Doctors say we need the updated COVID-19 shot. So why haven't we heard more about it?

When vaccines against COVID-19 first became available in Canada, public service announcements flooded radio and TV broadcasts and repeatedly popped up online and across social media feeds.

More than 80 per cent of people in Canada responded, lining up at mass vaccination clinics or booking appointments for their first two doses.

Federal, provincial and territorial governments' public awareness campaigns continued over the next few years, actively promoting booster shots to protect against waning immunity -- but the uptake was considerably lower.

• COVID-19 Brief newsletter: Sign up for fresh insights and analysis on the pandemic
• Top coronavirus headlines, all in one place

Now, there are two new COVID-19 vaccines -- reformulated by Pfizer-BioNTech and Moderna -- to fight the XBB.1.5 Omicron subvariant that has become dominant across the country. Yet despite the fact every province and territory now has at least one updated mRNA vaccine in hand, some experts say public awareness efforts to drive vaccine uptake aren't what they used to be.

Doctors say it's vital to get this version of the vaccine because it offers protection against the subvariant driving a current rise in COVID-19 cases and also because most Canadians are well past the six-month mark when immunity fades after previous shots or infections.

"It seems to me that we are sort of experiencing COVID amnesia," said Dr. Nazeem Muhajarine, professor of community health and epidemiology at the University of Saskatchewan.

Overall, communications efforts to break through that "amnesia" and get across the importance of getting the vaccine have been "less than optimal," he said.

"This fall, we are at a quite a different place in relation to COVID-19 than in each of the three previous falls -- we are in a better place, but we are not in a completely safe place," said Muhajarine, who is also a researcher with Canada's Coronavirus Variants Rapid Response Network.

Provinces and territories now have information posted on their websites about who is eligible to get the updated COVID-19 vaccine, where to get it and links to book appointments or find participating pharmacies.

But those websites require people to already be "motivated" to seek out a shot, Muhajarine said.

British Columbia's system is an example of a more proactive approach, he said.

Everyone in B.C. who got their primary COVID-19 vaccine series gets a text or email message informing them when it's their turn to get the new shot, the province's Health Minister Adrian Dix told The Canadian Press in an interview.

People can click through to book their appointment immediately, Dix said, noting that the message also reminds them to get their flu shot, which can be booked at the same time.

The invitations to book have been sent out "in order of vulnerability," he said, with the first messages going to health-care workers and long-term care residents, followed by seniors and people who have chronic conditions that make them especially vulnerable to serious illness. After that, the general public has started receiving invitations.

Dix estimated that about 144,000 invitations for COVID-19 and flu vaccinations are sent out per day in B.C.

The minister didn't comment on whether the budget for advertising and promoting the COVID-19 vaccine was similar to previous efforts, but said "the text (and email) messages are an invitation system which serve as the best possible promotion."

In an email response to The Canadian Press, the Public Health Agency of Canada said that provincial and territorial governments are responsible for their own advertising campaigns to promote vaccines.

But the agency said it is also promoting the updated COVID-19 vaccine at a national level as part of "three sequenced advertising campaigns this season, one on COVID-19 vaccination, one on seasonal flu and one on personal protective measures. "Its strategy also includes news media outreach, social media campaigns and webinars with health-care professionals.

The agency acknowledged that "the overall advertising budget has decreased in 2023-24" but said its campaigns are "increasingly more targeted to higher risk individuals."

Local public health units are doing the best they can to increase awareness of the updated COVID-19 vaccine within limited budgets set by provinces and municipalities, said Dr. Thomas Piggott, medical officer of health for Peterborough, Ont.

Piggott and his team are doing both traditional media and social media promotion, including Instagram live sessions where he answers people's questions about COVID-19, flu and respiratory syncytial virus (RSV) and available vaccines.

"Capacity continues to be a challenge because public health continues to be grossly underfunded in comparison to other parts of, you know, public service and the health-care system," he said, noting there's no word if the additional COVID-19 funding given to public health units during the pandemic will continue past the end of this year.

Dr. Vinita Dubey, associate medical officer of health for Toronto Public Health, said they continue to do paid advertising as well as media relations campaigns, but "there's no question that I think people need to hear it many different ways ... in order to get the message to sink (in)."

Toronto Public Health no longer has the same large-scale infrastructure of "community ambassadors" to reach marginalized neighbourhoods and people who speak different languages that it had during previous COVID-19 vaccine awareness campaigns, Dubey said.

It also has fewer people to work on "vaccine confidence teams" who would disseminate accurate information about COVID-19 vaccination and combat the flow of misinformation on social media, she said.

Ensuring people understand the importance of this fall's COVID-19 vaccine is not just about the amount of promotion -- it's also about describing the shot accurately, Muhajarine said.

Calling the XBB.1.5 vaccine a "booster" is not scientifically accurate and may lead people to underestimate its significance, he said.

"It is not a booster dose. It is a new vaccine reformulation," Muhajarine said.

"We are not trying to boost previous vaccine doses," he said. "We are trying to elicit an immune response to this current circulating variant."

"We don't say each year, 'Get your flu booster.'  We say, 'Get your flu vaccine."'

Dubey agreed.

"When you hear the word 'booster' you might think, 'oh well, I already got a bunch of vaccines, I'm good,"' she said.

The National Advisory Committee on Immunization recommends that everyone six months of age and older get the XBB.1.5 vaccine if it has been six months or longer since their last COVID-19 vaccination or COVID-19 infection.

NACI also recommends the XBB.1.5 vaccine for both children and adults who have never been vaccinated against COVID-19.

This report by The Canadian Press was first published Oct. 29, 2023.