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1 Masking and Vaccine Mandates in Ontario and Alberta Ethan Meyer University of Guelph POLS*3250 - Public policy: Challenges and Pr Professor Nanita Mohan November 17, 2023
2 Introduction: Across Canada, 4,795,000 people have been infected with COVID-19 and the virus has contributed to 55,000 deaths over the course of the pandemic (Public Health Agency of Canada, 2023). If not for public health measures imposed on citizens across Canada, the number of people infected and the death toll would be noticeably higher. Public health measures taken effectively helped curb the spread of COVID-19 and were beneficial in saving lives. In Ontario and Alberta, public health measures such as mask and vaccine mandates were imposed to reduce the spread of COVID-19. Through multiple streams theory and framing theory, a more in-depth examination can be taken into these policy processes with regard to their formulation and implementation. These theories will measure the issues of COVID-19 and explain the response taken by the government. The following paper indicates through multiple streams theory and framing theory why masking and vaccine mandates were imposed in Ontario and Alberta to reduce the spread of COVID-19. Province 1: Throughout the COVID-19 pandemic, Ontario imposed masking and vaccine mandates to help curb the spread of COVID-19. Early on in the pandemic, personal protective equipment such as masks were widely used to help mitigate the transmission of COVID-19. Essentially masks became required in all indoor settings across Ontario through mandates (Wu et al., 2020). The masking mandate was issued as a response to the drastic increase in the number of COVID-19 cases. Masks proved to be effective in reducing the spread of the illness and protecting individuals coming into contact with others (Wu et al., 2020). To impose this mandate, it was introduced by the 34 individual public health regions in the province from June 2020 to September 2020 (Peng et al., 2023). When the Ontario government imposed a masking mandate,
3 there was some backlash from a portion of the public who did not think the mandate was necessary. Since COVID-19 was so new to many, masking was seen as unnecessary as the impacts and consequences were not yet realized by the majority of the public. When the public was made aware of the dangers of COVID-19 masks became widely accepted in society. To test the effectiveness of the masking mandate, weekly reported case counts were observed for either an increase or decrease (Peng et al., 2023). However later on, observing weekly case counts did end up becoming an ineffective method to determine the effectiveness of the masking mandate when increased public health measures were imposed such as physical distancing, sanitizing of hands and vaccines, etc. Masking in Ontario was a very quick response by the government, where the masking policy was formulated effectively and introduced to the public appropriately. Weeks after the masking mandate was put into effect newly diagnosed infections decreased by 25% - 31%, (Ju, Boisvert & Zou, 2021 ). Ultimately, the Ontario government's masking mandate was an appropriate and effective policy that helped reduce the transmission of COVID-19. In Ontario vaccination efforts also began at the start of the pandemic after the approval of the Moderna and Pfizer mRNA vaccines by Canada. The provincial government did a respectable job distributing vaccines to the public and adopting a vaccine mandate. First doses were given to the most vulnerable populations and then distributed to other categories in the population (Gerretsen et al., 2021). As doses were readily more available and offered to the public, there were still groups of the population who were refusing to be vaccinated. This created a public health issue in Ontario as the province was begging to return to in-person activities and gatherings. To help solve this problem, so that in-person activities could return and businesses open without significantly increasing COVID-19 cases, the Ontario government implemented
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4 mandatory vaccination requirements in September 2021 (AlShurman et al., 2023). This vaccine mandate required an individual to show proof of vaccination to be allowed to enter most businesses and settings, be able to work in certain jobs, and travel. Imposing a vaccine mandate caused a lot of uproar and rift amongst citizens in Ontario and all of Canada, leading to the truckers' convoys that converged on Ottawa to protest. Some Ontarians viewed the vaccine mandates as an infringement on their rights by the government, although the objective of the vaccine mandate in Ontario was to prevent the spread of COVID-19 as the province began to reopen. Imposing a vaccine mandate helped fast-track the process of re-opening, but also caused a shift in public attitudes towards COVID-19 (Gerretsen et al., 2021). To effectively measure the vaccine mandate the number of COVID-19 cases was used. ICU patients who were vaccinated and not vaccinated were tracked and compared. As well, the total number of cases per week was examined for increases and decreases from weeks prior. Evidence that showed COVID-19 cases were decreasing meant that vaccine mandates were effectively stopping the spread of COVID-19 since only vaccinated people were able to attend social settings in public (Grewal et al., 2023). In summary, the strict mandating of vaccines in the province was a needed feature but should have been implemented more appropriately in order to avoid unintended consequences and poor public attitudes. Province 2: Much like most of Canada, Alberta adopted masking and vaccine mandates throughout the course of the pandemic to control COVID-19. Based on certain parts of the province and their public health sectors, mandatory indoor masking depended on the location. Alberta became the only province in November 2020, without a provincial masking mandate as in only certain areas it was mandated by public health regions. Public health regions across the province were tasked
