region, the Durham Health Department is working on, hopefully receiving information from those clinics that they were in the airport and then booking those workers for when their second shot is available for. This is what I can say from the Durham region, and again, most of the farms are ready to register their workers, and even those ones that they didn't have the first shot, they have already the day that they can go and put the first vaccine. There was also many questions regarding the health care because some workers, even they are here for like a two months or three months they didn't receive their health care yet. And the farm owners reached to us what we're going to do because some workers they did not receive the health care, but we could provide them with the information that they were still eligible to go and do the vaccine and they were very happy that they could take the workers even without the health care. So this is what is happening around here and I'm not going to take more time because I know we are very sure of the time today. Thank you. Thank you so much Elizabeth. Aswani, did you have anything to add as well. Yes, thank you so much. I am working with you know, I am a rich worker. So I have close contact to the workers and I have had a great opportunity to participate in different vaccination clinics, which is great has given me the opportunity to be reaching the workers and see how it's working and how it's been accepted to them. So I've been actually in the airport and I've been in Limiton in different clinics. And I just, I know in the airport we share this document like it's the one that we created with, I'm sorry, with OCAO, I'm in collaboration with OCAO, it is like I say at the beginning a great document because it's very easy to understand. It's, it has even like some codes that you can scan and I keep telling them like do you have time and if you are for like when you're going to be in quarantine and scan these codes and then go and watch the videos if you don't want to read. So, I think mainly I can say that they are like very happy like most of them they want to receive the vaccine. They are, they want to protect themselves, they want, I mean, in Mexico the situation is not that easy with COVID. So they feel like they want the vaccine and I think all the organizations, they have done a lot of work and a really good job and how they provided, how is the process. I agree with Lisa that kind of the main concern is like the second dose, right? Like how it's going to happen, when it's going to happen but besides that I can think that resources is important because they need the resources, they need that. And when they go to the airport I think that's something that is great is that they have the time to rest, right? They go and they have time to have some time off. I don't know how it is with the other, with the other clinics I'm thinking like if they go to work, do they have time to rest? That's kind of my main concern myself, right? Like do they have time to rest? Time to take off time after the vaccine. The other thing that I can say and I can share is that the workers, they like to have the information, right? And it's very important that they know that it's completely volunteer, that we reassure that. I know at the airport we do that and the other parts with farms and things like that. I don't know how can we reassure that farmers tell their workers that it's optional. That's in my perspective that's something that will be very important to acknowledge. And I think that's it for me. I don't know if there is more questions. I just like to add David that I find out also in our region that when we give this folder or the information before they are receiving the vaccine it prevented from having questions because when they make it to many of these clinics there is no Spanish speaking person. Most of the cases, so at least they are prepared to don't have as many questions and then they cannot be answered in their own language because many of them they cannot understand English. And I like to add that like in the vaccination clinics that I have in part of it, there is always a support for Spanish or for language support. So the consulate is very active on that too. So it is been great to see that there is a lot of language supporting the clinics that I've been participating on. They have also like in Limington in the clinic in Limington the nurses they have like a line like a telephone line that they can call directly with interpreters that are online. So I think that the issue for not having interpretation does not issue in my experience. The other thing that I'm liking to do like if they are not going to do it in the airport, it is great to have those resources. So I am a rich worker. And I think that for all the organizations that we are like in close contact with my grandfather and workers, I'm just sending the information to them, right? Like videos or for vaccination, all the information that I have, which is very versatile because sometimes you can just have a WhatsApp link. So you just send it to WhatsApp and I forward that to my clients before they go to the to the clinics to make sure that they read it. Like I say that these videos so you can send the video so yes. Thank you for everybody for there's been so much information in this webinar and I'm grateful that this will be posted to the Kairos website so that people can take their time and sort of look for resources out of it and there's been quite a few resources in the chat so feel free to save that chat as well for all of the links that have been included. I want to thank everybody who has spoken and asked questions through this process. Thank you so much to all our presenters everybody for coming and we will see you at the next one which I believe is about open work permits sort of further exploring those open work permits so thank you everybody for your patience for all of the wonderful information and we will see you at the next one.