At The Alex Community Health Centre, CEO Joy Bowen-Eyre didn’t have to unilaterally impose a vaccine mandate on the nearly 500 staff, contractors, and volunteers at the charity in northeast Calgary.

They asked her to do it first.

“We had staff who felt that the Alex was taking a leadership role by stepping in and wanting to do this,” Bowen-Eyre told Future of Good. When she sent out an all-staff email asking for feedback on a mandatory vaccine policy, later implemented in October, no one was horrified.

Creating a vaccine mandate for The Alex was a lot easier than it might be for smaller non-profits or charities. The Alex has a medical director and associate medical director on its team. It also works closely with Alberta Health Services, the province’s health agency, who offered guidance on the nitty-gritty of a vaccination policy.

In Canada, employers can’t legally fire employees for refusing to be vaccinated. So on top of rising demand for social services, Canada’s frontline social impact organizations — homeless shelters, youth drop-in programs, food banks, health services, childcare — have also navigated whether to implement vaccine mandates. For the vast majority of frontline, client-facing staff, the answer is straightforward: yes.

“We found that with our staff that is very child-service facing and in the front lines — they understood the risk,” said Evan Maydaniuk, director of development and marketing at Big Brothers Big Sisters of Winnipeg. “There was really no pushback from our service delivery team about getting vaccinated on time.” 

Big Brothers Big Sisters of Winnipeg also didn’t have a choice. In Manitoba, all child-focused services or agencies are required to have vaccination mandates in place (or require employees to be tested up to three times a week) — and Maydaniuk said the organization’s service delivery staff were well-prepared for it. 

Some admin and support staff at Big Brothers Big Sisters of Winnipeg are hesitant about receiving a COVID-19 vaccine, Maydaniuk added. They’ve been allowed to work remotely. The same is true at West Neighbourhood House, a Toronto charity focused on homelessness, poverty, aging, immigration, and other inequities. They’ve had a vaccination policy in place requiring any of their 200 staff members or 800 volunteers who show up on-site to have either one or two doses of a COVID-19 vaccine.

Anyone who doesn’t want to receive a vaccine is accommodated, but Lynne Woolcott, director of community response and advocacy at West Neighbourhood House, said they aren’t allowed on-site. “We would redeploy them as much as possible,” she told Future of Good. That doesn’t appear to have been a problem for West Neighbourhood House — Woolcott said the overwhelming majority of frontline staff had already decided to get vaccinated. 

But there is another dimension to vaccine mandates beyond staff and volunteers. Many of the programs offered by frontline service organizations, from counselling to after-school gatherings for children, are difficult — if not impossible — to move to a virtual environment. And many clients in these programs cannot be vaccinated as easily as staff members.

When Bowen-Eyre had the chance to get her first COVID-19 vaccine, she made a point of swinging by one of the largest mass vaccination clinics in Calgary at the city’s Telus Convention Centre. She wanted to see for herself how easy it would be for clients at The Alex — many of whom have cognitive difficulties, are living on the street, or have mental health issues — to get their own shots there.

In short, it didn’t make a lot of sense for clients of The Alex. Patients had to book appointments on a phone or computer, things some clients simply don’t have. Getting to an appointment is a huge deal for many of them, too, because of anxiety or other mental health issues. Even the heavy use of written signage, rather than easy-to-follow graphics, could be a barrier to clients who can’t read. “From a harm reduction philosophy, it’s just not appropriate,” Bowen-Eyre said. “From a trauma-informed lens, it’s just not appropriate.”

Frontline social impact organizations have had to choose between requiring vaccination for clients, or not. OUTSaskatoon, an LGBTQ community centre for the city, decided to require vaccination at their only remaining in-person gathering, a biweekly group for transgender and nonbinary people. (Attendees also need to wear masks and take temperature checks.) But Krystal Nieckar, OUTSaskatoon’s executive director, said it is a different story for clients who are homeless or need to use the organization’s food program.

“We haven’t asked them and we won’t in the future,” she told Future of Good. “We’ll continue to provide opportunities for folks and give them information on where they can get vaccinated. But we will not require them to be vaccinated to enter the space.” Their reasoning comes down to harm reduction: better to provide services to clients in desperate need of food or shelter than to turn them away at the door.

West Neighbourhood House is in the process of developing a policy for clients, Woolcott said, but said they aren’t currently asking clients who are receiving services — either in their own homes through a Meals on Wheels program, or arriving at the charity’s drop-in centre — for vaccination proof. “In all of those situations, we’re working in full PPE and people are required to use masks,” she explained.

Some frontline organizations, like Big Brothers Big Sisters of Winnipeg, simply don’t have a choice on whether or not to vaccinate clients. At the moment, Health Canada has not approved a COVID-19 vaccine for children under the age of 12. Maydaniuk said that, when that does happen, the organization will defer to whatever Manitoba’s health authorities decide. In the meantime, Big Brothers Big Sisters is already starting discussions with their mentors and client families.

“If the mentor is uncomfortable with a non-vaccinated child, we’ll work with them to either transition that to a virtual setting or discuss what that match will look like moving forward,” Maydaniuk said.

As for The Alex, Bowen-Eyre said that after many internal conversations, her organization has decided that any clients who participate in a group gathering need to show proof of vaccination. “We want to be able to say to all participants: look, this is COVID-free. We want you to come,” she said.

Initially, Bowen-Eyre said, The Alex’s staff were worried about whether a vaccine mandate would prevent clients from attending. They also had concerns about some of the social distancing policies, too. “Some of the clients who come and see us couldn’t necessarily keep a mask on because of their cognitive abilities,” Bowen-Eyre explained.

But Bowen-Eyre said the perspective of staff changed as they started to work through COVID protocols themselves. Those who were the most concerned about vaccine mandates or distancing requirements became some of their staunchest supporters. “It was that delicate balance,” she said, “of safety versus accessibility.”

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