Quebec's decision to delay its vaccine mandate deadline for health-care workers is a sign of the tough choices other provinces will face as they attempt to implement similar policies, experts and advocates say.

On Wednesday, Quebec Health Minister Christian Dubé postponed by a month a requirement for health-care workers to get vaccinated against COVID-19, saying it would have been "irresponsible" to suspend thousands of unvaccinated workers at a time when the health-care system is already fragile.

Premiers and health ministers across Canada will face similar dilemmas, says John Church, a professor at the University of Alberta who studies health policy.

"I think that every health-care system in Canada is in a similar situation to what Quebec is in, because of the system actually operating far above its normal capacity at this point in time," he said in an interview Thursday.

In Alberta, employees of the province's single health authority must be fully immunized against COVID-19 by the end of the month. Like in Quebec, where only four per cent of health-care workers are not fully vaccinated, even a small reduction in the number of health-care workers in Alberta would have a big impact, Church said.

"Under normal circumstances, the system would be able to adjust to that, but we are in extraordinary circumstances," he said, adding that military nurses have been deployed in the western province, where intensive care units are at nearly double their normal capacity. "Every single health-care worker, under these circumstances, matters."

Nova Scotia, New Brunswick, Saskatchewan and British Columbia have also announced vaccine mandates for health-care workers, some of which have already come into effect. In Ontario, individual health authorities and hospitals have implemented similar requirements.

Dr. Katharine Smart, president of the Canadian Medical Association, said the difficult situation Quebec found itself in is the result of larger systemic problems that predate the pandemic.

"What's happened in Quebec is really highlighting the legacy of underfunding and under-planning in the system that has left them with no wiggle room," she said in an interview Thursday. Canada faced a shortage of nurses and other health-care professionals before the pandemic, she said, which has only grown worse.

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Still, Smart said she hopes governments in other provinces that have said they will introduce vaccine mandates will not delay, adding that she sees vaccination as the path out of the pandemic.

"We strongly support them keeping the mandate," she said. "We've been calling for mandatory vaccines for health-care workers now since August. We feel that it's our moral and ethical responsibilities as health-care professionals to be vaccinated."

Kim Lavoie, chair of behavioural medicine at Université du Québec à Montréal, says provinces shouldn't set deadlines they can't meet.

"Going back on what you said was going to be the consequence really undermines credibility, and it creates frustration for those who are following the rules," she said in an interview Thursday.

Vaccine mandates and educational campaigns may encourage some hesitant people, Lavoie said. But there are others, such as people who are anti-vaccine or who believe in conspiracy theories, who can't be convinced, she added.

"There are going to be a number of people that will choose personal choice over their job and that might lead to service disruption in many provinces, at least for a period of time," she said, adding that the disruptions will impact the public. "It's not the government itself that's going to suffer, it's all of us."

Even though the vaccine mandate was pushed back, Lavoie said it has had some success: the number of unvaccinated health-care workers in Quebec has dropped by half since the mandate was announced in late August.

Meanwhile, Quebec reported 644 new cases of COVID-19 Thursday and two more deaths attributed to the novel coronavirus. COVID-19-related hospitalizations remained unchanged from the day before, at 298, and 76 people were in intensive care, a rise of one.

Quebec's public health institute said 90 per cent of residents 12 and up have received at least one dose of a COVID-19 vaccine and 86.8 per cent are considered adequately vaccinated.

This report by The Canadian Press was first published Oct. 14, 2021.

This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.

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