 We are honored to be here on the territories of the Musqueam of the Squamish of the Slewa First Nations. Earlier this summer we shared news that we had started the work necessary to offer a fall booster dose. Many of us might recall receiving text on this important safety step in mid-July when summer was just getting underway or at least it seemed that way. We are honored to be here on the way and with today marking back to school the end of summer holidays, the time of year when we get back to it, we are here to announce the details of the fall booster campaign. It is a welcome step that builds upon previous efforts and advances, especially health Canada's news during the summer that it had approved a pediatric COVID-19 vaccine, a booster dose for children ages 5 to 11. And on September 1st approval of a new booster dose, a bivalent, a booster dose, a bivalent, one that Dr. Henry will talk about in a few moments. For all of us with COVID all around us, it's been a busy summer. British Columbians have continued to protect ourselves, our loved ones and our communities by getting vaccinated in record numbers. As of August 15th, 92% of people in BC aged 12 and older had received the two dose primary series and more than 12 million COVID-19 vaccines had been administered. We started offering the pediatric vaccine on August 2nd and two weeks later, 20,000 children had registered to get their shot. And I again ask parents to register their children today. Getting our vaccines and our boosters for ourselves and our children have protected us against severe COVID outcomes requiring hospitalization, which has eased COVID stress on our health care system, a stress that continues on the level of our health care system. A stress that continues nonetheless to exist. 15,800 health care workers in the last week where we provided we have information, which the week prior to the week ending in Labor Day, we're off sick that week significantly above the usual numbers. And that has an impact everywhere in our health care system. Put simply, when we get our vaccines and our boosters, we save lives. It's vital work getting our vaccines and our boosters and our ongoing commitment to this effort has made and will continue to make all the difference to each of us in how we face COVID and how we live with COVID. On that point, we're here today to provide an update on our fall booster campaign. And I now invite Dr. Bonnie Henry to talk about the fall season and how we can continue to protect ourselves. Dr. Henry? Thank you very much and good afternoon. I want to start by talking a little bit about where we are in this pandemic and what we all need to think about as we start back to school and work for many people and head into the respiratory illness season this fall and winter. We still have a very uncertain trajectory of the pandemic in the next few months. And while I do believe we are emerging from the pandemic part of it, it is clear that COVID-19 will be with us for the long term. It is still, in my opinion, though, an unusual event, one for which we need to continue to take coordinated measures together. We know that we, for example, still have our special advisory committee nationally. The WHO has still called this a public health incident of international concern. And we know that there is still significant spread around the world and the public health impact of the emergence of potentially another variant of concern is still one of the uncertainties that we have to live with right now. But we do know more and more about the virus and about how we can manage both individually and collectively in this province. But we are not yet at a point where we can let our guard down, both here and globally, and the public health emergency that we have here and the measures that we can take remain important. We also need to continue to pay attention to the things we know will help against COVID-19 and also in the context of what we may be facing in the coming respiratory season, things like influenza, RSV, and other serious respiratory illnesses. So while my team have been working a lot through this summer to try and give a sense of what we might be facing in the fall and winter, and we will be talking more about that next week, we do know that the COVID climate, the climate that we are in, gives us a sense of where we are in the pandemic. And it is measuring things that we provide information on, like rates of illnesses. We know that that is focused on the people who are most likely to need treatment or to have interventions as a result of their illness, the PCR testing. But also on hospitalizations, ICU cases, people who end up dying from COVID-19, and we also look very closely at outbreaks in long-term care homes, assisted living in schools, now that kids are back, and other surveillance markers, like wastewater testing, seroprevalence studies that we are doing on an ongoing basis. And those all give us a sense of picture of what is happening in our community over time. Those are not things that change on a day-to-day basis, but they do change the information that we have been providing. And we have been working on, and we will give, as I mentioned, some details next week. But we also need to look at what is the weather on a day-to-day basis, like we would look outside and say, yeah, it's summer, so are we expecting sun or rain? Do I need sun's green or do we need my umbrella? And when we look at that from a COVID perspective, it means looking about how we are going to be able to do that on a day-to-day basis. If I am going to be a believer, then maybe I need to stay away from others. What am I going to be doing today? Am I going to be in a crowded place with lots of people? Maybe I need to take a mask with me. What is happening in my community, that COVID climate, but also looking at the things that I can do to see if I am staying home, if we are not feeling well. And the things that we need to think about now are not the same as the ones that we thought about over the last couple of years where we didn't have the level of immunity that we have now. But things that are indicators that we may be infectious to others are things like having a fever and a cough, fever and a rash, those are things that are from our past that we may remember. And we are likely to see more of those as we go into this fall season. So I need to think about what am I doing, what settings are going to be, and if there are lots of COVID or even influenza circulating, maybe I need to stay away from high-risk settings if I am at risk myself or if I am not feeling well. Post-pon that visit to somebody who is going through cancer treatments