Some non-front-line hospital staff get COVID-19 vaccines ahead of vulnerable populations, raising ethical concerns

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Some hospitals and health systems are offering COVID-19 vaccines to staff who don’t interact with patients, including administrators and researchers, as thousands of front-line workers and long-term care residents wait for their turn to be inoculated.

Erie Shores HealthCare in Leamington, Ont., and Toronto’s Michael Garron Hospital each began vaccinating non-front-line staff in recent days, while the University Health Network in Toronto invited a wide range of staff to a last-minute vaccine clinic on Sunday. Health officials in both British Columbia and Alberta say that vaccines have on occasion been given to lower priority individuals when approved recipients fail to show up for their appointments, in order not to waste doses.

With a limited supply of vaccines expected for the months to come, each province in the country has established ethical guidelines to ensure available doses are directed toward those most at risk. In Ontario, for example, the first phase of the vaccine rollout is meant to target health care workers and essential caregivers in hospitals, long-term care homes and other settings where seniors gather – followed by other essential caregivers, long-term care and retirement home residents, and First Nations.

Some hospitals say they’ve been forced to look outside these groups in order not to waste doses. Storage challenges have also limited distribution as the provinces ramp up their inoculation programs. Some regions have yet to see a single dose administered to high-risk populations, while several Toronto hospitals are planning to open up vaccination clinics to more staff this week.

Wajid Ahmed, Windsor-Essex’s Medical Officer of Health, spoke out about non-priority hospital workers jumping the queue after several area hospitals such as Erie Shores HealthCare confirmed they had offered vaccines to non-front-line workers, including top administrators. Dr. Ahmed said that it’s critical not to waste vaccines, particularly from open vials, but that health care systems need to be meticulous in how they prioritize vaccine rollouts to save as many lives as possible.

“We need to have better discussions so we have a … good process in place to make sure we’re doing everything to capture the right people, rather than going through a list of who’s available, or who put up their hands first,” Dr. Ahmed said in an interview.

Giving doses to lower-priority groups such as administrative and out-patient staff could constitute a “very serious ethical violation” that merits an investigation, said Kerry Bowman, a bioethicist at the University of Toronto.

“We with great work developed national consensus as to phase one of the ethical distribution of COVID-19 vaccines,” Dr. Bowman said. “That was pretty clear: The vulnerability was long-term care, senior citizens, Indigenous communities, etcetera.

“The hospitals have decided to use their own version of this, and what is happening within hospital settings is that many of the people receiving the vaccine are in fact not people who are in phase one as identified in the ethical criteria.”

As of Jan. 7, Canada has received 548,950 doses of the Pfizer/BioNTech and Moderna vaccines.

Vaccine availability is one struggle – the University Health Network (UHN) expected to receive 3,000 doses to administer this weekend, which didn’t show up – but their short shelf life is also putting health care systems in tough positions.

Pfizer-BioNTech’s vaccine must be used within six hours of being thawed and prepared, sometimes leaving hospitals to scramble to find arms to jab when there are extra doses in thawed vials or if preregistered staff don’t show up.

One such surplus scramble happened on the weekend, as Newmarket’s Southlake Regional Health Centre offered UHN additional Pfizer-BioNTech vaccines doses for staff.

A copy of UHN’s invitation to the Sunday clinic, viewed by The Globe and Mail, indicated that all staff, including researchers, were invited. But spokesperson Gillian Howard said the hospital amended the message to focus on patient-facing staff, with a goal of ensuring no doses were wasted.

“The goal is to vaccinate people who care for patients in acute care as soon as possible, given vaccine supply,” Ms. Howard said Sunday. “The goal is also to use all vaccine we’re offered if reasonable to do so.”

The hospital’s chief medical officer, Brian Hodges, also tweeted earlier on Sunday that he hoped all Toronto long-term care residents would receive doses by next Friday. As of Sunday, 12,210 Ontarians in long-term care have been infected with COVID-19 since the pandemic began, and 2,967 have died.

Toronto’s Michael Garron Hospital said Sunday it can now vaccinate more than 500 people a day. “To ensure there are large volumes of eligible people in our clinic each day to meet the 500 doses-a-day goal, we have now been offering vaccines to all MGH employees,” spokesperson Shelley Darling said in an e-mailed statement. The hospital said in doing so, it follows Ontario’s guidelines, and has offered vaccination appointments to health care staff from other hospitals, including UHN.

Asked if it was aware that some hospitals were giving vaccine doses to non-front-line staff, Ontario’s Ministry of Health told The Globe to speak with individual hospitals and reiterated its COVID-19 Vaccine Distribution Task Force’s recommendations.

Alberta’s Chief Medical Officer of Health, Deena Hinshaw, and Health Minister Tyler Shandro said in a statement last week that “if a scenario arises where staff have no booked appointments left but there are thawed doses available, those administering the vaccines are able to vaccinate each other.”

But Dr. Bowman, the bioethicist, said this speaks to a significant planning failure. “There absolutely needed to be a backup plan,” he said. “This didn’t hit us overnight.”

Christine Sorensen, president of the BC Nurses’ Union, said it is “extremely disappointing and concerning” to hear from members across the province about people who do not meet the priority criteria being vaccinated.

Ms. Sorensen, who has run mass immunization clinics for more than 30 years as a public-health nurse, also believes poor planning is to blame: “You always have more people ready to have the vaccine that are in the priority group, in case you have cancellations. And then you prioritize those people for the next clinic, so you always have a rolling group of people ready.”

In a statement Sunday, B.C.’s Ministry of Health said that “in the event vaccine doses are left over, there are processes in place for bringing in health care workers or other priority people to be vaccinated.”

Montreal’s McGill University Health Centre said Sunday that while it was broadly vaccinating workers who provide direct care to COVID-19 patients, it had also targeted specific groups, including staff who work with patients on ventilators and people in units dealing with outbreaks.

As parts of Canada struggle to give the vaccine to the right people, others haven’t gotten it at all. A spokesperson for Niagara Region Public Health said Sunday that it hadn’t gotten any doses at all, though Ontario’s Ministry of Health said it should receive shipments early next week.

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