Which of these people should be vaccinated first?
A is a 60-year-old accountant. She lives with her spouse, also a white-collar professional, in a detached home in an upper-income neighbourhood. She hasn’t seen family in months, and isn’t socializing with friends. She wears a mask when she goes out, though for the last year her commute has been to the desk in the spare bedroom.
B is a 30-year-old warehouse employee. His wife works in food-processing. The couple, their two kids and her parents share a three-bedroom apartment in a lower-income neighbourhood. Like A, B is masking and isn’t socializing.
But unlike A, B goes to work, five days a week. He commutes on public transit, and spends 40 hours a week labouring side-by-side with several hundred others. He does his best to keep his distance during lunch breaks.
Who should get the vaccine first?
In much of Canada today, A will soon be eligible for a shot, by virtue of age. In some parts of the country, such as Montreal and Toronto, she may already have been vaccinated. In contrast, B hasn’t received a shot, and it’s not clear when he might get one.
Does this make sense? No. Not if the goal is stemming the spread of the virus, reducing the growing burden on hospitals and rolling back the third wave.
For the next few weeks, provinces and health authorities should be urgently and aggressively directing a lot more vaccines to those who are at greatest risk of contracting and spreading COVID-19: essential workers, particularly those in large workplaces where superspreader events are possible.
In the long run, every Canadian is going to be vaccinated. Tens of millions of vaccine doses are coming, including 2.2 million this week. That’s enough to give a first shot to one out of every 14 Canadian adults this week alone.
But those shots have got to be properly targeted to deliver the greatest bang per shot – the most pandemic reduction per inoculation. A system overwhelmingly focused on age is no longer the best way of doing that.
Every shot given lowers the risk of the virus being caught or passed on; every shot reduces the chance of hospitalization or death. Every shot in an arm is doing good. But not all arms are equal.
This is not a question of “equity.” It’s a question of efficiency.
With Canada having vaccinated most of our oldest citizens – those at very high risk of death from COVID-19 – the challenge now is minimizing virus spread. And those most likely to catch it and spread it, through no fault of their own, are people like B.
Essential workers in contact with lots of other people are at much greater risk of catching the virus, and thereby adding to the number of infections. They are also at much greater risk of multiplying the case count, by passing it on to dozens of fellow workers, each of whom can also spark exponential spread.
Each person in B’s workplace is – again, through no fault of their own – a potential virus multiplication agent.
In contrast, stay-at-home Canadians such as A are at low risk of catching COVID-19, and at low risk of passing it on to anyone other than their own household.
What’s more, the ability of A to stay home is predicated on B going to work. The “stay home to stop the spread” strategy is unworkable unless B goes to work.
On Monday, Toronto Mayor John Tory said his city was working on sending mobile vaccination clinics to essential workplaces, as was done with long-term care homes.
That’s a great idea, and it needs to move from paper to reality across the country. But even as Toronto was investigating the possibility of targeting vaccines at warehouses and factories, soon, over the weekend it lowered the vaccination age at city clinics to 60, immediately.
For now, essential workers across the country, and in the hard-hit neighbourhoods where they live, remain future priorities on a vaccination schedule largely determined by age. If we want to bend the curve, that priority has to shift – and fast.
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