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People wait in line to receive a COVID-19 vaccination shot at a clinic in Montreal, March 7, 2021, as the pandemic continues in Canada and around the world.Graham Hughes/The Canadian Press

When the B.C. government opened the phone lines Monday for people 90 and over and First Nations people 65 and older wishing to book an appointment to get vaccinated as part of Phase II of its immunization plan, operators were in for a shock.

By mid-morning, the hotline had logged more than 1.7 million calls – a number far higher than the roughly 54,000 people who were eligible to register. People phoning in multiple times in an attempt to get through to a disorganized and overwhelmed call centre had something to do with that, but evidently, thousands of people who didn’t qualify called anyway.

This tells us three things. One, desperate people are not very good at listening to instructions. Two, there are a lot of people who are frantic about getting vaccinated. And three: No matter how much time governments have to get organized for these types of critical events, they will screw it up anyway.

Most importantly, perhaps, the whole debacle illuminated just how fraught government decisions are around the prioritization of vaccinations. Everyone wants a shot and everyone has their own reasons for believing they deserve one ahead of someone else. That’s why health authorities around the world have agonized over who should get to the front of the line, and who should wait until the end.

For most governments, decisions on who goes first have been relatively easy. The global consensus has been that it should be people living and working in long-term care homes, as well as front-line health care workers. But moral quandaries abound over who should come after that.

Should an elderly person with severe dementia be a priority over a 70-year-old who likely has far more life to live? Should age get more consideration than pre-existing conditions? Should a teacher get precedence over a cashier? The head of the BC Teachers Federation, Teri Mooring, suggested her unionized members deserve to be a priority because they “have kept the B.C. economy going, quite frankly.” (There might be others who would argue they deserve priority status for the very same reason, including grocery store employees and truck drivers and poultry plant workers.)

Last December, the U.S. Advisory Committee on Immunization Practices recommended – without much controversy – that front-line health workers and those working and living in nursing homes be first to get vaccinated. But then it advised that essential workers get inoculated before people 65 and older and at high risk. The backlash was extreme. The committee had to back off that plan and put older people ahead of essential workers.

It seems to me the primary concern in conceiving vaccination rollout plans should be this: What will save the most lives? And in that case, there is broad agreement that vaccinating elderly people ahead of essential workers is the way to go.

That’s why I think the British government got it right in its approach. After completing vaccinations for care homes and front-line health care workers, it will follow a logical, age-based system, ordered in five-year increments down to those aged 50. The Joint Committee on Vaccination and Immunization concluded that these groups represent around 99 per cent “of preventable mortality” from COVID-19.

It also avoids, in the early going at least, endless lobbying by various groups of “essential workers” who insist they sacrificed more and put themselves in harm’s way more than others who might fall into this category of worker.

The reality is that conducting a vaccination campaign based on age will catch essential workers too, ones who are older and more vulnerable. Think about it: Does it really make any sense to vaccinate a 25-year-old teacher or 30-year-old police officer ahead of a 70-year-old grandmother? Not to my mind. And that is not to dismiss the sacrifice that teachers and police officers have made this past year. It’s about protecting those most at risk of morbidity or mortality.

There has also been another discussion taking place in this country around priority, about whether doses of the vaccine should be diverted from regions with low COVID-19 levels to those where the virus is still surging.

What that looks like in real terms is the Atlantic provinces, which have had much lower COVID numbers because of the diligence of people living there, offering up their spot in the vaccination queue to someone in another province where the virus remains a bigger problem.

Maybe there is cold, hard logic to the idea, in theory. In practice, forget it. Maritimers have made enormous personal sacrifices in the name of keeping the virus out of their communities. They shouldn’t be penalized for that; no one should be.

After all, with vaccines – or, really, with anything – fair is fair.

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