or visiting your grandmother in long-term care and all the things that we need to think about on a daily basis as we are going into this fall and winter. And of course, cleaning our hands regularly and staying up to date on vaccination. It is without a doubt vaccination that has allowed us to get to this point where we no longer need to have broad imposed measures like masks, mandates, like closures, like distancing that we know are so disruptive to society and that we need it to slow the spread of SARS-CoV-2 when everybody was susceptible and we knew that severe illness could happen to large numbers of people. But because so many people have stepped up and received their immunizations, we are in a very different climate now than we were even just a year ago. The level of immunity that we have from infection and vaccination has been a game-changer. And we know the virus has changed as well and that has changed what we have had to do. But we need to keep it up to be certain we are protecting those most at risk and protecting our health care system in the coming months. I would also like to talk a little bit about immunity against COVID-19. So immunity can mean a lot of things and many people think of it as an all or nothing. But our body's immune systems are complex and we have talked about this quite a few times. Immunity is our body's ability to protect us from getting sick, getting infected in the first place, but also getting sick or seriously ill from a pathogen and agent such as a virus such as SARS-CoV-2. And we have learned over this last two and a half years a great deal about COVID-19, the illness about SARS-CoV-2, the virus and about immunity. Since we have had vaccines as well, we know our immune system is complex and responds both to vaccine and to infection. And that immunity is not just on-off, it can be different in different ways and it's not just one size fits all. We know that an infection-induced immunity, what some people call natural immunity, is the immune protection we get when we are infected with the virus. Whether it's the original strain, whether it's the Omicron, it gives a different level of immune response. And I've talked with a number of times about we have two main parts to our immune system and one of those is the antibodies that are generated when we are infected with the virus. And those antibodies are in our blood and over time, those go down. But the second part of our immune system is our cell-mediated immune system. And those are those memory cells. They have great names like killer cells that are exposed to that same virus again. They can come up and protect us from getting really seriously ill with the virus. That as many as one in eight people, and this is from data that was done here in Canada and also in other parts of the world, who are infected and don't infect it, but not vaccinated. So people who have only infection, whether it's from original Wuhan strain, from Delta, from Omicron, one in eight people don't develop a protective immune response. So they may have antibodies for a short period of time, but those may fade away. And they may not have stimulated that stronger, longer lasting response from the cell-mediated immunity. And we know that this immunity decreases over time and is different with different variants. And we see that particularly with Omicron, that if you have a mild infection with Omicron and you don't have your system primed through vaccination, that you may not develop seroconversion or enough of that strength immunity so that you can more likely to be reinfected, you're more likely to have more severe illness. We also know that vaccine-induced immunity is also complex. And when we know now that it gives strong protection against any infection after two doses, but it's better after three. So really, three doses is important for longer-lasting, stronger protection, both from those antibodies, which also fade over time, but that stronger cell-mediated immunity that we now know from the vaccine-effectiveness studies done here in VCE, done in Canada and elsewhere, that it gives you longer-lasting protection against severe illness, and that is preserved for many, many months and years. For some people, we also know, we've learned that if you're older, if you have certain immune-compromising conditions, you may need more vaccine and your immune system tends to decrease that protection sooner than people who have a good, strong immune system. So we need to protect those people with additional doses when we see surges in transmission in the community. We also have a new thing that we've come to understand a lot more, and that we've now learned that there's better and sometimes longer-lasting protection with hybrid immunity. So when somebody is both vaccinated and has had an infection, this is especially true now with the Omicron, where we've seen lots of infections, and I think everybody knows at least somebody who's been infected this summer. But those infections have been mostly mild, because we've primed our immune system. It stimulates those antibodies, it stimulates those cell-mediated immunity, so even people who might have had a severe infection before, their immune system is able to minimize the virus and protect them in a way that we haven't had before. So what does all this mean? With vaccination and with hybrid immunity, we now know that there are far fewer people in our community now today who are at risk of severe illness from COVID. And we have tools now to top up immunity for those people who are still at risk, and that includes the newest approved bivalent vaccine booster. We have treatments that can be used for people who are most at risk if they do get infected, including things like Paxilovid and Citrovimab. So the new bivalent vaccine is a combination vaccine, and we use multivalent vaccines, you know, bi is just means two, so this one has two different proteins in it. These types of combination vaccines are actually very common. The most common one that people probably know very well, is that there are a lot of other influenza vaccines. Influenza vaccines have three or four different strains of influenza in the one product. We also have polio vaccines and pneumococcal vaccines that have multivalence in them as well. So every year we know that scientists combine activity against a number of the recent strains of influenza, for example, and that is included in the latest vaccine. So this is very similar to what we're doing now with COVID. Health Canada approved the use of a combination bivalent COVID-19 vaccines. It's approved for use in adults 18 years of age and older, and I'll talk a little bit about