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“Well, you know, look,” Smith responds, before taking aim at provinces that are continuing to provide COVID vaccinations for free, as they’ve done since the shots were created: “I don’t think that they’ve done the analysis that we’ve done. I think they’re going to be a bit shocked,” she says.

To Smith, the argument for slapping a price tag on COVID vaccinations for most adults who aren’t immunocompromised or living in seniors’ homes is that a decline in cases and vaccine uptake no longer justify such an expensive shot, particularly when some may get thrown out. She points to the flagging popularity of the vaccine, the cost of wasted doses and the knee and hip replacement surgeries that money might buy instead. (According to , only 16.7 per cent of Albertans had received the latest version of the vaccine by the end of June last year; among the provinces, only Ontario was lower.)

But her critics see a premier still mired in pandemic politics, perhaps more than any other leader in the country. Smith has arguably long walked a line between alienating her fiercest supporters — some of whom are skeptical of vaccines — and keeping mainstream voters on board, but her decision making is now cast against the backdrop of an American government increasingly hostile to scientific research and decision-making.

If Trump-style politics are trickling north, the border is arguably most porous near Alberta. Smith is “deeply influenced by the United States,” says Duane Bratt, a political scientist at Calgary’s Mount Royal University who is editing a forthcoming book on her first years in office. Smith has made appearances alongside right-wing American personalities like Ben Shapiro and Tucker Carlson, visited Donald Trump at  and made culture war standards priorities for the Alberta government, such as banning ”” school library books and creating  sports divisions.

Now, as America, led by vaccine skeptics like U.S. Health Secretary Robert F. Kennedy Jr., continues to restrict access to the COVID vaccine —  that this fall’s shots would be limited to seniors and people with health problems — fears are mounting that Alberta is watching. The worry is that it will become even harder to get a vaccine in the Prairie province, but also that health decisions will be increasingly subject to ideology, not research.

“As the U.S. goes in these areas, so goes UCP Alberta” — Smith’s governing United Conservative Party — “although more slowly and less bombastically,” longtime Alberta political columnist  wrote this week. “The province is not listening to the vast majority of the experts — not the Canadian experts,” argues Dr. James Talbot, a former chief medical officer of health for Alberta.

 “Instead, it’s listening to this small, Fox News-loving minority.”

But according to Bratt, the fact that Albertans are supportive of science and vaccination presents a political hurdle. Smith won’t come out and openly criticize the shot, he says, so “what she wants to do is make it as difficult as possible to get vaccinated — so going after affordability, going after availability.

“By putting this administrative burden on Albertans, vaccination rates will plummet, and then she can say, ‘See? Albertans don’t want to be vaccinated.’”

Notably, the news release announcing the vaccine changes cited the U.S. Federal Drug Administration’s decision to stop recommending COVID vaccinations for pregnant women and many children, as well as U.S. Centers for Disease Control estimates of cost. Not mentioned is the fact that Canada is responsible for its own , which continues to recommend vaccinations for pregnant women because of the additional risks posed by COVID.

Talbot scoffs at the idea that lower vaccination rates are a reason to order fewer doses, rather than a call to action. “When was the last time you saw a successful business run a bad marketing campaign and then blame the customers for failing to show up?” he asks.

Besides which, the need for vaccination persists, he adds. According to the provincial dashboard, 405 Albertans were killed by COVID in the last respiratory season, and more than 3,000 hospitalized. That’s more than double the fatality rate of influenza, the vaccine which continues to be provided free of charge. 

To use another measure, Talbot also points out that more than 740,000 Albertans have opted to get the COVID vaccination since last fall, which is almost as many as the just over 928,000 that voted for Smith’s party in the last provincial election in 2023. “Yet the province is not listening to the vast majority of Albertans, nor the vast majority of the experts,” he says. 

Smith herself has long been skeptical of vaccination. Shortly after becoming premier in 2022, she for referring to those who hadn’t been vaccinated for COVID as “the most discriminated-against group” in her lifetime; a video made before she was premier surfaced later, in which she said the vaccinated had fallen for the “charms of a tyrant” in an apparent reference to . (Smith was vaccinated during the pandemic, although she flew to Arizona for a non-mRNA shot.)

That ethos has followed her into government, where she commissioned a task force made up mostly of people who had been critical of the pandemic response to review the pandemic response, which the use of COVID vaccines should be halted pending “full disclosure of their potential risks.” (Its final report was broadly rejected in the health community, with critics pointing out that data from around the world has found the shots are safe and effective for the vast majority of people.) Meanwhile,  a small number of anti-vaccine town halls that claimed that child deaths have increased 250 per cent since the pandemic. (They have not, and that number was eventually removed for the event description.) 

As a result, some in her base see the issue of vaccination differently than more mainstream Albertans; some are angry that COVID vaccines are still available at all.

Highlighting the narrow path Smith walks, a caller to her radio show recently asked about the very vocal former doctor in Alberta who has long claimed that ivermectin can help heal cancer and why his work is being repressed by the Smith government. (Ivermectin is the antiparasitic drug that some believed treated COVID, despite a lack of evidence.)

Why, the caller wanted to know, was Smith standing in the way of a useful treatment? 

But the government’s most recent stance on vaccination recent policy has softened slightly, perhaps as a result of the pushback. Officials now say health-care workers will not have to pay for a COVID vaccination, although critics of the policy say it still doesn’t go far enough in protecting them.

Still, Smith is playing with political fire, Bratt says. While she remains popular as a leader despite the unpopularity of some of her policies, he argues voters have been distracted by Alberta’s fight against Ottawa and comforted by healthy government revenues. Now, the current federal government is more popular in the West than Justin Trudeau’s was, and softening oil prices are set to take a multibillion-dollar bite out of Alberta’s ²ú³Ü»å²µ±ð³Ù.Ìý

There’s also the ripple effects of undermining vaccination programs, Talbot says. There’s the increased pressure more COVID cases will put on emergency rooms, and the downstream costs of long COVID.

Plus, there is now confusion about how flu shots will work in the fall, he says, while Alberta continues to grapple with one of the worst per capita measles outbreaks on the continent, which has also been made worse by a lack of vaccination. 

Flagging vaccination in just one area could be chalked up to poor planning, he says. “But if you’re bungling measles and you’re bungling COVID and you’re potentially going to bungle influenza, then it starts to look like your platform is to undermine really important parts of the Canadian health-care system.”