(Originally published in the Monday, January 11th edition of the Toronto Star)
After a year of intense turmoil, anxiety, and despair, there is light at the end of the tunnel. Two mRNA vaccines, produced by Moderna and Pfizer/BioNTech, are a phenomenal advancement in our fight to end the pandemic, offering a significant reduction in the burden of disease in our communities.
Never before has so much scientific progress been made in a short period of time. This speaks to human resiliency and ingenuity in face of adversity.
After going through rigorous clinical study, and early indications from the massive global rollout, there is confidence that this is a safe vaccine. While adverse events should continue to be tracked in experience, and the effectiveness may not be 95 per cent in real world populations, all indications are that this vaccine will change how we view COVID-19 moving forward.
Many institutions across the country have started vaccinating. Prioritization focuses on those in long-term care, the staff/caregivers to take care of them, and front-facing health-care workers. This is to preserve health systems and prevent death amongst those who are the highest risk.
While Canada should be congratulated for having access to an early supply of vaccines, there needs to be serious discussions about the redistribution of this supply to areas that are in desperate need to reduce transmission in the highest burden areas and keep health systems active. There also needs to be serious provincial discussions on pushing vaccines to regions at high risk, rather than urban centres with population density.
For example, the region of Niagara, with nearly half a million residents, has not received any supply of vaccine yet, despite having more active cases in the hospital and the long term care sector, than within the entire population of the Atlantic region (which has received over 20,000 doses).
There is a sense of concern, that when it eventually does come to Niagara, quantities will not be sufficient. While one would want to be equitable to every long-term care resident and health-care worker across the country, the reality is there are some who face significantly higher risks of exposure and subsequent death, that are not in line to receive the vaccine.
Thunder Bay, a centre that provides tertiary care health services to an area of Northern Ontario double the size of Nova Scotia, including Indigenous communities, has received a minimal allotment, despite having more active cases than Nova Scotia. A local outbreak in the regional hospital would be devastating in the ability to provide health care to a significant portion of the province and may lead to subsequent chains of transmission in remote communities.
In addition, the framework for vaccinations needs to be adaptable in real time with reallocation and it needs to be transparent. In an unprecedented health care crisis, transparency builds trust.
As health-care workers in line to receive the vaccine, we reflect on this when our turn comes. The selfies, videos, news stories, and adulation by health-care workers, while seeming to be champions, is a double-edged sword. Those who do not have access to the vaccine may feel left out, fearful, and guilty that they are not afforded the same privilege. This increases the anxiety of continuing to work, protect their families, and their community at large.
Residents of congregate care facilities and their families face another day wondering when their turn will come. Health-care workers outside of hospitals, who continue to provide community-based care wonder how long they can expose themselves to risk, before their turn in the prioritization. While health-care workers have a sense of altruism, it is taxing and is contributing to burnout.
Finally, although Canada has the fortune of a mass vaccine campaign, many of our colleagues in other nations may not be afforded the same access for months to years.
As individuals, we should be cognizant of these inequities, be mindful of our social media presence, and understand that vaccines may offer an incredible relief for some, but anxiety for others.
As supply outpaces demand, our personal images play a role in championing vaccine uptake, but given the current issues they should not be used now. Although there may be hesitation currently, individual consultations, education, and transparency play a far greater role in ensuring those who need it roll up their sleeve.
From a systems standpoint, we must advocate for an equitable distribution both provincially and federally. While we understand that there is a need for vaccines to go to all parts of the country, there needs to be a fair assessment of burden as a part of this approach.
While every Canadian, vulnerable or not should be able to access the vaccine at some point in the next year, the way we distribute vaccines is critical. Constant reassessment of the localized burden of community disease allows us to redistribute vaccines, rather than following a distribution based on population. It is about vaccinating and not just logistics.
Dr. Zain Chagla is an infectious diseases physician in Hamilton and an associate professor at McMaster University. Dr. Karim Ali is an infectious diseases physician in Niagara and an assistant clinical professor at McMaster University. Dr. Syed Zaki Ahmed is an intensive care physician in Thunder Bay and an associate professor at the Northern Ontario School of Medicine.