that in a minute. So this is a form of combination vaccine that has the spike protein in it, not just for the original Wuhan variant, but also for an Omicron variant. And it is based on the Omicron BA1, but clinical studies have shown that that BA1 component of the bivalent vaccine stimulates a very strong immune boost against all of the Omicron strains, including BA45. So that's important. I know the U.S. has approved a bivalent vaccine that includes the BA45, a more closely related one. But in Canada, the one that's been approved with all the data that we have is the one that's bivalent with BA1, and that in the clinical studies has shown to give a really strong increased boost against all of the Omicron subvariant. So I think that's important for us to recognize. And so this version, as I said, was designed against the BA1, and we know that it is BA45 that we're seeing most commonly now, particularly BA5, but it's not a dramatically different strain. It's not a new variant. It's not a new variant of concern. It's still within that Omicron, and so we're seeing good protection. It also protects against infection. So that's the part with the antibodies in your blood that we see decreases in all of us the most, and there's lots of good reasons for that. We know that the protection lasts best in the first eight to 12 weeks after you get your booster shot. That's important because as we're putting all of these pieces together for thinking what might happen in the coming weeks and months, we want the people who are most at risk to have that boost up, that top-up of their protection so that they have antibodies to protect them from infection when we expect to see COVID increasing again. And as I said, we'll be talking some more about that, but what we're looking at is probably November, December. And the other things that we're putting into the mix is it's very likely we're going to see influenza this year. And we haven't seen influenza in the last couple of years, but people are traveling more, we're doing more together. And we look at what happened in Australia, New Zealand. We see that influenza was a fairly bad season this past year for them, and it came early. So what we're planning for and what we need to think about is how do we best protect people from influenza, from COVID, at a time where they both might be circulating and that is really November, December. So that's a little of the thinking that's been going into who's going to get this by the available vaccine booster and when. So the timing will be based on risk and on the time since your last dose. So first of all, we need to know who are the people most at risk for poor outcomes from COVID-19, and I think this will be no surprise to anybody. We have learned that there are people whose immune systems don't respond as well and decrease faster. And primarily, that is people who are immune compromised due to underlying disease or due to the medications they're on and people of older age. So it includes people being treated for cancer, people with chronic kidney, liver, lung diseases, pregnant people, and a number of other disorders and medications, and people over the age of 60, particularly over the age of 80, but we really want to protect people over the age of 60. And NACI recommends our National Advisory Committee on Immunization has put out their statement on who should get a fall booster, and it's based on people who've had their vaccine for six months or more. Their last dose was six months or more. And although there is some leeway there, depending on circumstances, but at least three months since the last dose. And for some people, and Dr. Ballin will get into some of those details, we really want to give it prior to six months, like if we have a local outbreak or so that we can do residents of a long-term care facility, for example, all at the same time. The other group that we now need to look at is people who have hybrid immunity that I talked about, and people should wait at least three months after having an infection before you get your next booster dose. That allows your immune system to mature and to develop that boost from the infection as well. I think it is also very important to say to people who are not vaccinated, even if you've had an infection, we know you are at higher risk of being reinfected and higher risk of having more severe illness if you're reinfected. So you should be vaccinated on top of having had an infection, whether it was Delta, whether it was in 2020 or whether it was recent from Omicron. Immunization will help develop stronger, longer-lasting immunity, and you are eligible for your dose one today. And I encourage anybody who's not been immunized to go out and get that vaccine now. In terms of the bivalent combination vaccine, the following people will be offered around six months. So people, residents of long-term care facilities, assisted living, homebound, and other congregate living settings for seniors, older age adults, age 60 and up. People who are, what we've described is clinically extremely vulnerable, and we have three groups of those in BC and particularly those age 12 and up with an underlying medical condition or disability. Adults, people who are First Nations, Métis or from those communities where infection can have disproportionate consequences. Residents of other congregate living settings like migrant workers, shelters, correctional facilities, and everybody else should consider getting this fall booster. And I would say you should think about getting this at the same time as you get your flu shot because that will give you the best protection as we head into the highest risk period. And we'll say that some of the long-term care facilities, if you remember, many of the people who are recommended strongly to get this bivalent dose are people who were eligible for a dose four, a second booster. And that was, and when we get to Octoberish, that'll be about five, five and a half months since we started that fourth dose program. So they'll be rolled into getting that vaccine then. And that we think will give the best possible protection for all of us as we're expecting to see a surge of COVID in the November-December timeframe. So as we are beginning this fall respiratory illness season, we need to do so with the best protection we can. If you've just had your booster, it's okay to wait three to six months to get another one. And I've also encouraged all of those who've received their invitation for a booster who are young and healthy and haven't got that third dose to get it now. It will give you that stronger, longer-lasting protection through the fall. And I also