5 with creating their own COVID-19 safety measures (Waldner et al., 2021). This made many regions have mandatory masking before other regions, but eventually, in December 2020, a provincial masking mandate was announced. When the provincial masking mandate was announced many Albertans opposed the directives of the provincial government. This led to anti-mask protests and rallies held to oppose the new mandate. Many Albertans did not understand that masks are indeed important to help prevent the transmission of COVID-19. The main objective of Alberta's mask mandate was to prevent the spread of COVID-19 and was a way for individuals to protect themselves. During the beginning of the pandemic, Alberta had one of the lowest compliances when it came to public health recommendations like masking at 37% (Waldner et al., 2021). With such low compliance with public health measures COVID-19 cases and outbreaks dramatically increased. As the pandemic worsened, compliance with public health measures were then taken more seriously. In summary, masking in Alberta was first implemented in certain areas of the province by public health regions for all indoor areas or spaces where people were not able to safely physically distance themselves from one another. The masking mandate proved to be necessary and was effective in preventing COVID-19 cases. To protect many Albertas and reduce the spread of COVID-19, vaccine mandates were instituted in Alberta for indoor activities, jobs that dealt with vulnerable populations, and kids going back to school. Alberta's vaccine-mandated response was very lackluster with certain public health regions having indoor vaccination policies before other regions (Maquiling, Jeevakanthan & Fane, 2023). Depending on where an individual lived there were different vaccine mandates, until Alberta announced that it was going to have a provincial proof of vaccination mandate in September 2021. To help increase those vaccinated in the province, a
6 100-dollar incentive was included for those who received doses and a 1 million dollar lottery draw for the vaccinated. After the mandate announcement, a study in Alberta found a 300% increase in those being vaccinated (Karaivanov et al., 2022). Staggering rates of vaccination were found to be from the vaccine mandate as well as the incentive that helped push COVID-19 vaccination. After the mandate was announced vaccination increased significantly but over the course of the pandemic Alberta would have one of the lowest vaccination rates (Faye, Perrin & Trumpy, 2022). Vaccine mandates in Alberta were among the least strict in the country in terms of restrictions. Although restrictions were lower than in other provinces, the vaccine mandate still effectively interfered with people's everyday lives causing protests all over the province. The southern border crossing in Coutts, Alberta was blockaded by protestors during the early months of 2022. These protestors were a part of the freedom convoy movement across Canada demanding the end of the Vaccine mandates. The vaccine mandate's objective was to reduce viral transmission and also increase vaccine uptake among Albertans (Karaivanov et al., 2022). If an individual was vaccinated they could participate in most forms of ‘normal life’, but someone who was not vaccinated was limited to what they were able to do in public. Over the course of the pandemic, vaccine mandates proved to be successful in Alberta by increasing uptake and reducing the spread of COVID-19. Theory 1: Multiple streams theory is an optimal theory to help explain why mask and vaccine mandates were imposed in the provinces of Ontario and Alberta during the COVID-19 pandemic. In Ontario and Alberta, masking mandates were very similar in the restrictions imposed on the general public. Most indoor spaces in the two provinces required that an individual wear a mask to be allowed entry. In terms of carrying out the mandate, Ontario left it
