When a COVID-19 vaccine arrives, which Canadians will get it first?

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When the first COVID-19 vaccines become available, there will not be enough for all who want them, both nationally and internationally.We will take a closer look at the issue of global vaccine distribution and prioritization in another article.

But for now, in Canada, who should get it first and how will that be decided?

Why we can expect vaccine shortages

There is more than 166 vaccines at different stages of preclinical and clinical (human) tests right now, says the World Health Organization. WE and European Experts say in an optimistic scenario, the first of these vaccines could complete testing and gain approval for distribution next year.

But then a factory would have to produce them to the safety and quality standards required for something that is going to be injected into the human body – which it can only do at a limited rate, according to experts such as Dr. Joel Lexchin. He is a professor emeritus at York University and an emergency physician in Toronto who has studied and written on drug policy.

Meanwhile, with a global pandemic wreaking havoc on countries’ economies and the lives of people around the world, there is a strong demand for the vaccine from the world’s population of 7.8 billion people.

“Not everyone will be able to get it,” Lexchin said. “And so we’ll have to prioritize. ”

For this reason, we expect, at least initially:

  • Some countries will have more access than others.
  • Some groups within these countries will have more access than others.

We’ll take a closer look at international issues in another article, but here are some of the issues facing leaders in Canada.

How countries will decide on the highest priority groups

When supplies are tight, countries will need to find a way to get the “maximum benefit for the minimum supply we have,” says Dr Noni MacDonald, professor of pediatrics and infectious diseases at Dalhousie University and at the IWK Hospital in Halifax, which has studied ethical issues related to vaccines. “This is what you have to do. ”

In Canada, this evidence-based assessment is carried out by the National Advisory Committee on Immunization, which it says is guided by the goals of the Canadian pandemic response:

  • Minimize serious illness and overall death (including from causes other than COVID-19).
  • Minimize societal disruption, including reducing the burden on healthcare resources.

He says the vaccine should play an important role in achieving this.

Of course, across the world, frontline healthcare workers caring for patients with COVID-19 should be given the highest priority for access to vaccines as they are at high risk of being exposed to the virus. viruses and are essential to minimize harm of this type. as serious illness and death.

BC paramedic Jeff Booton, who was among those caring for a COVID-19 patient, cleans his ambulance. Front-line healthcare workers caring for patients with COVID-19 are expected to be given the highest priority for access to vaccines as they are at high risk of exposure to the virus and are essential to minimize harms such as serious illness and death. . (Jonathan Hayward / The Canadian Press)

Beyond that, decisions get complicated, but in general countries are expected to target populations at very high or highest risk of serious illness and death, Prof. Ruth Faden said. , founder of the Berman Institute of Bioethics at Johns Hopkins University in Baltimore, Md.

“And these people will probably vary from country to country,” she told CBC News. For example, in the United States, she noted in an article in Futurity, obesity has a major impact on the risk of serious disease.

Prioritization begins at the clinical trial stage

For now, NACI recommends target groups clinical tests.

Baden says this is “critical” because vaccines can work differently in different groups and sometimes these groups can be left out: “There is a huge recognition and awareness of the importance of diversifying who will be involved in these trials. phase 3. ”

For early phase clinical trials (phases 1 and 2), NACI recommends prioritizing not only healthy adults, which are typically used for testing for safety, but also:

  • Adults aged 60 and over with no underlying health problems, due to their increased risk of serious illness.
  • Children and adolescents, immunocompromised adults and pregnant women “as soon as possible” to add them.

For late phase (phase 3) clinical trials, where safety has already been established and the focus is on efficacy, NACI recommends prioritizing people:

  • With health issues that are risk factors for severe COVID-19, such as asthma, diabetes, hypertension, chronic lung disease, and cardiovascular disease.
  • Whose jobs make them more vulnerable, such as other healthcare workers, emergency workers, those with a lot of social contact at work or international business travelers.
  • Whose social conditions make them more vulnerable, such as people living in long-term care facilities or in overcrowded or remote places, the homeless and people with tobacco use disorders, alcohol or drugs. It may also include certain races or ethnicities or certain immigrants or refugees and international travelers.