want to thank everybody. We are here where we are in BC because everybody has stepped up. So many people have done what we've done to protect ourselves, our family, and our communities, and it's made a tremendous difference. And I'll now turn it over to Dr. Balam who will provide more information on when and where the vaccine will be available. Thank you so much, Dr. Henry and Minister Dix. And good afternoon to everyone. It's always a privilege to be here to be part of this really remarkable effort to bring our lives back to normal in the midst of a pandemic. What I'd like to do is just walk you through some of the specifics of how this fall booster program will proceed. And I'll just catch up on a few things just on our activity over the last six months. Over this time, the vaccine program, really since the peak of the first booster program, you'll remember that started in November and carried through to throughout January. And since that time, we've continued to offer vaccines for people who come to us with whatever dose, no doses, dose one, dose two, a booster. We've had a lot going on. And we've continued to deliver the program through pharmacies and through the health authorities. On average, about 85% of the vaccinations that we've done over the last six months have been done in our pharmacy sector. And I just really want to do a shout out to them. They've really done a remarkable job in coordination with the BC Pharmacy Association. And the health authorities have done the rest of the job and they have a harder job to do. Their job is to do the outreach for people who are hard to find, people are frail, elderly in facilities, homebound people, frail people who are not able to come out to a clinic. So they have a hard job to do in terms of the numbers, not such a high volume as the 600 or so pharmacies who have continued to provide vaccine. And health authorities have also done the children's campaigns, both the 5 to 11 campaign and then the most recent six months to four-year vaccination program that was authorized in mid-August by NACI. So since March 2022, we've delivered the spring booster campaign for our most vulnerable individuals, those over 70, and those who are medically very susceptible to infection due to immune suppression and Indigenous peoples. The Moderna vaccine was introduced, as I said, for six months to four years, the Moderna pediatric. And we just, as Minister Dix mentioned, we just commenced the first booster for children 5 to 11. So today, all individuals six months of age and over are eligible for vaccination against COVID. And we, from 5 on up, as you'll see, are all eligible for a booster this fall. And we really want to just put in, you know, this is the first day of school. Children across the province are returning to school and it's very, very important that as parents and families, grandparents, that we really try and ensure that those children and youth are protected against COVID. They're going into a setting where, you know, we know they want to participate in many activities and not be home ill. And so getting vaccinated, whether they're unvaccinated or they're actually eligible now for their first booster or they've been eligible for a while, if their youth really want to encourage that they take advantage of this campaign, where a vaccine will be very, very available across pharmacies and health authorities. I think in the 5 to 11 age group, we are hopeful that we will pick up on our results. We have about 58%, just under 60% of our 5 to 11 group that have received dose one and just under 50% who are fully vaccinated with two doses. And just want to, you know, just encourage them to carry on and take their vaccine as it's being made available throughout the next coming months. The importance of being vaccinated does continue to resonate with our public who have been so enthusiastic. And I just wanted to share a little factoid with you that every day in the province, 50 to 120 youth or adults actually have stepped up to get their first dose. So making this available, easy to find, you never know what the reason is. Somebody who's among the 10, 9 or 10% that are unvaccinated, why they'll suddenly choose to get it, but it's really important that we remain very available and encouraging and supportive to make sure they take that opportunity. And we want to encourage the 1.3 million people who got fully vaccinated but have yet to have a booster. This is the time to come in and get your first booster. It's really important, as Dr. Henry has explained, you are not going to get that same strength of protection, even if you've had a COVID infection. And we just really want to encourage that group, especially to come and get it. Then I'll talk to you about where the different groups will be prioritized for invitations for the fall campaign. So now on to some details. Dr. Henry has talked about the new bivalent or combination vaccine, that's Moderna's product that has been approved. We were actually hoping we could say today it's arrived in British Columbia, the first trash, but it's not quite there. But we're expecting that it's imminent, that we will be getting our first trash of that supply into the province. And basically, we anticipate that we'll have about 1,100 pharmacies participating in this fall booster campaign all around the province and that there will be on any daily basis more than 100 health authority clinics working with the pharmacies together to provide the capacity that we need to get our population. Everybody five and up is eligible for a booster to get them on an expedited basis, able to access this booster. And hopefully as many as possible before we start getting into respiratory season in November and December of this year. The health authorities, not only will they have mass clinics, but they will also do, as I said, all the difficult outreach to populations who are, you know, more vulnerable, are homeless, are sheltered, corrections. And as well, they do the facility program. So they will be visiting long-term care. Ideally, we'd like to wait to do long-term care for the high dose flu vaccine that's specific for that very frail group of elderly. We hope to have that starting somewhere between the middle and the end of September. And at that point, the health authorities will move out to start their vaccinations in long-term care and assisted living. Dr. Henry has alluded to the fact that we will be co-administering influenza vaccine for the general population accessing the fall booster as soon as it's available. And normally, that vaccine arrives in the beginning of October. So we basically modeled and planned that starting