The Antic Doctor appeared on my front porch on the last Thursday in February. He was visiting from another city, where he does important pediatric research and has been helping out in his hospital’s COVID intake clinic. He wanted to borrow a bicycle pump.
I was looping on my mask when he bounded into the foyer, maskless.
“What are you doing?” I said, recoiling.
“I’ve had my vaccine shots,” he said.
“And how do you feel?” I asked.
Canada pre-purchased millions of doses of seven different vaccine types, and Health Canada has approved four so far for the various provincial and territorial rollouts. All the drugs are fully effective in preventing serious illness and death, though some may do more than others to stop any symptomatic illness at all (which is where the efficacy rates cited below come in).
- Also known as: Comirnaty
- Approved on: Dec. 9, 2020
- Efficacy rate: 95 per cent with both doses in patients 16 and older, and 100 per cent in 12- to 15-year-olds
- Traits: Must be stored at -70 C, requiring specialized ultracold freezers. It is a new type of mRNA-based vaccine that gives the body a sample of the virus’s DNA to teach immune systems how to fight it. Health Canada has authorized it for use in people as young as 12.
- Also known as: SpikeVax
- Approved on: Dec. 23, 2020
- Efficacy rate: 94 per cent with both doses in patients 18 and older, and 100 per cent in 12- to 17-year-olds
- Traits: Like Pfizer’s vaccine, this one is mRNA-based, but it can be stored at -20 C. It’s approved for use in Canada for ages 12 and up.
- Also known as: Vaxzevria
- Approved on: Feb. 26, 2021
- Efficacy rate: 62 per cent two weeks after the second dose
- Traits: This comes in two versions approved for Canadian use, the kind made in Europe and the same drug made by a different process in India (where it is called Covishield). The National Advisory Committee on Immunization’s latest guidance is that its okay for people 30 and older to get it if they can’t or don’t want to wait for an mRNA vaccine, but to guard against the risk of a rare blood-clotting disorder, all provinces have stopped giving first doses of AstraZeneca.
- Also known as: Janssen
- Approved on: March 5, 2021
- Efficacy rate: 66 per cent two weeks after the single dose
- Traits: Unlike the other vaccines, this one comes in a single injection. NACI says it should be offered to Canadians 30 and older, but Health Canada paused distribution of the drug for now as it investigates inspection concerns at a Maryland facility where the active ingredient was made.
How many vaccine doses do I get?
All vaccines except Johnson & Johnson’s require two doses, though even for double-dose drugs, research suggests the first shots may give fairly strong protection. This has led health agencies to focus on getting first shots to as many people as possible, then delaying boosters by up to four months. To see how many doses your province or territory has administered so far, check our vaccine tracker for the latest numbers.
“Like the most powerful man on Earth,” he said. “I’ve been hugging people.”
“I’m sure,” I said. I noticed an edge of bitterness in my voice. “And how long do you figure I’ll have to wait?”
“Well,” he demurred, “that depends on supply, which is in the hands of the feds and the provinces. Between three and six months.”
I immediately wanted revenge. Nothing serious: steal his car, maybe, or his wallet. The crazy idea of demanding a cash payment flitted across my mind. I wanted to take something from him unfairly, to compensate for his having regained the freedom the pandemic has taken from every one of us, however unevenly.
This is vaccine envy. It is not the worst problem to have in this troubled world. I could be a front-line worker, or a teacher, or jobless, or sick or mourning.
But I am one of the countless number living in suspension, subject to the suffocations and anxieties of lockdown. As COVID-19 inoculations finally appear in significant numbers for the first time, vax envy is rampant. It’s a part of every conversation. A rabid search for appointments is pushing the ethical boundaries of what people will do for a dose, and infuriating entire demographic slices of the nation. Hunters stalk the internet for extra doses. The longer we wait for our jabs, the more we want them. Welcome to the hell of vaccine triage.
Vaccine envy can afflict anyone. I know an otherwise even-tempered, Toronto-working stiff in his late thirties who is the only person in his extended family, aside from his grade-school children, who hasn’t been vaccinated. One sibling is a doctor; no beef there. Another qualified for a vaccine by living in a remote region that has been designated medically vulnerable, despite having no cases of COVID. None of these exemptions from waiting to be jabbed bother him as much as his neighbour who has a non-medical job in virtual health care. “He’s technically eligible,” and therefore irritating.