Who has been prioritized for pandemic influenza vaccination

The groups most vulnerable to COVID-19, including older adults, are a bit different from what they were for influenza pandemics such as H1N1 (where pregnant women, infants and young children were most at risk). But the priority groups recommended by the federal government when this vaccine was rolled out give some idea of ​​what prioritizing the COVID-19 vaccine might look like. When the first seven to 10 million doses of the H1N1 vaccine were rolled out in 2009, these are the people the government recommended to vaccinate first:

  • People with chronic illnesses under the age of 65.
  • Pregnant women.
  • Children under five (but not infants under six months).
  • People living in remote and isolated settings or communities.
  • Health workers involved in the pandemic response or who provide essential health services.
  • Family and caregiver contacts of people at high risk who cannot be vaccinated (such as infants under six months of age or people with weakened immune systems).

The Government noted that the list was not prioritized, that it was up to the provinces and territories to adapt the guidelines to their needs, and that it could be adjusted as the budget was adjusted. we would learn more about the virus.

The United States Centers for Disease Control and Prevention has an even more detailed priority list for different levels of pandemic influenza severity (COVID-19 is considered equivalent to the highest severity).

Why the groups for COVID-19 may be different

As mentioned, COVID-19 tends to be severe in different age groups than pandemic influenza. But it can also spread more easily and have a wider range of symptoms – including the absence of symptoms – and there is evidence that it can spread asymptomatically.

It is believed to be one of the factors behind serious epidemics among groups such as migrant farm workers and workers in meat packing plants.

Lexchin suggests these are some of the groups he would prioritize for immunization given the history of the pandemic in Canada so far, and that it should be offered to anyone who works in a facility they have contact with. close with several people.

“You have to assume that anyone belonging to one of these vulnerable groups could be infected and you therefore have to [vaccinate] Everybody. ”

In the United States, there is evidence that Latino and black residents have a higher risk of dying from COVID-19 than their white or Asian counterparts, and there is evidence that race may also be a factor in Canada. For example, Toronto recently reported that blacks and other people of color made up 83% of COVID-19 cases in the city, even though they only make up 50% of the population.

fil he told me“There is an important conversation to be had as to whether, as part of the long-awaited racial calculus in the United States, we should consider putting people of color at the top of the priority vaccine list in the early days. ”

While this may sound controversial, she thinks it should simply be seen as a priority for people at high risk “whether they are at high risk directly because of age or a relevant comorbidity or for whatever reason. , they are part of a group that is at high risk. risk. “

Mexican migrant workers, left to right, Jeremias Cruz, Antonio Dias and Adolfo Gonzalez get their hands sanitized by Juan Silva after the four complete their month-end banking in Leamington, Ont., June 30, 2020 COVID-19 among migrant workers, who live in overcrowded conditions. (Rob Gurdebeke / The Canadian Press)

The vaccine we end up with could affect prioritization

Beyond the differences in the course of the disease itself in different groups, the COVID-19 situation is unique due to the large number of vaccines under development, based on different strategies and technologies.

This means that they are likely to differ in terms of the dose volume and number of doses needed, the speed with which they can be produced in large quantities, and the ease of transport and distribution. Some may also be more suited to certain populations than others – for example, some may be better suited to older people and others to younger people.

MacDonald gave the example of a vaccine that works well in people aged 20 to 50 but hardly works in an 80-year-old. In this case, she said, “We won’t get a very big effect trying to vaccinate everyone in a long-term care facility… but we would do very well to give the health care providers who treat them the vaccine so that they are less likely to cause an infection. ”

It’s also possible that with some vaccines, some people need one dose and some others, such as the elderly, need two, MacDonald said. Thus, twice as many people in the first group can be vaccinated with the same amount of vaccine.

“How will it weigh? We have never had these kinds of considerations to make in the same way in the past with new vaccines. ”

MacDonald is among the experts who are hoping that ultimately several COVID-19 vaccines in development will hit the market and individuals will be able to access the one that is best for them.

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