probably the week of the third that we will be able to offer both COVID and influenza when you go to get your vaccination, whether it's a pharmacy that you're going to or a health authority clinic. Now, just to remind you that this new combination by bivalent vaccine will obviously provide very good protection. Not everyone is eligible to receive it. Adults 18 years and over have been approved by Health Canada and recommended by Nassie to receive the new bivalent vaccine. For youth 12 to 17, Dr. Henry has recommended that those who are high risk have immunosuppression, have chronic medical conditions that compromise them, that they will be eligible to receive this bivalent vaccine. But for the rest of youth, we will offer them a fall booster using the regular vaccine that has been used to immunize them to date with their dose one and dose two. We understand that there is Pfizer vaccine that is working its way through the regulatory process, and we have had some information from the NOC, which provides us all the logistical information about delivery of vaccines, and we're hoping that we will receive some Pfizer vaccine in the coming weeks as well that will be a bivalent product as well, but that's still preliminary and working its way through the regulatory program. So I think one of the things that everyone wants to know is when am I going to get my invitation for my fall booster? And first of all, we will use our get vaccinated BC system that I think most of you are familiar with. It's been a terrific system, and some of you have, most of you have accessed it online. Some have used the call center to get some help with that, and that will continue to be the case, but we will be sending out our invitations through that system, either to your e-mail or to a mobile number, and I just want to be clear that we recently have had an upgrade to the system that now allows you to actually go in and update your contact information, which is really important. Not everyone is like me that has had the same mobile number for 20 years. I gather people do change their number, and so it will be really important you go on the get vaccinated system. There's an icon you can click on and then update, whether it's your e-mail or your mobile, so that you'll be sure and get your invitation. We will flow invitations for the fall booster campaign based on a number of variables, which are mostly direction from public health and dictate the priorities. I'll just go through the key groups. First of all, the interval from your last vaccine is a really important indicator. As Dr. Henry has said, immunity does wane. For those who only got up to dose 2, they are well over a year, many of them have had their last vaccination. They may have had COVID in the meantime, but we will be targeting especially those very high priority individuals in those groups as early invites to the campaign. Those who are clinically extremely vulnerable. We have three groups of those who are immunosuppressed, either severely or moderately, and then people have chronic conditions like diabetes, some of the neurodevelopmental issues, chronic lung disease, a whole variety of conditions that Dr. Henry referred to. That's the second high priority group that will be invited as a priority for the campaign. Indigenous, our public, our Indigenous community, 18 and over. And then we will use the age cutoff of 60 years of age to finalize the priority groups who are vulnerable to COVID-19. We will be talking about those who are vulnerable to COVID infection and to having more adverse outcomes. Health care workers is the final group that I just want to speak to. Our health care workers were a high priority when the first booster came in order to protect our health care system and many of them are well over six months since their last dose and we want them to be protected, as Minister Dick says, to protect them from getting sick, but we will be talking about those conditions in our program. Health care workers are a really important group. And finally, the group, very vulnerable folks, 70 and over, and immunosuppressed who were invited for the spring booster campaign. As Dr. Henry has said, we are going to time their invites so they will be the first on deck in October to get the combined influenza and COVID vaccine opportunity. As Dr. Henry just referred to, elderly and long-term care, assisted living, homebound individuals, congregate settings who are considered high risk, other high risk groups that we know have adverse outcomes, those in shelters, congregate settings, corrections facilities. The health authorities are responsible for those and when the bivalent vaccine arrives, they will be making plans to, along with the long-term care and assisted living programs, they will be able to get the vaccine available to the mass clinics and the pharmacy program that will be running across the province. We built a model for immunized BC to actually project both who will invite and what we expect the uptake will be. We will be able to vaccinate at peak, about 250,000 to 280,000 individuals a week. So that's about, you know, a quarter of a million or more people will be able to do that. That capacity will remain for about 10 weeks. Starting in the middle of September on September 19th when the health authorities start up their mass clinics and the pharmacies, the full tranche of pharmacies who will be participating, about 1100, and we will run that capacity as long as we need to as the demand is flowing. That's about the maximum that we can get. And then as the demand falls off, as we expected to at the end of November, we will be basically backing off the health authority clinics and turning the program over to the pharmacies and then the health authorities will carry on doing the difficult to reach, the facility program, and the children. At this time, as I said, the arrival of the vaccine, the bivalent vaccine is imminent this week. It will be sent to the pharmacy distributors as soon as it arrives. It will be repackaged by them and then distributed to pharmacies around the province. The next week we'll get a bigger, we hope to get a bigger tranche of vaccine that will be used to load up the health authorities, make sure they're ready for their start on the 19th. And we will start issuing invites. As soon as we have a vaccine in the province, we will have the highest priority invites at that point in time and allowing the commencement of the campaign. And it will be ramped up and reach peak by the third week in September. Now, we do know that there are some people who may not want to, are not sure they want to do the bivalent vaccine. Dr Henry has