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A pharmacist technician fills the Pfizer-BioNTech COVID-19 mRNA vaccine at a vaccine clinic in Toronto on Dec. 15, 2020.

Nathan Denette/The Canadian Press

Decisions to give COVID-19 vaccine first to long-term care residents and staff, health care workers on the front lines of hospital ICUs and elders in Indigenous communities are relatively easy calls to make.

Deciding who will get the vaccine in the first part of 2021, before the large-scale rollout to general public, will be a much more difficult task. Soon, the social-media images of someone getting the jab could induce envy instead of optimism.

The question is who will get the vaccine in the months ahead, after the highest-priority groups, but before the general public is immunized in the summer and fall. Governments and vaccine task forces are going to have to decide whether it’s police, firefighters, grocery store clerks, the people who maintain the electricity grid or other groups who are next.

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Those workers, or the groups that represent them, are already making the case for how essential they are. And in recent days, there’s been an upswing in the general tension over who will be vaccinated first.

South of the border, there is already anger over reports of wealthy Californians using all their financial might to get the vaccine early, including asking their concierge health care providers to assemble detailed patient files listing potential COVID-19 vulnerabilities. On Thursday, Alberta’s Chief Medical Officer of Health, Deena Hinshaw, told reporters, unprompted, “please be patient while we all wait for our turn,” and asked the public to be supportive of the initial groups getting the vaccine.

“There will eventually be enough vaccine for everyone who wants it. It will just take a little time,” Dr. Hinshaw said.

In Alberta, the rollout of the vaccine is divided into three phases. Phase 1 started this week with an Edmonton respiratory therapist and an intensive-care nurse at the Foothills hospital in Calgary getting Alberta’s first jabs of the Pfizer-BioNTech vaccine. At least 400 of their colleagues, including intensive-care unit doctors, got vaccinated this week, too.

Others near the front of the line are those living in long-term homes, including two First Nations seniors facilities, who likely will receive the easier-to-manage Moderna vaccine later this month. Early next year, the priority list will be added to with home-care workers, more hospital workers, more long-term care residents, seniors 75 and older, and First Nations and Métis people 65 and older.

Phase 2 is expected to begin in April, and according to the government it “will be targeted to the next groups of prioritized populations.” Who exactly those prioritized groups are has not yet been determined.

When will Canadians get COVID-19 vaccines? The federal and provincial rollout plans so far

Premier Jason Kenney said this week he expects groups representing a whole host of essential workers will be making their case to get the vaccine in Phase 2 to Alberta’s COVID-19 Vaccine Task Force, headed by senior provincial bureaucrat Paul Wynnyk, and the province’s Emergency Management Agency. “We’ll leave that determination to the experts,” Mr. Kenney said.

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He said the next tranche of the rollout could include those who deliver critical, non-medical services, such as workers who operate the electricity grid. “That’s the kind of thing you can’t risk going down,” Mr. Kenney told reporters.

But there are some groups who believe they should be part of Phase 1 who aren’t currently on the government’s list. Dusty Myshrall, president of the Alberta Paramedic Association, said in an interview this week he believes paramedics should be considered a critical part of the health care work force, and should be vaccinated in Phase 1. But right now he has no idea if they will be.

Paramedics are mobile, dealing with emergencies in peoples’ homes and throughout the communities in which they work – and Mr. Myshrall said because of this they have a higher risk of spreading the disease to others. There also could be consequences for the health care system if the ambulance network becomes stressed, with too many paramedics out sick or in isolation.

“We want the vulnerable to be vaccinated first. Then we should be part of that conversation,” Mr. Myshrall said.

At a national level, the Canadian Teachers’ Federation says teachers and education workers should be on provincial vaccine priority lists, as they are in close contact with students indoors every day, often in schools with poor ventilation. The federation added that Health Canada hasn’t authorized the Pfizer-BioNTech vaccine for recipients younger than 16.

“Therefore, unlike most other professionals under consideration for the priority list, teachers and education workers will be exposed daily to groups of individuals who do not have immunity against this deadly disease,” the federation said.

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There are still many difficult discussions to be had. It’s a question of how acrimonious it gets, and how much purpose and grace – and fortitude – we will have, collectively, as we wait. The middle part of the vaccine rollout is going to be messy.

The initial COVID-19 vaccinations in Canada and around the world raise questions about how people react to the shot, how pregnant women should approach it and how far away herd immunity may be. Globe health reporter Kelly Grant and science reporter Ivan Semeniuk discuss the answers. The Globe and Mail

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters and editors.

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