An independent committee of experts advising the federal government has come up with its initial set of recommendations for who in Canada should be first in line for COVID-19 vaccines once one or more become available.
Detailed recommendations from the National Advisory Committee on Immunization were released by the government on Tuesday and also published by the Canadian Medical Journal. While they are not binding on Ottawa, or on the provincial and territorial agencies that will ultimately take charge of vaccine delivery, they reveal what considerations are likely to guide the distribution of the millions of doses of vaccines that Canada has already arranged to purchase.
Those deals could see Canadians being vaccinated as early as the first half of next year, although that timing will depend on the results of clinical trials. None of the vaccines that Canada is eyeing have yet been approved by regulators.
“What we’re aiming for is to be ready when the authorization comes,” said Caroline Quach, an infectious diseases specialist at the University of Montreal and chair of the committee.
In its report, the committee identified four broad categories and related criteria for prioritizing who should be vaccinated. They include:
- individuals at high risk of severe illness or death from COVID-19, including people of advanced age or those with medical conditions that increase their risk factor;
- individuals most likely to transmit COVID-19 to members of a high risk group, including health care and long-term care workers;
- workers involved in maintaining essential services – a category that will be up to governments to define and prioritize;
- anyone at high risk of infection because of working or living conditions and where infection could lead to disproportionate consequences.
The final group is defined as consisting of those who are routinely in settings where physical distancing and other preventive measures are difficult to follow and where access to health care is reduced, including those living in Indigenous communities.
Dr. Quach said the committee both commissioned and was informed by research reviews of risk factors for severe outcomes of COVID-19. Children, who as a group do not exhibit high risk of severe illness from COVID-19, are not in the high-priority categories.
The report does not rank the four categories, in part because there is not yet enough data to indicate which vaccines, if any, will be safe and effective for people in those groups.
The committee, which has been at work since late spring, has been in regular contact with the international suppliers making the vaccines that Canada is set to purchase and receiving updates, through non-disclosure agreements, on how they are faring in clinical studies.
A key detail has been ensuring that those studies include representation from the groups that the committee has identified as among the priority categories.
“We hope to be able to say this vaccine is better suited to that group, and so we’ll match them. But I don’t know if, in terms of the availability of vaccines, we’re going to have the luxury," Dr. Quach said.
The report also does not say what should happen if there are fewer doses available than would be needed to vaccinate everyone who is identified as belonging to one or more of those categories. Those details will ultimately be for Ottawa and the provinces to sort out.
Another key question is whether members of those groups that have been identified as high priority for vaccination will accept a vaccine.
To help gauge public response to the guidelines, researchers at the University of Alberta together with the polling company Leger are preparing a survey expected to go out to 2,800 Canadians, including those identified as members of priority categories, later this month.
Shannon MacDonald, an expert in immunization policy with the university’s faculty of nursing who is leading the survey, said the results should help identify both public knowledge gaps and attitudes about how vaccines should be rolled out among high-priority groups.
“Science can’t always answer every question. There is a role for values in determining this,” Dr. MacDonald said.
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