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7 up to its public health regions to put the mandate into effect over a two-month period, before declaring a province-wide masking mandate (Karaivanov et al., 2021). In Alberta, similarly, public health regions first put mandates into effect, but these mandates were optional depending on the public health region. In December 2020, Alberta was the last province to adopt a provincial-wide masking mandate. In comparison, Ontario quickly and more efficiently implemented a province-wide masking mandate, whereas Alberta was very delayed in its response and the implementation process displayed flaws. To explain masking mandates in Ontario and Alberta it is important to use multiple streams theory to help understand the policy process. This theory explains that when the three streams of problem, politics, and policy merge they produce a policy output (Howlett, McConnell & Perl, 2017 ). A window of opportunity is created when these three streams merge together leading to issues reaching the policy agenda. In this case, the problem stream was the rapid spread of COVID-19 causing many to become ill and in some instances causing death. The politics stream consisted of formal policy decision-makers in the government who saw it was in Ontario and Alberta’s best interest to take necessary action. In the policy stream, different ways to protect citizens against COVID-19 were being examined. The best policy produced was provincial mandates on face masks when physical distancing can not be done or when indoors. In this rapidly occurring event, the three streams converged to produce masking mandates in Ontario and Alberta to prevent the spread of COVID-19. Limitations identified by multiple streams theory is that during this focusing event of COVID-19, policymakers had imperfect information and limited time to develop the best output to stop transmission (Cairney & Jones, 2016). Another limitation, in this case, is that the multiple streams theory does not take into account the roles that institutionalized norms and ideas play in shaping policy agendas (Rüb, 2016). For example in Ontario and Alberta, the formation of
8 masking mandates was directed around businesses with the main goal of keeping them open, to keep the economy running. Imposing a masking mandate allowed businesses to remain open, but could only do so if customers wore a mask. In both Ontario and Alberta the masking mandates were effective in their role of reducing the transmission of the virus and through multiple streams theory it helps show how policy was able to be put into action. Vaccine mandates in Ontario and Alberta throughout the pandemic were very similar but like with the masking mandate the same theme was experienced with COVID-19 vaccination mandates where Alberta was lackluster in their response and Ontario was more efficient. Restrictions were essentially the same in both Ontario and Alberta in terms of where proof of vaccination was required to be shown. To enter most facilities, work in certain occupations, and travel, proof of vaccination was mandatory. Ontario implemented its vaccine mandate by announcing a province-wide mandate that would be administered through regional public health units. In Alberta, certain public health regions developed their own vaccination policies, while others did not have any. Many bigger cities put in place their own requirements for vaccination to enter certain settings, which showed a less efficient approach to vaccine mandates because depending on the region a person was in, the requirement of the COVID-19 vaccination varied. Alberta did end up imposing a province-wide vaccine mandate to help curb COVID-19 just as Ontario did. Multiple streams theory as explained prior, requires the three streams of problem, politics, and policy to converge in order for policy action to take place (Cairney & Jones, 2016). The problem stream created in this instance was that to end the pandemic everyone needed to be vaccinated but certain groups of the population were not being vaccinated. The politics stream consisted of formal policy decision-makers looking for a solution to end the pandemic as quickly
9 as possible through the use of vaccines. In the policy stream, actors devised policies to combat COVID-19 but ultimately landed on a vaccine mandate to increase the number of people vaccinated. All three of these streams saw the window of opportunity and converged, making it onto the agenda (Cairney & Jones, 2016). The multiple streams theory shows how a significant event like the COVID-19 pandemic affected all three streams and allowed them to come together to make a policy output. In Alberta and Ontario, the vaccine mandates did create problems of their own as citizens saw the vaccine mandates as an infringement on their rights as Canadians (Rana, 2022). This prompted the freedom convoy, which saw large protests in Ottawa and the blocking of the Coutts border crossing in Alberta. A recommendation for how the vaccine mandates in both provinces could have been improved is in the implementation stage where the mandate needed to have more clear outlines on its purpose and impact. In Ontario and Alberta, the vaccine mandate was not clearly outlined enough to the public which created distrust and disruption. Many citizens believed they were being forced to become vaccinated but they were not. The mandates in Ontario and Alberta were directed at protecting the public and slowing the transmission of the virus to allow for the reopening of the two provinces. Multiple streams theory shows how the three streams came together to produce the solution of vaccine mandates to increase those vaccinated with the end goal of concluding the pandemic. Theory 2: Another theory to help understand Ontario and Alberta's policy formulation and implementation of masking and vaccine mandates is framing theory. Framing theory is a constitutive component of the agenda-setting process. Every part of the policy process is virtually influenced by framing as how an issue is framed depicts the types of responses
