A dose of the Pfizer-BioNTech COVID-19 vaccine is given to a recipient at a vaccination site in Vancouver on March 11, 2021.JONATHAN HAYWARD/The Canadian Press
When COVID-19 vaccines started to trickle into Canada in December, health officials had to decide who should get them first. Given the scarcity of doses, the answer was easy: residents of long-term care and retirement homes.
These vulnerable seniors made up 81 per cent of the deaths in Canada in the first wave of the pandemic. If there was only a smattering of available jabs, it made sense to deliver them to the people at by far the greatest risk of death.
The question facing public-health officials and political leaders now is whether focusing on vaccinating those oldest and most at-risk from COVID-19, rather than those most likely to spread it, is still the best strategy.
Thanks to a vaccine rollout that began in LTC homes, deaths there have dropped dramatically. In the second week of January, Quebec recorded 131 LTC deaths from COVID-19. Last week, the number was five. It’s the same story in Ontario, which has recorded just nine virus-related LTC deaths since March 1.
This counts as a big change in Canada’s pandemic, and a huge improvement. It’s proof the country made the right choice when it allocated the first, scarce doses of vaccine.
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).
- 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.
- 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.
- 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.
- 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.
But this week the delivery of vaccines to Canada will go from first gear to something approaching the posted speed limit on a country highway. More than a million doses will be arriving weekly between now and the end of May, a number that will increase as production of more recently approved vaccines ramps up.
Other factors have changed since Canada devised its rollout strategy, too. Most notably, we now have a better idea of how effective the vaccines are.
Early data from Israel show that the Pfizer jab not only reduces the likelihood and intensity of infections, but also cuts down on transmission. A study released Monday in the United States shows that the AstraZeneca vaccine is highly effective against COVID-19′s worst outcomes.
At the same time, however, there is growing concern about variants of the COVID-19 virus that are more transmissible. That appears to be one of the reasons why, in much of the country, case counts are on the rise again.
Given these facts, what is the fastest and most efficient way to use vaccines to win the race against the variants? Should priority for shots continue to go to people most at risk, which means focusing on the oldest Canadians? Or should priority switch to those most likely to spread the disease?
Those are two very different groups. People under 60 make up 80 per cent of Canada’s recorded infections to date, but only 4.1 per cent of COVID-19 deaths.
People aged 60 and up account for just 20 per cent of the infected, but 96 per cent of the deaths.
Choosing whom to prioritize is a long-standing and complex debate among scientists. One recent study in the journal Science Advances suggested it is best to target vulnerable populations if vaccine effectiveness is low. But when vaccines are highly effective and readily available, it found that the more efficient strategy is to concentrate on vaccinating high-transmission groups in order to more quickly achieve herd immunity – thereby protecting unvaccinated people of all ages and vulnerability.
Right now, Canada’s strategy continues to focus on rolling out vaccines by descending order of age, with additional priority for health care providers, front-line workers, Indigenous Canadians and people with pre-existing conditions.
The younger age groups most likely to carry and transmit the disease will be vaccinated last.
That’s not an unreasonable strategy. If all goes well, most Canadians will be vaccinated by midsummer anyway. And many people would be alarmed to see healthy 25-year-olds getting jabbed while someone in their 50s was still waiting their turn.
But other places are at least edging in that direction. U.S. President Joe Biden wants the states to open vaccinations to every American over 18 by May 1. In some states, such as Nevada, everyone over 16 is already eligible.
Would it make sense for Canada to loosen or modify the system of age priority? It’s a tough call that would have to take account of the speed of our vaccine deliveries, which are well below the U.S. pace.
But in a crisis, all options have to be considered. The places that defeat the pandemic the soonest will be those that get the most bang out of their vaccine supply.
Editor’s note: An earlier version of this article included an incorrect percentage of deaths for those over age 60.
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