Cost of Living·Analysis

How to decide who gets a shot when there won't be enough COVID-19 vaccines for everyone at first

With more than 7 billion people in the world, and no guarantee the vaccines Canada has signed deals to purchase will be effective — expect tough choices on who will get a COVID-19 inoculation first.

Expect tough choices on initial doses of a coronavirus inoculation in Canada

The federal government is ordering more than 75 million syringes, alcohol swabs and bandages so it is can innoculate Canadians as soon as a COVID-19 vaccine is ready. But who will get it first? (Ted S. Warren/The Canadian Press)

There's a good chance you're not going to be one of the first people to receive a COVID-19 vaccine in Canada.

While Canada has now signed deals with six pharmaceutical companies to purchase between 20 to 72 million doses of vaccine each, there's no guarantee any or all will be effective. 

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And if there is a safe and working inoculation, Canadians are unlikely to receive all the doses needed in one shipment. 

After all, there are over seven billion people in the world. And Canada is certainly not the only country to place advance orders for a vaccine.

Although the federal government has already procured enough needles and vials to get every Canadian inoculated twice, the medicine itself will take time to get manufactured and distributed.

Expect some tough choices ahead: who will get the vaccine first, and why?

Goal is to minimize deaths and societal disruption

The National Advisory Committee on Immunization (NACI) is responsible for advising the federal and provincial governments in this area. While it hasn't directly stated its priorities in distributing a potential COVID-19 vaccine, it's guided by Canada's overall pandemic goals, which are to minimize deaths, serious illnesses and societal disruption.

There are several ways to think about this dilemma, according to Ellen Rafferty, health economist at the Institute for Health Economics in Edmonton, Alta. 

Sometimes the most efficient strategy is actually vaccinating … those who are most likely to transmit the virus to those high risk groups."- Ellen Rafferty, Institute for Health Economics

Each choice will have implications for who is at the front of the vaccine line, according to Rafferty, who is also a postdoctoral fellow at the University of Alberta.

"One of the key considerations is focusing on the highest risk groups," said Rafferty, who's not a member of the NACI. This would include groups most likely to have serious outcomes with COVID-19, such as older populations or groups with specific medical conditions.

"But the interesting and kind of confusing thing about infectious disease is that sometimes the most efficient strategy is actually vaccinating the people around those people," explained Rafferty.

"So focusing on those who are most likely to transmit the virus to those high risk groups – people like nurses in long-term care."

Who is second (or even later) in line?

Few experts will dispute putting health care professionals and at-risk individuals at the front of the line. 

But who gets the jab after that – second, third, fourth in line – is less obvious. 

If the goal is to minimizing societal disruption, Rafferty argues essential workers outside of the health care sector, particularly those working in places at a higher risk of an outbreak, would likely be next on the list.

Teachers, pictured here checking the temperatures of students in Texas amid the COVID-19 outbreak, could be one of the groups to get access to a vaccine before the general population. (LM Otero/The Associated Press)

This could include anyone who interacts with large swaths of the public. For example, this group could include teachers, social workers, supermarket employees or cooks.

Another determining factor could be age, which is considered by NACI as part of their "equity matrix." Children, after all, have the most to lose in terms of life expectancy. 

Even a lottery system determined by something arbitrary, such as a birthday, could be possible according to health economists such as Rafferty. This would happen if it came to a point where there was no way for public health officials, economists and other experts to determine where a vaccine might do the most good.

Massive logistical challenges ahead

The vaccine itself may not be the only thing in short supply – people need to be able to provide and administer dosages.

"Whether that be pharmacists or public health nurses or doctors, they need the time to do it," said Ellen Rafferty.

Administering tens of millions of vaccinations would be a massive public health undertaking, though Canada won't be alone in facing these challenges.

For the global economy to recover, other countries will also have to grapple with these questions and challenges.

In addition, many Canadians may not initially even want a vaccine.

A survey by the non-profit Angus Reid Institute in early August found a roughly a third of respondents — said they'd likely wait before getting a COVID-19 vaccine, even if it was available.

Canada agrees to share internationally 

On that front, Canada has signed onto an international vaccine-sharing program called COVAX. Nearly 200 participating countries have agreed to share the vaccines they've procured, should any of those bets turn out to be the winner. 

If the best and most effective vaccine turns out to be none of the six candidates procured by Canada so far, we would likely receive batches from other countries that made the right bet. 

Trudeau explains how COVAX works

3 years ago
Duration 1:01
Prime Minister Justin Trudeau says the COVAX facility will succeed even if some large countries don't participate in the program to help fund vaccinations for less wealthy nations.

Conversely, if one of the vaccines Canada has procured is successful, we'd have to share our supply with other countries. 

Either way, the agreement aims to have two billion doses of vaccines ready by the end of 2021.

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This would only be enough to immunize one in four people around the world, but proponents say it should cover most frontline healthcare workers and high-risk individuals. 

The United States has not signed on to the COVAX agreement. 

A nurse prepares an experimental COVID-19 vaccine to administer to a volunteer in London, UK, in August. Canada is purchasing doses of multiple vaccine candidates in advance to prepare for potential treatment. (Kirsty Wigglesworth/The Associated Press)

R.J. Leland, an assistant professor of philosophy at the University of Manitoba, says vaccine sharing is the ethical thing to do. He recently co-wrote a paper on fair and ethical vaccine distribution.

"Perhaps there's some degree of special concern with compatriots that's appropriate," said Leland.

"But if you aren't willing to limit that [concern] at some point, if you aren't willing to sacrifice some economic or health benefits in exchange for massively larger gains outside of your country, then you just aren't interested in a fair and equitable response to the pandemic."

Written and produced by Richard Raycraft, with files from CBC News.
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