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10 administered (Sniderman & Theriault, 2004). In Ontario and Alberta, the framing of COVID-19 was essential for the government to create a masking policy to combat the virus. The media played a major role in framing the epidemic that was leaving many very ill and causing the death of others (Capurro et al., 2021). To frame COVID-19 as an issue it followed the six key dimensions of issue framing consisting of causality, severity, proximity, incidence, novelty, and problem populations (Rochefort, 2016). When news of COVID-19 first broke, blame for the pandemic was an accidental cause. In the beginning, everyone did not know what to expect, but the severity of the issues was made clear through the media from reports of the government. Then a mobilization of political support was formed to take action (Rochefort, 2016). Next, the prevalence of the problem was made aware that the issue was going to get worse. Later, the COVID-19 pandemic was labeled as an unprecedented event causing major challenges (Rochefort, 2016), and finally, a target population of elderly, children, and people with compromised immune systems was identified to protect, being the most vulnerable. In order for the Ontario and Alberta governments to develop a masking mandate for COVID-19, it was crucial that the issue was framed in a severe context to warrant government action (Sniderman & Theriault, 2004). The problem of COVID-19 went directly to the top of the agenda-setting list and became the most important issue. Being priority number one, all focus was on finding a solution to help reduce the spread of COVID-19. A masking mandate was the result of this process and required people in Ontario and Alberta to wear a mask when indoors or if unable to physically distance themselves. Once masking mandates were in place, framing was still done to maintain public support for the mandate. Conclusively, framing COVID-19 as a serious issue helped authorize masking mandates in Ontario and Alberta which sufficiently helped in limiting the escalation of the epidemic.
11 In addition, framing theory can be used to explain vaccine mandates in Ontario and Alberta. Framing is a very effective tool for directing attention to problems that need to be recognized (Chong & Druckman, 2007). Framing helps create better perspective and understanding, only if used correctly. The implementation of vaccine mandates in Ontario and Alberta differed a little based on how COVID-19 was framed in the two provinces. In Ontario, the epidemic was framed by the media and government as a severe issue that demanded government action immediately (Chong & Druckman, 2007). In Alberta, the epidemic was not framed as seriously as it was in Ontario, which can be attributed to the lackluster response to a province-wide vaccine mandate. The different levels of framing on the issue of COVID-19 influenced the type of responses displayed by both governments. Furthermore, once vaccines were implemented they were framed as vital and people who were not vaccinated held the image that they were the problem. People not vaccinated in Ontario and Alberta were seen as the spreaders of COVID-19 and as people who were not doing their part to help. A weakness of framing theory is that everyone has their own or different mind frames (Borah, 2011). Not all individuals perceive the framing of an issue the same way, which can be examined through the complexity of the vaccine mandates and how its intentions were not framed clearly enough to the public. Framing of the vaccine mandate was done poorly in Ontario and Alberta which sparked unrest in the provinces (Fernandes, 2021). How the vaccine mandate would be implemented caused mass confusion and portions of the population did not like that most settings required proof of vaccination. The idea of vaccine mandates caused a lot of controversy regarding rights and freedoms which was an issue created by this policy put forth by the Ontario and Alberta governments (Fernandes, 2021). Framing theory is a good theory to help show that framing done by the media and government during the
12 COVID-19 pandemic was a crucial component of the vaccine mandates formulation and implementation effort. Conclusion: In the following paper, through multiple streams theory and framing theory, vaccine and masking mandates imposed in Ontario and Alberta significantly assisted in reducing the spread of COVID-19. The COVID-19 responses administered in Alberta and Ontario were relatively the same, with some differences in terms of implementation. Masking and Vaccine mandates in both provinces had a huge impact on the overall outcome of the pandemic. Through the theories of multiple streams and framing it showed how the policy processes produced these outputs and many of the factors that led to the creation of these mandates. In multiple streams theory, it identified that masking and vaccine mandates were created as the three streams of problem, politics, and policy merged forming a window of opportunity resulting in COVID-19 policy output. In terms of framing theory, how COVID-19 was framed proved to be a very important part of the policy process with regard to formulation and implementation. In summary, Masking and Vaccine mandates in Ontario and Alberta were essential in reducing transmission and allowing the provinces to operate.
