Provincial vaccine plans delivered by British Columbia and Manitoba are setting the stage for distribution models in other provinces. In the weeks ahead, other provinces are likely to release plans that are largely in-line with the steps taken in B.C. and Manitoba, with few exceptions to reflect local realities.
The Public Health Agency of Canada has set some terms that provide guidance for our current situation.
“The equitable allocation of vaccines where there is limited supply needs to take into account who is most at risk of exposure and severe outcomes, feasibility and acceptability of the vaccine and ethical considerations.”
We are in a limited supply scenario and will be for the foreseeable future. In a pandemic, it is difficult to know what to expect at any time, but statements like these give us hints.
First, minimizing severe outcomes is vital if politicians wish to limit their political risk. The most severe outcome of COVID-19 is death. Canada has done poorly minimizing fatalities within long-term care settings. Steps have been taken in many parts of the country to vaccinate the workers and residents of long-term care facilities, which should blunt the trajectory of deaths for the rest of the pandemic. Outside of long-term care facilities, older Canadians continue to have the greatest risk of experiencing severe illness and hospitalization. Keeping patients out of ICUs and out of hospitals is important for the resilience of our overall health care system. From the standpoint of reducing severe outcomes, age-based vaccination rollout makes a lot of sense.
Second, feasibility is a major consideration in mass vaccination. In the health professions, frontline workers often have regular serology reports that highlight how up-to-date they are with vaccinations. Outside of the healthcare sector, political leaders have to consider the blowback from leaving other sectors or professions out in the cold. With such a highly sought commodity, verifying the eligibility of recipients is critical to avoid issues with deployment. In considering how quickly, and reliably you can verify the eligibility of someone who shows up at a mass vaccination facility, driver’s licenses, passports or ID cards are useful tools. They have the added benefit of being official government documents. That makes age a highly feasible metric to verify on-site.
Precedent is highly valuable to politicians making informed, and difficult decisions. One of the reasons provincial politicians are pushing so hard to receive more vaccines is that it becomes easier to make decisions, giving them some flexibility in supporting certain sectors or professions. For now, and considering the consequences, an age-based approach is the most likely path governments will take to limit pressures on the health-care system, reduce deaths, and avoid any political consequences.