described that it's a very good vaccine with added protection against Omicron. We have a lot of people who are vaccinated with Pfizer and Moderna available. We continue to have Janssen and Novavax available and we really encourage people who perhaps are not sure, they don't know enough about this vaccine, get your fall booster with either the existing vaccines that you're very familiar with or with Novavax or Janssen. We really want people to be protected for the respiratory season. Nassie's guidance is very, very clear as is Dr Henry's getting a little bit more of this fall, especially once you're six months or more from your last dose. And finally, for all the parents, just one more plug for those parents of children who are anywhere from 5 to 18, get your kids vaccinated. And it will be a real privilege for our team to carry on providing this program to support the fall booster to protect our public, keep our economy going and make sure that those most vaccinated are continue to be well protected in this province. Thank you very much. Over to you, Minister. Thank you, Dr Henry. Thank you, Dr Ballum. And just want to say finally before we take your questions how important it is to get vaccinated. I think Dr Henry and Dr Ballum have made this clear. But we, the priority we give to it, you can sense from Dr Ballum's briefing that we're building up in a short period of time, we're building up in the last night between 250,000 and 280,000 people a week. That's an enormous effort by our pharmacy sector and thank you to pharmacists, by our doctors, by our nurses, by other health professionals who are taking part in these vaccination programs. It occurs at a time when there are very significant demands on the healthcare system and the fact that this is such a priority for us and the fact that so many people are contributing to this and we have a lot to good reason to get vaccinated, to protect yourself, to protect the ones you love, to protect the ones you don't know, to protect your community, to protect the healthcare system, but there will be an opportunity to get a fall booster. I encourage everybody, everybody to get one. And I want to again thank all those in British Columbia from people who work in healthcare, everyone in the province for their ongoing support and effort as we continue to do so. Thank you. As a reminder for reporters on the phone, please press star one to enter the queue. That's star one to ask a question. Please also remember to take your phone off mute, you will not be audible until your name is called. For media in the room, please line up at the microphone provided and someone will check in with you. Please wait to be called and make sure to provide your full name and address at the end of the call. Thank you very much for your time, Richard Dussman. Please go ahead. Dr Henry, I'm trying to understand how someone makes the decision around getting the bivalent and the flu shot if they want to do that at the same time. Should people wait until that point in October? Will the most vulnerable be required or guided to wait until that point if they need to waste a lot of the other vaccine that we currently are providing and currently have in stock? In terms of who gets what when, if you're somebody who has not had a booster dose, you should get a booster dose any time now and get your flu vaccine when it comes available later on in October. We kind of titrate it so those people who are at highest risk, who most need the bivalent booster, are going to be at about five, five and a half months come October. Those are the people who had their fourth dose in the spring vaccine campaign. You think we planned it. It actually lines up very well for them to be able to get co-administered their flu vaccine and the COVID booster. So people in long-term care, people over the age of 70. So for them, we right now, and I think this is part of what we're challenged with all of us, is that we can't get rid of uncertainty. There's a lot of uncertainty. But this is our best guess of what's going to happen and unfold over the coming months. So if you are younger, you only had two doses on board or it's been a long time, you're a vaccine when it becomes available in the coming weeks, and you can get your flu shot when it becomes available later on in October. So don't worry so much about getting them together. We're trying to reserve that for those people we know need both and where we can get efficiencies by giving it to people together. But I think we do need to recognize that if we start to see outbreaks in long-term , we will speed that up and we will change our approach and make sure we can get booster doses regardless of whether the vaccine, the influenza vaccine is available or not. So this is our best guess right now. And as I mentioned, I'll be providing a little bit more background about how we came to those decisions next week when we talk a bit about the modeling and thinking about what might unfold over the long-term. They are still the vaccines that we need to give for dose 1 and dose 2 because there are a higher amount of antigen in them and you need that to start off with your primary series. The primary series is still two doses. We have also learned that their dose is really important for longer-term protection, both from antibodies, so protection against infection, but really important for developing that robust, effective vaccine. I will also say that we have been titrating how much we get from the knock, from the national supply, so that we don't have a lot of excess doses on hand. And Dr. Valens-Tiemempe is working on that to make sure that we are not wasting vaccine as much as possible. We do know that some of it will be coming up and expiring later in the fall and in the fall. We try and as much as we can titrate the types of vaccine for the demand for those vaccines as we have been doing for the last year and a half. I will also say that this uncertainty is something that, and I have talked about oscillations that are sort of getting smaller and smaller over time, and I do believe we are going to be out of the emergency response pandemic phase with this new SARS-CoV-2 virus. But we are not there yet. So what we are doing for this fall is based on what we have learned that we are still in a very uncertain period of time. There is still a lot of transmission globally. We still have the possibility of having new variants that escape vaccine protection potentially. I think that is becoming less and less likely as people globally are vaccinated. But those are the things that we still need to be prepared for over this coming year, I think, that will emerge and then we will