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13 Bibliography: AlShurman, B. A., Tetui, M., Nanyonjo, A., Butt, Z. A., Waite, N. M., Vernon-Wilson, E., Wong, G., et al. (2023). Understanding the COVID-19 Vaccine Policy Terrain in Ontario Canada: A Policy Analysis of the Actors, Content, Processes, and Context. Vaccines , 11 (4), 782-813. http://dx.doi.org/10.3390/vaccines11040782 Borah, P. (2011). Conceptual issues in framing theory: A systematic examination of a decade's literature. Journal of communication , 61 (2), 246-263. https://doi.org/10.1111/j.1460-2466.2011.01539.x Chong, D., & Druckman, J. N. (2007). Framing theory. Annual Review of Political Science , 10 , 103-126. https://doi.org/10.1146/annurev.polisci.10.072805.103054 Capurro, G., Jardine, C. G., Tustin, J., & Driedger, M. (2021). Communicating scientific uncertainty in a rapidly evolving situation: A framing analysis of Canadian coverage in early days of COVID-19. BMC Public Health , 21 (1), 1-14. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-12246-x Cairney, P., & Jones, M. D. (2016). Kingdon’s Multiple Streams Approach: What Is the Empirical Impact of this Universal Theory? Policy Studies Journal , 44 (1), 37–58. https://doi.org/10.1111/psj.12111 Faye, B., Perrin, D., & Trumpy, C. (2022). COVID-19 lessons learned review: Final report. https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/emergency-preparedne ss-response-recovery/embc/reports/covid-19_lessons_learned_report.pdf Fernandes, E. J. (2021). Immunizing Canada from Pandemic Populism: How to Uphold Equality, The Rule of Law, Trustworthy Institutions, and Civil Order. https://eugenefernandes.com/wp-content/uploads/2021/11/FERNANDES-Eugene-JCCF-Essay.d ocx.pdf Gerretsen, P., Kim, J., Caravaggio, F., Quilty, L., Sanches, M., Wells, S., Brown, E. E., Agic, B., Pollock, B. G., & Graff-Guerrero, A. (2021). Individual determinants of COVID-19 vaccine hesitancy. PloS One , 16 (11), 1-14. https://doi.org/10.1371/journal.pone.0258462 Grewal, R., Nguyen, L., Buchan, S. A., Wilson, S. E., Nasreen, S., Austin, P. C., Brown, K. A., Fell, D. B., Gubbay, J. B., Schwartz, K. L., Tadrous, M., Wilson, K., & Kwong, J. C. (2023). Effectiveness of mRNA COVID-19 vaccine booster doses against Omicron severe outcomes. Nature Communications , 14 (1), 1-10. https://doi.org/10.1038/s41467-023-36566-1
14 Howlett, M., McConnell, A. and Perl, A. (2017), Moving Policy Theory Forward: Connecting Multiple Stream and Advocacy Coalition Frameworks to Policy Cycle Models of Analysis. Australian Journal of Public Administration , 76, 65-79. https://doi-org.subzero.lib.uoguelph.ca/10.1111/1467-8500.12191 Ju, J. T. J., Boisvert, L. N., & Zuo, Y. Y. (2021). Face masks against COVID-19: Standards, efficacy, testing and decontamination methods. Advances in Colloid and Interface Science , 292 , 1-16. https://doi.org/10.1016/j.cis.2021.102435 Karaivanov, A., Kim, D., Lu, S. E., & Shigeoka, H. (2022). COVID-19 vaccination mandates and vaccine uptake. Nature Human Behaviour , 6 (12), 1615-1624. https://web.archive.org/web/20220404090721id_/https://www.nber.org/system/files/work ing_papers/w29563/w29563.pdf Karaivanov, A., Lu, S. E., Shigeoka, H., Chen, C., & Pamplona, S. (2021). Face