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A woman opens the door to a person in a wheelchair at Pinecrest Nursing Home in Bobcaygeon, Ont., on March 30, 2020.CARLOS OSORIO/Reuters

An independent advisory panel has told the federal government that the first people in the country who should receive a COVID-19 vaccine are those living and working in long-term care facilities followed by anyone who is 80 years or older.

Those categories rose to the top above front-line health workers and others in a list designed to guide federal, provincial and territorial governments on how best to distribute a limited number of vaccine doses.

The list was provided to the Public Health Agency of Canada during a Nov. 25 meeting of the National Advisory Committee on Immunization. It is a narrowing down of a broader set of groups that the committee published earlier in the month without ranking.

Depending on how the list is interpreted, the ranked groups are likely to represent somewhat more than the approximately three million Canadians that could receive two doses of a vaccine in the early months of 2021, based on preliminary delivery schedules. However, the ranking also includes the expectation that a portion of those who are prioritized will refuse a vaccine.

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“Our aim is to protect the most vulnerable first,” said Caroline Quach, an infectious disease specialist at the Sainte-Justine University Hospital Centre in Montreal who chairs the committee. “We have started with the elderly in long-term care facilities and their staff because that is where the highest burden of illness is.”

Dr. Quach said that while health care workers outside of long-term care come after the elderly, “I suspect that these groups will tend to be vaccinated almost in parallel.”

Officials with the federal public health agency have not yet said whether they support the sequence recommended by the committee.

“These recommendations are preliminary in nature,” the agency said in a statement to The Globe and Mail. “Final key populations for early COVID-19 immunization will be determined ... once more is known about the vaccines for Canada and their delivery schedule.”

Initially, vaccines from international suppliers such as Pfizer and Moderna will be received by the federal government as the purchaser, but their distribution to individual Canadians is the purview of provincial and territorial governments. Those governments may choose to organize priority groups differently, based on logistics, Dr. Quach said.

The complete list recommended for vaccination in order of priority includes:

  • Residents and staff of long-term care, assisted living, retirement homes and chronic care hospitals
  • Individuals of advanced age (starting with 80 years and expanding by five-year increments to 70 years as doses become available)
  • Health care workers, taking into account exposure risk
  • Indigenous communities

In the previous, unranked version of the recommendations, Indigenous communities were identified as among those settings where infection could lead to disproportionately serious consequences because of reduced access to health care.

The Ontario government has appointed retired general Rick Hillier to chair a vaccine distribution task force, although the other members have yet to be named publicly.

Mr. Hillier said it’s up to the provincial government to decide who receives the vaccine first, but the task force will be focused on the most vulnerable, such as long-term care residents.

Officials in the long-term care and retirement home sectors are already urging the provinces to give priority to vaccinating residents and staff in these facilities, but have not been told who will be at the top of the list.

“While we await details on the process, we hope and expect that both the federal and provincial governments understand the heightened risk to our residents and employees and will commit to prioritizing us in their plans,” said Sharon Ranalli, a spokeswoman for Chartwell Retirement Residences, which owns 166 retirement homes and 23 long-term care homes in Canada.

Meanwhile, nursing leaders say front-line health care providers should be vaccinated before elderly people who live at home because such workers will be critical as hospitals battle the pandemic over the winter.

Linda Silas, president of the Canadian Federation of Nurses Unions, said she expects provincial governments will move health care workers higher up the priority list, regardless of the committee’s advice.

“Every day the number of health care workers on sick leave is going up and up,” she said. “[Health sector] employers across Canada are very concerned with what’s going to happen with their work force. Who’s going to be there to take care of the sick?”

Ms. Silas said she supports putting residents and staff of seniors’ facilities at the top of the list.

In the first wave of the pandemic, at least 21,842 health care workers contracted SARS-Cov-2, the virus that causes COVID-19, according to the Canadian Institute for Health Information. They accounted for just over 19 per cent of those who tested positive as of July 23. By that point, at least 12 Canadian health care workers had died of COVID-19.

The committee’s ranking stands in contrast to the recommendations of its U.S. counterpart, which on Tuesday voted to put health care workers and nursing-home residents at the front of the line, ahead of other essential workers, such as teachers, police officers and farm workers, followed by adults with high-risk medical conditions and those over the age of 65.

Members of the Advisory Committee on Immunization Practices, which advises the U.S. Centers for Disease Control and Prevention, discussed their rationale and voted on their recommendations in a public meeting broadcast online Tuesday.

Yet, the high prioritization of the elderly in the list has some support from mathematical modelling that can be used to explore in advance which vaccination strategies are most likely to reduce deaths owing to COVID-19.

In one such model, Chris Bauch, a University of Waterloo mathematician, and colleagues found that the total number of deaths owing to the pandemic would be most reduced if older populations are vaccinated first as long as it is still early in the pandemic, such as by March. However, if no one has been vaccinated by the next fall, the priority should shift to those who are most likely to transmit the disease, including younger people, to reduce contacts in a population where natural immunity is gradually increasing.

He said that the committee’s strategy appears to be designed to minimize deaths and added, “I think that they will accomplish that with the proviso that the vaccines are coming in the first quarter” of 2021.

Françoise Baylis, a philosopher who specializes in bioethics at Dalhousie University, said an argument could be made in favour of vaccinating most health care workers after the elderly, who are at by far the highest risk for severe illness and death from COVID-19.

“By actually protecting those most likely to end up in the health care system you could argue that you are, in fact, at the very same time, protecting your health care workers,” she said.

With reports from Karen Howlett and Laura Stone

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