Who should a COVID-19 vaccine first in Canada? New formal advice released - Toronto Star

Canadians have been given their first look at who could be prioritized once a COVID-19 vaccine becomes available in this country.

A national advisory body tasked with giving immunization advice released on Tuesday its first set of guidelines. They suggest the elderly and the high risk as well as health-care and essential workers should be first in line for a vaccine.

The National Advisory Committee on Immunization’s guidelines are not binding but are designed as advice to public health bodies to “minimize serious illness and overall deaths while minimizing societal disruption as a result of the COVID-19 pandemic.”

They’re based on the assumption that once a vaccine becomes available, there won’t be enough to go around — at least not at first. To that end, the guidelines are designed to plan out an “efficient, effective and equitable allocation.”

According to the guidelines, key groups include:

* those at high risk of severe illness and death: including those of advanced age or with other high-risk conditions;

* those most likely to transmit COVID-19 to those who are high risk: including health-care workers and caregivers, as well as household contacts of those at high risk;

* essential service workers: to be identified in conversations with the provinces and territories, but potentially including police and grocery store staff; and

* those whose living and working conditions put them at risk of infection: potentially including Indigenous communities.

“I don’t think there are any surprises here,” says Amy Greer, an infectious disease epidemiologist and associate professor at Guelph University.

The priority groups are similar to what’s outlined in the national influenza pandemic plan, she noted. The guidelines are also generally in line with what the World Health Organization has recommended.

But what will be different this time, Greer said, is that these will all be brand new vaccines that are being mass produced for the first time.

“When a vaccine becomes available, we know that the limiting factor is going to be, ‘How many doses can these producers get off the production line per week?’”

“When that’s the case, the prioritization exercise is to say, ‘How do we get the most bang for our buck?’”

Officials stress that these first guidelines are not set in stone, because there are still a lot of unanswered questions about what a vaccine will look like. Prioritization could change in the face of data that shows a vaccine is more effective in a particular group, manufacturing shortages or oversupply, or even the need for additional booster doses.

As a result, these recommendations could change as we go, officials say, and will be updated after major milestones; for example, when potential vaccines begin to get regulatory approval.

Canada currently has a handful of advance agreements that entitle us to a certain number of doses of promising vaccine candidates, but even the most advanced ones are still in the final stages of human testing, after which they face the scrutiny of Health Canada.

Most experts say it’s not unlikely that we’ll eventually end up with multiple vaccines, but how effective each one will be and when we’ll be able to start distributing doses remains to be seen.

There are other factors that will help determine which group would be top priority, or how people would be ranked within a key group, including the characteristics of eventual vaccines, the supply of each vaccine and the state of the pandemic when doses become available.

Before all else, vaccines have to be considered safe for a particular population.

For example, most vaccine trials are testing on healthy adults for safety reasons, and haven’t yet expanded to seniors or more high risk groups. If an early vaccine doesn’t have data to show it works on older people, those doses would be given to other key groups instead.

Also, just because someone is on a prioritization list doesn’t mean they’ll actually want to get a vaccine, or be able to, Greer said.

The government needs to start communicating about the vaccine to try to counter misinformation, she said. It also needs to plan for the people on these lists who don’t live in a city or can’t easily get to a vaccine clinic.

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“We need to think right now about how are we actually going to operationalize the delivery of vaccines,” she said.

The recommendations acknowledge the need for accessibility, and call for public health agencies to increase access to immunization programs and engage marginalized and racialized populations in planning.

Like flu shots, the actual vaccinations will be handled by provincial or territorial authorities, which need to begin planning the rollout of their programs, the recommendations say, including safety monitoring and immunization of populations in remote communities.

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2020-11-03 23:03:45Z
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