Seniors, long-term care workers should be first in line for COVID-19 vaccine, committee says

NACI says the next priority groups should be people over 80 and front line health care workers

Cbc.ca
Dec. 7, 2020
John Paul Tasker

The independent committee charged with deciding who should be the first Canadians to be vaccinated against COVID-19 today released its final directive recommending that long-term care home residents and seniors over the age of 80 get priority access to shots.

The National Advisory Committee on Immunization (NACI) said the initial, limited quantity of vaccine doses should be reserved for people who are most at risk of contracting the virus and developing severe symptoms.

While the federal government is procuring the vaccines and consulting with bodies like NACI to help coordinate distribution based on need, it will be up to the individual provinces and territories to decide who gets vaccinated when.

Canada's long-term care homes have been hit hard by the novel coronavirus, with thousands of deaths reported since the onset of this pandemic.

NACI said that since the elderly residents of long-term care and assisted living facilities, retirement homes and chronic care hospitals face "severe outcomes" and a much greater chance of dying from the disease, they should be at the top of the list for the initial batch of roughly six million doses that will be made available in Canada in the first three months of 2021.

Pfizer's vaccine, which is expected to be the first product approved by regulators for use in Canada, requires two doses -- so roughly three million people should be inoculated in this first stage of the rollout.

NACI said it's not just the residents who should go first -- it's also recommending that provinces and territories prioritize the staff who work at these sites for early vaccination.

After long-term care home residents and staff are immunized, NACI said the next priority group should be all Canadians over the age of 80.

"All adults of advanced age should be prioritized for initial doses of authorized COVID-19 vaccines, beginning with adults 80 years of age and older, then decreasing the age limit in 5-year increments to age 70 years as supply becomes available," the final directive reads.

After the 80-plus cohort is vaccinated, front line health care workers should be next in the queue, said NACI.

The committee said that doctors, nurses and other staff at hospitals should get their shots early to maintain staffing levels in the health care system.

"Immunizing health care workers and other workers functioning in a health care capacity (e.g. personal support workers) minimizes the disproportionate burden of those taking on additional risks to protect the public, thereby upholding the ethical principle of reciprocity," the directive reads.

NACI also expressed concern about Indigenous adults living in communities "where infection can have disproportionate consequences, such as those living in remote or isolated areas."

Because health care options are limited at the best of times in these remote areas, Indigenous individuals can face an elevated risk of death and "societal disruption," NACI said. For that reason, the committee said that some First Nations, Métis and Inuit communities should be in the first cohort to get vaccinated.

These four groups -- long-term care residents and staff, the elderly, front line health care workers and some Indigenous adults -- are expected to consume all of the six million doses to be delivered in the first three months of 2021.

"As a ballpark, these four groups of people, as things are rolled out, should be covered by the initial doses," said Dr. Theresa Tam, Canada's chief public health officer.

Maj.-Gen. Dany Fortin, the military commander leading the Public Health Agency of Canada's national operations centre on vaccine logistics, said today it's likely the provinces will have access to vaccines in early January to start inoculating phase one groups.

In an interview with CBC's Power & Politics, Fortin said Alberta Premier Jason Kenney's suggestion that his province will have some of the Pfizer product on hand by January 4 is "a reasonable assumption."

During a briefing with reporters on Thursday, Fortin said the federal government already has secured the freezers needed to store the Pfizer product and 14 distribution points will be ready to receive vaccines starting on Dec. 14.

The military commander has planned a series of what he called "dry runs" with the provinces and territories to ensure staff are ready to deploy shots when they're available after Health Canada's expected regulatory approval.

Second phase vaccinations for essential workers
In the second phase of the vaccine rollout, which could begin in April 2021 as more supply comes online, other essential workers will have access.

The vaccine advisory committee said first responders -- such as police officers, firefighters and health care workers not included in the initial rollout -- should be next in line in this second phase.

The residents and staff in other "congregate settings" -- such as migrant workers, prisoners in correctional facilities and people in homeless shelters -- should then follow, NACI recommended.

Canada has seen a number of outbreaks in correctional facilities and places like farms and meat production and packing facilities where maintaining physical distancing is challenging and infection prevention and control measures are limited.

NACI said it would be prudent for provinces and territories to make shots available in these high-risk places early to stop further caseload spikes.

Other essential workers should be included in the second wave of vaccinations, NACI said. Ultimately, it will be up to the provinces and territories to more precisely define who qualifies as an "essential worker," but the committee suggested grocery store staff could be on that list.

Dr. Howard Njoo, Canada's deputy chief public health officer, said Canada is expecting more product to arrive from the other drug companies that have developed promising vaccines -- such as Massachusetts-based Moderna and Johnson & Johnson's pharmaceutical division, Janssen -- in the months to follow.

"We'll have enough for everyone because there's nothing magic that happens between the end of March and the beginning of April. These shipments will be coming and more doses will be coming," he said.

Public Services and Procurement Minister Anita Anand announced today that Canada will buy 20 million more doses of the Moderna vaccine than originally planned.

The risk of spoilage
Data from the company's final clinical trial are encouraging, demonstrating the vaccine is 94.1 per cent effective at preventing COVID-19 and 100 per cent effective at preventing severe cases of the disease.

Because initial quantities are expected to be quite limited, given global demand, NACI urged provinces and territories to implement measures to avoid "dose wastage."

NACI said these jurisdictions should be prepared to vaccinate groups that don't easily fit within the predefined categories to avoid losing usable product through spoilage. The Pfizer vaccine needs to be kept at approximately -80 degrees Celsius to remain stable and cannot be easily transported from one setting to another.

"If doses of COVID-19 vaccine(s) have been delivered to an immunization setting and have been used for a group recommended in Stage 1 but cannot be re-located to another setting for other groups recommended in Stage 1, remaining doses on-site may be provided to individuals in the groups recommended in Stage 2 in order to minimize the risk of vaccine wastage and maximize the benefits of vaccination," the committee said.