Meaningfully Slowing COVID

"We can tie ourselves up in knots trying to develop and implement a precisely and perfectly fair queue for vaccines, and time is very much of the essence right now."

"There's been a little bit of polarization of view on vaccine timing in Canada, [with] fundamentalists [wanting to hold back equal numbers of second doses, to ensure strict compliance with the authorized dosing schedule, and] absolute speed demons who want first doses yesterday and second doses whenever."

"There's no contraindication to immunizing people who have had a past COVID-19 infection."

"Provinces need to know when supplies of given vaccines will arrive, in what numbers and with what degree of certainty. We need advanced logistics integrating both levels of government and the sites where vaccines are being given. Otherwise we'll be holding back vaccines in freezers as much by accident as design."

Dr.David Naylor, co-chair, COVID-19 immunity task force

While this classroom shows masks and space between desks, that's not the reality everywhere in Canada, say teachers. Calls are emerging for teachers, school staffers and child-care workers to be counted among the essential workers who could get the COVID-19 vaccine in the second phase, after the highest-risk groups. (CBC)

"If everything were flipped, and what we knew was that the vaccines were 95 percent efficacious in preventing transmission, but we had no data about whether it would prevent disease or mortality, perhaps that would shift my thinking [on a shift of thought to prioritize the young]."

"I think there's an ethical obligation to go in and protect those populations [the elderly and infirm], first and foremost, before anyone else."

"You're gambling a bit there if you think that those who have had a previous diagnosis are any less in need to be vaccinated."

"We know that Black and racialized communities have experienced a greater burden. [A special group has been struck to] think that through a bit more, and get to a more granular level to see how that will be operationalized [prioritizing of Black and racialized groups for immunization]."

Dr.Maxwell Smith, bioethics professor, Western University, member, Ontario COVID-19 vaccine distribution task force

Canada is struggling to get a grip on a vicious pestilence, facing roadblocks in administering vaccines as a result of scarce availability with additional doses set to arrive incrementally to inoculate a population of 38 million people, meaning to focus on the plight of the elderly health-impaired as a priority, since a large proportion of the national death toll has been among that group, to an frightening 82 percent figure of failure in protecting the residents of long-term care homes. Now, to complicate matters even further the far more contagious strains that have developed in the U.K. and South Africa are making inroads, setting back any gains.

In Indonesia, where one of the worst outbreaks has arisen in Southeast Asia, the government has prioritized its young working-age population, not the elderly -- with the reasoning that the CoronaVac produced by Sinovac Biotech of China lacks data on its safety and efficacy for the elderly because that age demographic wasn't included in its trials. Their reasoning is that vaccinating those between the ages of 18 and 59 would result in a "fortress" to shield the elderly, and slow down the spread of the virus.

In contrast, 20- to 29-year-olds in Canada account for the highest percentage of all confirmed COVID-19 infections at 18.7 percent, at a time that 96 percent of the over 17,400 deaths in Canada have occurred in the 60-and-older population. Rationally, with those numbers it makes sense to prioritize people of the age group suffering the most serious cases of COVID and dying from the virus. Pfizer's and Moderna's vaccines are 90 to 95 percent effective in prevention of people contracting the virus becoming seriously ill.

Most immunologists in Canada subscribe to a pragmatic approach supported by Canada's National Advisory Committee on Immunization along with the World Health Organization scientific group, that two-step doses can safely be stretched to 42 days in circumstances such as what Canada is facing; a severe shortage. The question is how long protection from the initial dose may last, a concern of growing importance given the stark reality that the new mutated variants are expected to begin outnumbering the prevalence of the original SARS-CoV-2 virus, bringing with them a wide assortment of questions. And the second shot of the two-dose vaccines is valuable for providing a boost in immune response.

 

For the most part, provincial and territorial governments have not yet disclosed which groups will be prioritized in the second phase of COVID-19 vaccinations. (Jerome Delay/The Associated Press)

 

According to the federal vaccine advisory group, with conditions of limited supply "initial doses may be prioritized" for those who have not had a previouslyconfirmed SARS-CoV-2 infection. Which raises associated issues; how to screen everyone for antibodies to the virus before inoculating them...

The COVID mortality rate raises other ethical questions of great debate; in Quebec and Alberta,     COVID mortality was over three times higher in neighbourhoods with the highest proportion of visible minorities, in comparison to neighbourhoods with the lowest proportion of visible minorities, according to Statistics Canada. British Columbia's death rate was over ten times steeper in neighbourhoods with the highest proportion of visible minorities.

These are conundrums, questions lacking answers that tend to confuse issues and create polarizing opinions on how best to proceed to attain the most benefits for the population as a whole during this time of grave attacks on the well-being of populations the world over. While much of the world is stumbling from one methodology to another in hopes that something will work -- and may work for a period of time before a resurgence occurs -- Israel has vaccinated over two million of its population, a rate of 25 doses per 100 people as opposed to t he total number of shots in Canada representing 458,000 people, a rate of 1.22 per 100 people.

In view of these perplexing details related to a pestilence about which much remains uncertain, added to which mutations are developing that make it more difficult to grasp at a potential solution, Dr.Naylor concludes the country is in dire need of figuring how to move to action much more expeditiously than is now the case. There is a need to step up the action; the 6 million doses expected by the end of March would be the start, to immunize 3 million people. And growing vaccinations from there on in the second quarter from April to June. "Immunizing two-thirds of those 30 million souls won't stop the epidemic, but could slow things down meaningfully", he offers.