have a longer-term strategy for whether we need a booster every year or whether we will get more information about how long that protection lasts, especially the protection against more severe illness. And this time next year I will be talking in perhaps in a different way. Dr. Henry, again, considering that the vaccination rate for 5 to 11-year-olds is so low and much lower than the older age demographics, what is the province doing to change its approach to encourage 5 to 11-year-olds to get vaccinated? And will there be any consideration being given to different types of clinics, including vaccinating at schools, a wider range of schools across the province? That is a concern for us. I think there has been a couple of things. Part of it is the timing of availability of vaccine for school-aged children. And there is a lot of things going on this summer. I think a lot of people had experience of infection. And we have seen that in some of the zero prevalence data that we have that we are just analyzing now and I will talk more about next week. We have seen that a lot of people have been vaccinated in the last 6 to 8 months. I think that impacts people's decisions on whether to get a vaccine or not. So now we need to say, yes, even if you have had an infection, you need to get that first or second or third dose of vaccine. And now is the time to do it because it is going to give you that stronger, longer lasting protection in that age group. And we have been working on a lot of things in the coming weeks. And yes, in schools where it makes sense, so there are some schools where that will be a part of offering school-based immunization but not all schools because we know that local public health knows where those strategies work best and where people are able to get vaccine and access vaccine and we will be able to titrate that depending on the program. Our next question is for Xiaozhu, Globe and Mail. Thank you for taking my question. Given the lack of uptake on the first booster shot, are you expecting better uptake on the Pfizer booster and what is your plan to ensure that there is better uptake? We actually had pretty good uptake for dose three but there is, as we talk about, 1.3 million people who have not had that third booster shot. And we have been trying to understand what are people's reasons. A lot of it is because they had a recent COVID infection as well as we know Omicron has been spreading quite a lot. So we have heard from people that about a third to 40% of that 1.3 million people are willing to get a vaccine. They were waiting for the bivalent vaccine. So we will be targeting and one of the things we are saying today is if you are in that group of people, this is your vaccine to get in the coming months. How did you have a follow-up? No, I don't. Thanks. Our next question still on the phones is for Moira Whiten, please go ahead. Hi, thank you for taking my question. I just want to clarify, the follow-up booster is being recommended for people no matter how many initial shots they have, whether that be the primary series or a third booster, first booster or a second booster, is that correct? Moira, a little bit of nuance as always with these things. I know it is complicated. If you have not had any vaccine, you need to get the original formulation with the higher antigen dose. But yes, regardless of whether you have had 2 or 3 or 4, we are recommending for people who are at highest risk and for all adults that they get this booster shot after about six months. Moira, did you have a follow-up? I do, and they think about clarification. Following up on Richard's question, there is a really low number of small children or four and under getting vaccinated. How much of this do you attribute to the newness of the program? And what strategy are you going to be employing to build trust in that vaccination program? I know there is a lot of parents and I talked to many of them at some of the schools. We had a vaccine to protect our youngest children. You know, six months, we know that infants are particularly at risk and can have very severe illness with COVID. Older children, thankfully, tend not to get a severe illness. But it is still important to protect them from getting sick. We have seen a very slow start to it. We are only about 10% of where we want to be. We have heard a number of people say they haven't yet brought their younger children. Partly it is because of timing when the vaccine became available. There was a lot of people with lots going on during summer. So we are hoping that that will increase. We have also been doing targeted outreach to families with children to remind them that we have these clinics now, the public health clinics that are available for kids. We have offered COVID vaccine and as I mentioned, we are starting a new targeted advertisement campaign to build some confidence and to help parents answer the questions they have about vaccination for our youngest children. I don't know if you want to add anything to that. It is a decision that we heard many parents are anxious to make for their children, but they have to wait a little bit and see how it is working and other children. We have more data now on an ongoing basis about safety, about how well it is working, about the vaccine formulation itself for younger children and how effective it is. So I would encourage you to talk to your health care provider, talk to your pharmacist, talk to your pediatrician. There is lots of great information for parents on the vaccine evaluation center at Children's Hospital about these specific vaccines that are formulated for younger children. One of the things that we have been working on is making especially the vaccine for younger children available through pediatrician and family practitioner offices because we know that those are trusted sources for parents where they feel comfortable bringing their younger children to get immunized. For our next question we are going to go to a reporter in the room. This is a question for Dr. Ballum. Could you just clarify does somebody need an invitation to get the bivalent vaccine? What happens if they show up and they are not sure if they get the bivalent one? If somebody makes an appointment for next vaccine should they expect that that will be the case or they only get it if there is an invitation? Just to clarify we will not given the size and the capacity we are trying to create at this point it is by invitation only. When you get to your invitation we will assume that you will want a bivalent vaccine if you are eligible. If you are 18 and over that would be the vaccine that you want to have the regular vaccine