masks, public policies and slowing the spread of COVID-19: Evidence from Canada. Journal of Health Economics , 78 , 1-44. https://doi.org/10.1016/j.jhealeco.2021.102475 Katz, G. M., Born, K. B., de Wit, M., McKenzie, K., Flood, C. M., Bell, C., ... & Hopkins, J. (2021). COVID-19 vaccine certificates: key considerations for the Ontario context. Science briefs of the Ontario COVID-19 science advisory table , 2 (39), 1-21. https://covid19-sciencetable.ca/wp-content/uploads/2021/07/Science-Brief_Vaccine-Certi ficates_published_202107021-1.pdf Maquiling, A., Jeevakanthan, A., & Ho Mi Fane, B. (2023). The effect of vaccine mandate announcements on vaccine uptake in Canada: An interrupted time series analysis. Vaccine , 41 (18), 2932–2940. https://doi.org/10.1016/j.vaccine.2023.03.040 Peng, A., Bosco, S., Tuite, A., Simmons, A., & Fisman, D. (2023). Impact of Community Masking on SARS-CoV-2 Transmission in Ontario after Adjustment for Differential Testing by Age and Sex. medRxiv , 1-29. https://www.medrxiv.org/content/10.1101/2023.07.26.23293155v1.full-text Public Health Agency of Canada. (2023, May 9). COVID-19 epidemiology update: Summary — Canada.ca . https://health-infobase.canada.ca/covid-19/ Rochefort, D. A. (2016). Agenda setting, problem definition, and their contributions to a political policy analysis. Handbook of public policy agenda setting , 35-52.
15 https://books.google.ca/books?hl=en&lr=&id=n4EwDQAAQBAJ&oi=fnd&pg=PA35&d q=categories+of+issues+framing+Rochefort+and+Cobb&ots=LJw64-Uj1j&sig=oICBZY YXDC1rma7utm_vCw_smUA#v=onepage&q=categories%20of%20issues%20framing% 20Rochefort%20and%20Cobb&f=false Rüb, F. (2016). Decision Making under Ambiguity and Time Constraints. Assessing the Multiple Streams Framework [Review of Decision Making under Ambiguity and Time Constraints. Assessing the Multiple Streams Framework ]. European Policy Analysis , 2 (1), 51-109. https://doi.org/10.18278/epa.2.1.12 Rana, R. (2022). Exploring Positive and Negative Liberty for COVID-19 Vaccination. Doctoral dissertation, University of Toronto, Canada . 1-35. https://www.proquest.com/openview/28739c4a619122f684cd6e56951afa00/1?pq-origsite =gscholar&cbl=18750&diss=y Sniderman, P. M., & Theriault, S. M. (2004). The structure of political argument and the logic of issue framing. Studies in public opinion: Attitudes, nonattitudes, measurement error, and change . 133-165. https://books.google.ca/books?hl=en&lr=&id=-K5cDwAAQBAJ&oi=fnd&pg=PA133&d q=framing+theory+issue+framing&ots=nDE-ezxRxn&sig=D-r5rKrXrQ_8xI-ZM8LgCIK znIw#v=onepage&q=framing%20theory%20issue%20framing&f=false Waldner, D., Harrison, R., Johnstone, J., Saxinger, L., Webster, D., & Sligl, W. (2021). COVID-19 epidemiology in Canada from January to December 2020: the pre-vaccine era. Facets , 6 (1), 760–822. https://doi.org/10.1139/facets-2021-0029 Wu, J., Tang, B., Bragazzi, N. L., Nah, K., & McCarthy, Z. (2020). Quantifying the role of social distancing, personal protection and case detection in mitigating COVID-19 outbreak in Ontario, Canada. Journal of Mathematics in Industry , 10 (1), 1-12. https://doi.org/10.1186/s13362-020-00083-3
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