By Tonda MacCharles
Dec. 2, 2020
OTTAWA—The best way to prioritize who should get a COVID-19 vaccine, after high-risk, high-priority individuals get first crack, is to go by age not by underlying health condition, says Canada’s top public health adviser.
“We know that underlying health conditions puts people at high risk,” said chief public health officer Dr. Theresa Tam. “But when you actually analyze all the different underlying medical conditions and the age it still comes out that the age is in fact the most important (factor) when you look at severe illness and mortality.”
“The age group, based on all analysis, is actually the easiest and the most scientifically sound way” of increasing population coverage for vaccines after the first four priority groups’ needs are met, she said.
It’s the first time Tam has set out a possible sequence for vaccination of next-in-line groups after the first-in-line priority groups are immunized.
And it comes as questions mount about how swiftly Ottawa will distribute a vaccine, and who will be first to get the limited doses available.
Prime Minister Justin Trudeau said Tuesday once again that he expects most Canadians to have access to a safe, effective vaccine by September 2021.
Procurement Minister Anita Anand said although she is negotiating for earlier deliveries, right now everything depends on the day that Health Canada approves a vaccine. Her best estimate for first delivery of vaccine supplies: early in 2021.
Health Minister Patty Hajdu said regulators at Health Canada are now reviewing data for four possible vaccines, after Johnson and Johnson submitted an application Monday for approval of its candidate. Hajdu said Canada is the first country to which it applied.
The federal government and provinces have already agreed on the broad strokes of who should be first in line for a shot, but provinces will make the final determinations, Hajdu said.
“We have a shared set of principles now as a country across provinces and territories with the federal government,” she told reporters. “At the end of the day it is the provinces who deliver health care, and it is the provinces who will decide on the priority populations.”
In Ontario, Health Minister and Deputy Premier Christine Elliott said the members of a task force led by retired Gen. Rick Hillier will soon be named, and will include a bioethicist to help determine Ontario’s priorities.
“We are working on that right now,” Elliott told reporters, after visiting McKesson Canada’s Brampton warehouse. “But I think it’s fair to say that we want to make sure that our most vulnerable residents are the people that we want to protect. And, of course, we want to make sure that our front-line health-care providers can continue doing their excellent work.”
Hillier agreed those would be the “top number one and number two priorities.”
“It’s easy to say that, but when you operationalize it and bring it down to you have 50,000 vaccines and you have them available on this day, then you want to be very careful.” He said in some cases, such as long-term-care homes, “those two priorities, I think, will probably go together.”
By Dec. 31, Hillier said Ontario will be “able to move the vaccines almost as quickly as we get them so that we don’t waste any time between arriving from the producer to going into the arms… of those who are waiting to get it.”
But Hillier also delivered a pep-talk, urging patience, reminding Ontarians of the efforts Canadian soldiers made in wartime.
“We’d all like it for the vaccine to be here tomorrow, to be 100 per cent effective. And everybody has it on the day after. We know that’s not going to occur,” he said.
“People are tired and say, oh my goodness, we can’t carry on. Well, guess what — you can,” he said.
If vaccines don’t arrive until later than early January, when Ottawa has promised to begin distribution once regulatory approvals green-light them, Hillier said Canada will learn valuable lessons from those countries which get them first.
The priority groups listed by several premiers publicly in the past week are based on guidance provided by the national advisory committee on immunization.
Hajdu said the external body, which provides expert advice to Health Canada, has “given us broad buckets of priority populations who should receive it first, all with the goal of saving lives and stopping the spread.”
It recommended priority go to those at high risk of severe illness and death, including the elderly; those most likely to spread the virus to other high risk groups (such as health-care workers, personal-support workers and caregivers in long-term-care facilities); workers providing essential services who cannot work virtually and face exposure (such as police, firefighters, grocery store staff); and those whose living or working conditions put them at elevated risk of infection and where illness could have disproportionate consequences, including remote and Indigenous communities.
The guidance amounts to national-level “recommendations” for provinces and territories “who will then have to refine those prioritizations based on their own processes,” Hajdu said.
When it first published its guidance last month the committee summarized several dozen scientific studies and said that those over age 70 (versus those under 45) and people with certain underlying health conditions (obesity, heart failure, diabetes, chronic kidney disease, dementia) are at highest risk for severe illness and death from COVID-19, and should be among the first in line.
While provinces have agreed on overall priority groups, Tam said Ottawa continues to discuss with the leadership of First Nations, Métis and Inuit communities their list of priorities.
Tam said there isn’t enough data yet from clinical trials on how vaccines have an impact on children and pregnant women, and so federal officials are looking for more information on those groups.
Hajdu told reporters Health Canada is a “gold standard regulator” and is sharing data and its findings on COVID-19 vaccine candidates with regulatory authorities in the U.S., the European Union and the United Kingdom.
“We’re respected around the world for our regulatory process first of all because it’s smooth and it’s fair but it’s also a standard of safety which is in fact something many countries look to when they’re doing their own approvals.”
But the Trudeau government faced another grilling in the House of Commons by Opposition parties over the lack of clarity around its immunization plans.
Conservative Leader Erin O’Toole slammed said the Liberal government for wasting time on a potential vaccine developed by a Chinese company, only to be left scrambling to sign other deals.
Trudeau retorted O’Toole “should not just make stuff up. The fact is that we secured contracts for vaccines in August, and right now we are moving forward with the approvals for four different vaccines.”