that you started with that is fine as well. If you don't want the bivalent as I said and you would like to get your fall booster with a Novavax or potentially a Janssen you are 18 and over that you have to do through the call center. But we are assuming that the majority of people will want the bivalent that will be the default vaccine but that is the regular vaccine we have been using for the last two years are the vaccines that would be used for that primary series. I know you have been reluctant to reintroduce public health measures but you are also worried about the fragility of the healthcare system and the fact that we could be facing a double whammy with influenza this year. What are the numbers that you are looking at before you consider reintroducing public health measures to control potentially not just COVID but potentially also the flu as well? Really good question and there is no one single thing and we talk a lot about what we are following and what we are looking at in terms of what is transmission in the community, outbreaks, who is getting sick, who is getting sick, who is getting sick. I will say that the pool of people who are susceptible is different now and that is because of the level of immunity we have from infection and also primarily from vaccination and the combination. So the tools that we used when we had no immunity and where we needed to take drastic measures to slow down the spread of the spread of the virus is effective and are no longer needed for the most part. So doing a mandate, making it a legal requirement for people across the board to do something is actually a very, it is a last resort tool that we use very judiciously in public health. So I don't see us getting there unless we have the emergence of something very new and different where we know that ourselves, all of us have had experience with this virus now. Schools know how to deal with it. They have understood the disruptions that some of the temporary measures we had in place like cohorting and distancing and mandates, mass mandates, the impact they have on disruption of learning in schools but we also know there are some things we need to keep doing all of us, paying attention to our awareness. How am I feeling today? Do I need to stay away from others until I feel better? And staying home with real hand hygiene? Those are the things that we can't ever lose and I hope we are baked in but we can trust people now I think in our community to do those measures. We don't need a heavy hand of putting in legal restrictions in my opinion. Our next question is also in the room. Hi. My question will be for Minister Dix in French please. Thank you so much. So I'll just need a couple of words in French on this campaign of vaccination in the fall of autumn. What is it going to look like and what words to tell us at what point is it an important campaign in the context we know there is a bivalent vaccine at the moment approved by Santé Canada? We are always living in a pandemic which has an influence on a lot of elements of our society, in particular our health system but already everywhere. Vaccination is a tool for us to respond to that. It is for each person an opportunity to protect themselves, to protect what they love and to protect the community. We have a lot of new vaccines. We have new vaccines. And these are vaccines that are effective against the variants of democracy. And so I think that everyone, as soon as they are invited to vaccinate for this autumn period, I think it is essential, it is important for us as a society but it is important for each one of us. And it is for this reason that we have put in place important effective all over the system. We will see about two or three or four which is still extraordinary in addition to what we do now in the health system. We do more than now, than ever before. We do more visits for primary health now. But in addition, we will have a campaign that every week will be able to vaccinate approximately 280 people which demands the priority given by this effort. And I think the priority that I think that everyone between us will give effort and that is to say against an invitation to be vaccinated to be vaccinated. Thank you very much. Second question, always in French, that is to say, Dr Henry spoke of the peak that we expect to have possibly in November with the Covid-19. We know how many hospitals here in the British Columbia are under pressure. We have seen, among other things, the closure, the reduction of hours in the urban emergencies. First, are you worried about the influence of influenza? And what can we see? Can we see two measures? So in two parts, please, the answer. And in 2020, in 2021, in July of this year, we have made preparations for autumn and winter because these preparations are essential not only for public health but for the health system. I am always worried because there are things that we know well and then there are other things, always. There are always surprises and the Covid-19 gave us every surprise. We remember that last winter, last December, there was the development of the democracy that was so popular. So we made preparations but I think I have a lot of respect for our professionals in the system and we will be ready to respond to all of this. Now, today, this month, we have made more surgeries this month than ever before. More tests, more visits, more calls to the ambulance. And the health system has responded to this, despite all the challenges and difficulties. There are some urgent services in particular Clearwater but also Mackenzie at Jetwind who has had to reduce their services for a few weeks and what we are looking for and what we are working on on this question that we are working on is to have a permanent response to these situations. But I think the health system will be a measure to respond but everyone must participate. Everyone must be vaccinated who are invited to be vaccinated. It is essential for all of us not only for the health system but for our own health. Do we have any other measures? I think there is preparation but what we have done since the beginning of the pandemic is to adapt to circumstances and it is different now. 92% are vaccinated in our population. It is different than in the winter of 2020 but we are always ready to do what we have to do. And Dr Henry has demonstrated that for two and a half years we are ready to do what we have to do but what we have to do has to be changed too. And so we are going to now, and it is for this reason that we have such a campaign of vaccination for autumn and for winter. And that is all the questions we have for today. Thank you. Thank you.