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Ontario Medical Review
June 29, 2022
Dr. Eileen de Villa
Medical Officer of Health for the City of Toronto

This article originally appeared in the Summer 2022 issue of the Ontario Medical Review magazine.

One-size-fits-all approach wasn’t an option to COVID response

Toronto engaged trusted ambassadors to get vaccine message out

Like so many other physicians, the COVID-19 pandemic has challenged and tested me over the past two years. As a public health physician, I am a doctor to many. With a population of nearly three million people from many different walks of life, Toronto presents a brilliant diversity. As our city’s motto notes, this diversity is our strength and contributes to a vibrant metropolis. It also means that a one-size-fits-all approach to public health, and the COVID-19 pandemic in particular, was never an option.

Many residents come to Toronto seeking opportunity after experiencing adversity. There are also lifelong residents who have experienced, and continue to experience, racism, colonialism and other forms of systemic oppression in health and social services. In this context, mistrust of government – public health included – is understandable. The onus was on us to work to build trust with the community to implement an equitable COVID-19 vaccine strategy that benefited all Torontonians.

Physicians share their views on the unique challenges facing patients and how they address health inequities to improve access to the heath-care system.

The business of building trust with entire communities and groups of people is different than building trust with individual patients you see frequently in an intimate setting and with whom you build relationships over time. Even within different cultural and linguistic groups, there are differences in values, needs and preferences. We knew that if we were to succeed in building this trust and increasing vaccine uptake, we needed to be open and honest about what we knew and what we didn’t know and what was within our abilities and what wasn’t. Above all else, we needed to collaborate with community members and trusted partners and ensure that they were an integral part of our campaign.


There is no wonder drug that can solve health inequities. Therefore, this work necessarily involved a layered approach, relying on trusted community ambassadors to share information about COVID-19 vaccines and address residents’ questions and concerns. It also required concerted efforts by Toronto Public Health and partner staff to remove barriers to accessing the vaccine, such as transportation and translation services, and a continuous process of dialogue, engagement and adjusting our tactics to respond to community feedback.

Although disparities remain and our work continues, we have seen the benefit of this approach in rising vaccination rates across priority neighbourhoods that have disproportionately borne the impact of COVID-19. The success of the COVID-19 vaccine campaign is a testament to the fact that if we commit resources and are willing to be open and collaborative in our approach, we can make a difference.

Photo: Dr. Eileen de Villa, medical officer of health for the City of Toronto, reflects on the work required to build trust with entire communities and groups of people, and the challenge to implement an equitable COVID-19 vaccine strategy that benefited all Torontonians.

Credit is due to the many leaders across the city who realized the benefit of co-operation, rather than divisiveness. This includes community partnerships, political leadership, health-care and public health leaders, among others. It is clear that this co-operative approach has yielded dividends in tackling a complex public health challenge. It is especially remarkable when we consider that in public health, in a pandemic, the decisions are seldom easy and the choices are seldom simple.

I am optimistic that this experience offers important lessons and a foundation for future work as we turn our attention to other pressing health and social issues that the pandemic has laid bare: poor mental health, the opioid crisis and the dearth of affordable and supportive housing options. Above all else, these past two years are proof that even when the challenge seems daunting or insurmountable, we can find our way through, together.