A couple I know in British Columbia spent 5½ hours on the phone last week trying to get his 90-year-old mother a vaccination after the debut of B.C.’s reservation hub. The call centre opened at 7 a.m. and crashed at 7:02 a.m. The husband spent three hours hitting redial; at 10 a.m., he was placed on hold. His wife took over at 11 a.m. and was on hold until 12:30 p.m., and was confirming the last details of the appointment when the line went dead. Fortunately, the reservationist called back. Meanwhile, her mother, in her 80s, recovering from a recent stroke, was mistakenly offered a vaccination as part of her treatment. “I kept telling my mother,” my acquaintance told me, “take it, take it, take it, then saying, ‘No, that would be wrong,’ then saying, ‘No, take it.’ Vaccine envy is lower-brain-stem stuff, for sure.” The opening turned out to be a regular flu shot, not a COVID vaccination at all.
Vax envy spiked in Southern Ontario this week with the announcement that hospitals and pharmacies in select cities are booking appointments for 194,500 doses of the AstraZeneca elixir as early as this weekend – but only (this was the shocker) for people 60 to 64 years old. Clinical trials of the Astra-Zeneca vaccine have not included enough subjects over 65 to warrant approval for that cohort. Then Denmark, Norway and a large handful of European countries halted AstraZeneca vaccinations completely while they investigate whether the vaccine works against the South African variant, and whether it produces blood clots. Neither that alarming development nor the age restriction stopped legions of 65-plus Toronto seniors from preregistering with multiple hospitals across the city, in the hope, as one told me, that “you’re first in line if they have extra shots.”
The Wheezy Banker – no one with vaccine envy wants to use their real name – a keen athlete who has suffered from asthma attacks all his life, was “trying to be a good sport” about the AstraZeneca age cutoff. He’s a privileged man; what does he have to complain about? His complaint is that he’s 65, and doesn’t qualify – whereas his non-asthmatic wife, the Happy Loner, is 63, and does. “It’s so [profanity] irritating,” he said. “I can’t [profanity] stand it. Not only does she get the vaccine before I do, she’s already got an appointment for next Monday.” She finds it unsettling that she qualifies while he doesn’t. “It’s kind of a weird thing in a relationship for one of you to be crawling onto a life raft while the other’s kicked off,” she said. Nor is she “thrilled to be taking something at 63 that is possibly a problem at 65.” (Her children shamed her into taking the appointment anyway.) Meanwhile her husband longs to be one of the vaccine chosen, poised on the verge of what he imagines will be a Satyricon of postpandemic pleasure and good cheer. “That’s going to be the newest, hottest pickup line in a pub: ‘I’m totally vaccinated!” And it’ll work for all age groups.”
Ironically, the Wheezy Banker is a financial backer of a company that administers COVID vaccine in Houston. Ten per cent of its daily vaccination bookings fail to show; having provided jabs to all their employees, management invited the Wheezy Banker to fly down for his. But he didn’t want to skip the line – unlike, say, Mark Machin, the former chief executive of the company that invests the Canada Pension Plan Investment Board Plan, who was forced to resign after he flew to Dubai last month to be pricked with his partner. His supporters in the business community argued Mr. Machin had not deprived a Canadian of a jab, and didn’t deserve to lose his job. But he could very well have deprived a Dubaian. Vaccine envy isn’t a sin. Jumping the line is. There are reasons why.
One of the main causes of vaccine envy is the constantly shifting ethical framework of who gets what vaccine when. A recent survey by The New York Times revealed, for instance, that 35 states prioritize people with Down syndrome for early access to COVID-19 vaccine. But some of those states don’t offer the shots to people with other developmental disabilities. Why not? California originally prioritized by age alone, but has now upped the status of certain medical conditions. Connecticut flipped in the opposite direction. Similar reversals have occurred across Canada as well.
