Age-based dose distribution may not always be best call

Hey there, time traveller!
This article was published 07/05/2021 (1990 days ago), so information in it may no longer be current.

I got my first shot of Pfizer vaccine last weekend, and while I’m relieved to have started my journey to possible COVID-19 immunity, I’m also feeling more than a little guilty.

All things being equal, I’m not sure people like me should be vaccinated right now. I’ll knock on wood repeatedly while I explain why.

I’m only in my late 50s (which I’m told is the new 40s), in good health (knock-knock), and I have a job that allows me to stay well away from the front line of the pandemic.

So, how is it that I’m already half-vaccinated and others of clearly greater need are not? Such as Manitobans who care for organ transplant recipients.

This week, the Canadian Transplant Association wrote a letter to provincial Health Minister Heather Stefanson asking Manitoba ensure organ recipients get their second doses of vaccine within the prescribed time limits set by manufacturers.

The association also asked Manitoba to prioritize household caregivers of organ recipients to ensure they do not inadvertently pass on COVID-19 to their immunocompromised wards.

Stefanson’s response?

According to Mark Miles, director of the Manitoba chapter and recipient of a heart transplant in 2015, there has been nothing but silence.

“With an issue like this, why wouldn’t you take time to respond?” he said.

For some weeks, school teachers have been getting the same treatment. Given the importance of keeping schools open, teachers have demanded on an almost daily basis to move to the front of the vaccine line.

Out of the blue last week, Manitoba Premier Brian Pallister floated a bizarre plan to have teachers travel to North Dakota to get vaccinated, much like truck drivers have been doing.

The plan has failed to materialize and, this week, the vaccine implementation task force told teachers they would not be prioritized.

Manitoba’s approach has largely mirrored that taken in most of Canada.

Health-care workers and the elderly, particularly those in long-term care facilities, were given the first doses, along with Indigenous people. Other groups (police, firefighters and paramedics) were also given early access.

Lately, Manitoba has taken to opening up eligibility to any adult, of any age and occupation, in certain hot-spot areas or neighbourhoods.

However, like a deadly game of musical chairs, teachers have consistently been among those left without a seat.

Although there is no conceivable way this, or any other government in the country, could satisfy the expectations of every group that wanted to be vaccinated on a priority basis, Manitoba’s approach to dose distribution has been quite a muddle.

Like many governments, it has relied heavily on age as the determining factor. While that will eventually get the job done, it’s important to remember last fall, when epidemiologists and public health experts were debating the best way to distribute vaccines, there was a fairly vigorous debate about how much age should be used to determine eligibility.

In December, the U.S. Centers for Disease Control and Prevention’s vaccine advisory committee recommended a three-stage launch: the first cohort would include health-care workers and residents of long-term care; followed by essential workers (everything from emergency responders to police to teachers to critical retail and transportation); followed by adults with high-risk medical conditions, and adults 65 years of age or older.

Critics claimed this approach would lead to an exponential increase in the number of deaths among the elderly.

However, proponents pointed out while older people are more vulnerable to dying from COVID-19, they were catching the virus from younger people who move about more.

It should be noted even with most elderly and health-care workers vaccinated, COVID-19 is still running rampant in most countries. Mortality may be down because the most vulnerable got a jab, but the threat is as great as it has ever been.

If the early focus is going to be on the elderly and sick, then, at some point, every vaccine effort has to pivot to protect the broadest definition of essential workers. New Zealand, which has been as successful as any country in controlling the virus, vaccinated its border personnel first, even before the elderly and health-care workers.

The next time, as soon as we reach a point where the risk of mortality is lessened, we have to stop worrying about age and concentrate more on those people who are the greatest risk of acquiring the virus and passing it on to others.

It’s really pointless to offer a jab to a perfectly healthy, 50-something journalist when there are teachers and organ transplant caregivers with a greater need.

dan.lett@freepress.mb.ca