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Nurse Mandeep Kaur administers a dose of the Moderna coronavirus disease (COVID-19) vaccine to Brittany Orantes, health administrator at a vaccination centre, in Brampton, Ont., on March 4, 2021.CARLOS OSORIO/Reuters

Cops before teachers? Dentists before workers at food-processing plants? Grocery store cashiers before truckers?

Canada’s coronavirus vaccination campaign is finally picking up speed, and as it accelerates, provincial governments are deciding which essential workers should get spots closer to the front of the line.

While several provinces are still refining their priority lists, a scientific debate has broken out about whether it makes sense to factor in occupation at all when age and home address may be better predictors of who is likeliest to fall seriously ill with COVID-19.

“The problem with vaccinating essential workers is implementation. It’s much more challenging,” said Peter Juni, scientific director of Ontario’s COVID-19 science advisory table and a professor of medicine and epidemiology at the University of Toronto.

Tracking Canada’s COVID-19 vaccine rollout plans: A continuing guide

Moderna, Pfizer, AstraZeneca or Johnson & Johnson: Which COVID-19 vaccine will I get in Canada?

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).

PFIZER-BIONTECH

  • 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.

MODERNA

  • 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.

OXFORD-ASTRAZENECA

  • 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.

JOHNSON & JOHNSON

  • 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.

Coronavirus tracker: How many COVID-19 cases are there in Canada and worldwide? The latest maps and charts

Ranking vaccine recipients has become more urgent now that millions of additional doses are pouring into Canada. On Friday, Prime Minister Justin Trudeau announced that Pfizer-BioNTech would be delivering an extra 1.5 million doses in March and more than expected in April and May. Health Canada also approved a fourth vaccine on Friday, a one-shot product from Johnson & Johnson.

As well, the National Advisory Committee on Immunization (NACI), recommended this week that Canada be the first country in the world to stretch the interval between doses to four months – instead of three or four weeks – so more Canadians can get the protection of a single shot sooner.

So far, provinces have been doling out their limited vaccine to residents and staff of nursing and retirement homes, front-line health care workers, Indigenous people and the elderly, with age cut-offs that vary slightly between and within provinces.

Most are following the spirit, if not the exact letter, of NACI’s non-binding advice on who should be vaccinated during the first phase of the campaign. The committee’s second phase includes “essential workers,” but vice-chair Shelley Deeks told The Globe and Mail that NACI plans to leave it to provinces to define which job categories count as essential.

Most haven’t done so yet. Alberta and British Columbia, as examples, have rolled out plans focused on age and health condition, with brief mentions of adding essential workers in phases 2 or 3 if supplies permit.

That has opened the door for teachers, police officers, truckers, funeral-home workers, grocery-store staff, food-industry employees and others to argue for a higher place in the queue.

“We think that essential workers ought to be prioritized given that there are additional vaccines available, and that teachers ought to be in that priority order of front-line workers,” said Teri Mooring, president of the BC Teachers’ Federation. “[Teachers] have kept the B.C. economy going, quite frankly.”

Ms. Mooring pointed to data from WorkSafeBC showing workers in the education sector were second only to health care workers in the number of claims they’ve filed related to COVID-19 – proof, she said, that teaching was a high-risk occupation during the pandemic.

Paul Meinema, national president of the United Food and Commercial Workers union, said front-line workers in food retail and manufacturing, meat packing and security industries deserve priority.

“Workers in these sectors are putting themselves in harm’s way every day that they show up to work, and they have faced a heightened risk of contracting the coronavirus since day one of the pandemic,” Mr. Meinema said.

It’s difficult to say whether schools are inherently riskier or more valuable to society than meat-packing plants, the sites of Canada’s largest COVID-19 outbreaks.

Rather than agonize over which occupations get first dibs, it’s better to treat front-line workers as a single priority group and vaccinate them all as quickly as possible, said Caroline Colijn, a Simon Fraser University professor and Canada 150 research chair in mathematics for evolution, infection and public health.

She co-authored a modelling study, which was published last month but has not yet been peer reviewed, that predicted vaccinating by essential-work status rather than age in British Columbia and similar places would prevent 200,000 more coronavirus infections, 600 more deaths and produce a net monetary benefit of more than $500-million.

Mobile teams could conduct vaccination blitzes at factories, warehouses and other workplaces to relieve the logistical headaches of asking recipients to prove they’re essential workers, Dr. Colijn added.

Ontario’s science advisory table advocated a different approach, arguing in a recent brief that more infections and deaths would be staved off if the province set its priorities by age and postal code, with a focus on the poor and racialized neighbourhoods that have been hit hardest by SARS-CoV-2, the virus that causes COVID-19.

In vulnerable areas, the initial age cut-off could be lowered to 50 or 55, Dr. Juni suggested. Several provinces have already taken a similar approach with Indigenous people. Saskatchewan opened vaccinations to everyone over the age of 50 in its virus-battered northern region, while the eligibility is set at 70 everywhere else.

“Our approach is extremely feasible,” Dr. Juni said. “Show me your driving licence. And that tells me whether you can get vaccinated today.”

On Friday, Ontario unveiled a phase 2 vaccination plan that leaned more toward the view of its own science advisers. Between April and June, shots will be offered to people between the ages of 60 and 79, alongside people with chronic health-conditions and those who live in neighbourhoods that have been hot spots for coronavirus spread.

Ontarians who “cannot work from home,” will come next, starting with teachers, childcare providers, food-manufacturing employees, agricultural workers and workers who respond to critical events, including funeral workers and police officers and firefighters who haven’t already been vaccinated.

Earlier this week, Premier Doug Ford’s government raised eyebrows when it moved police officers who respond to medical emergencies into the first phase of its vaccination plan, a decision made around the same time it agreed to start vaccinating the homeless.

Ontario had already made shots available to a broader range of health-care professionals than any other province, including firefighters who respond to medical calls, optometrists, dentists, registered massage therapists and social workers, among others.

Alison Thompson, a public health ethicist and associate professor at the University of Toronto, said that while ranking recipients by age is the simplest route, it’s not necessarily the fairest.

“I think that there are people who are younger and who have other vulnerabilities who ought to be prioritized at the same time,” she said.

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