Does that mean the patchwork of ethical frameworks adopted around the globe to rank vaccination status are meaningless? “Shifting recommendations do not necessarily mean that it’s all arbitrary,” Debra DeBruin, the interim director of the widely respected Institute for Bioethics at the University of Minnesota, told me over the telephone the other day. She specializes in the ethics of public-health emergency response, and has for 15 years. “What’s really morally important is to offer higher priority to people who are at higher risk from COVID.”
It’s the next step that causes arguments – ”the even more complicated task of combining those moral considerations with scientific considerations of who’s at what level of risk.” This is when public-health officials try to decide whether meat packers (essential workers in COVID-ridden workplaces) are at greater risk and deserve vaccine priority over, say, teachers and/or truck drivers. “That’s about epidemiology and ethics together. And that’s a really hard judgment call.” As researchers learn more about the still confounding coronavirus – this week’s AstraZeneca panic being a case in point – epidemiological priorities change, however sketchy that looks. The only real ethical sin in a pandemic desperately short of vaccine, Dr. Bruin maintains – besides governments that abdicate responsibility, as happened when Donald Trump disdained masks – is “if you skip ahead in line when there are other people who could access that vaccine. Then what you’re doing is taking a resource away from somebody who needs it more than you, which increases the period of time they’re at risk”– and a risk to others. “That’s really a problem.”
The alternative – waiting your turn – can feel like impotence. “There is something powerful about the idea that we are all in this together,” Tim Harford, the author of The Underground Economist, wrote in a recent Financial Times column. “That until the lockdowns can be eased for everyone, they should be eased for nobody.” Dr. DeBruin thinks that would be a “heavy burden to impose.” But everyone who has experienced vaccine envy has had that thought. At least that way, no one grabs an advantage.
Alas, even vaccination isn’t much of a ticket to anything. According to the Centre for Disease Control, fully vaccinated adults must still wear a mask in public places, stay six feet apart, and avoid crowds and poorly ventilated spaces. What you can do, after you have been vaccinated – besides not die of COVID, and hang out with other vaccinatees – is this: You can gather indoors with unvaccinated people from one other household (that is, who all live together) without a mask, unless someone’s at risk for severe illness. That’s the big thrill that awaits us in the medium term. Break out the sparklers, Reverend.
People are finding their long-awaited jabs to be emotionally moving. It’s called vaccine ecstasy. I know a now-vaxed woman who burst into tears when the nurse called her name: “Don’t worry, hon,” the nurse told her afterward, “it happens all the time.” But the freshly vaccinated feel sheepish as well. “There is a slight upward shift in your view of the world,” the Antic Doctor admitted. “But there is mild guilt, too. As long as there’s a front-liner or a meat packer or a respiratory therapist who’s going in, there’s mild guilt.”
I was thinking about the anticlimax of vaccination late one afternoon, about the way it will gradually rebury the collective alertness to death that the pandemic uncovered, when the Happy Loner, the Wheezy Banker’s wife, called to give her 63-year-old side of their story. Lockdown has been an introvert’s paradise. “Because I’m lucky enough to have a roof over my head, and have groceries, and can live safely, this pandemic has been one of the most creative times of my life,” she said. “And I don’t know how I can tune out my non-COVID life once I’ve got my vaccine. So I may be the only person not looking forward to it.” The best part is that she’ll be able to hug her grandchildren again.
The strangest quality of Canada’s collective vaccine envy has not been lost on the Happy Loner. Everyone wants to be among the first to be vaccinated. But the people who actually have been targeted to be vaccinated in the first wave, beyond health care workers, are the aged, the homeless living in congregate settings, Indigenous adults and the chronically ill – the most COVID-vulnerable among us. People who have been neglected in the past now have the one thing the rest of us long for most. The last are first and the first are next to last. There has to be a lesson in that. “That’s who is suddenly privileged with the vaccine,” the Happy Loner said before she rang off. “It’s a complete inversion of the social order.”
It might be a good idea for those of us still waiting (less and less patiently) for a vaccine to try to appreciate that sensation, of being the unprivileged, while we can. Vaccine envy means you haven’t got what someone else has who needed it more. We’ll all miss that fleeting moment of being equal when it’s gone.
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