A week before New Year’s Eve, I started to receive promotional material from restaurants, my gym and arts groups, gushing about how 2021 will be different. Life will be good again, and 2020 will be but a dream.
That was then; this is now. The vaccine rollout has gone poorly, in Manitoba and elsewhere in North America. Compared to the U.K. and especially Israel, Canada’s paltry vaccination rate is embarrassing.
Israel’s swift vaccination program stems from several factors. Most important is that in exchange for medical data on the rollout, especially on adverse reactions and duration of immunity, Pfizer will ensure a consistent supply of the vaccine. Sure, privacy and ethics concerns exist, but I would bet they worry few Israelis.
A small state with a unitary government (no pesky provincial premiers all too ready to claim credit and shift blame) and a population accustomed to mobilizing in times of national emergency are also important factors in Israel’s success.
A federation such as Canada, where provinces have the primary responsibility for health and social services and the federal government acts as the funder and overall regulator, faces challenges in co-ordinating a national response to public-health issues. Aside from the mutual blame game that erupts when things go south, the vaccine fiasco threatens economic recovery.
Here is the issue: what happens if (when) new, more infectious variants become dominant, as many epidemiologists believe is occurring? Again, using Israel as the example, despite having more than 25 per cent of its population vaccinated, its cases of COVID-19 continue to reach all-time highs.
The news gets worse. Israel adopted the strategy of distributing the first dose of the Pfizer vaccine widely, but the single dose is not as effective as the double dose. Due to the new British variant of SARS-CoV-2, many who received a single dose still became ill with COVID-19. A single dose of the Pfizer vaccine is only 52 percent effective, which considerably lengthens the time to herd immunity as those partially vaccinated contract the disease.
So we are racing across thin ice, with a crack chasing behind us. Here are the challenges:
First, the Pfizer and Moderna vaccines are likely the only options for the near term. Writing in the peer-reviewed scientific journal Plos One, Hilda Bastian analyzes the status of the dozens of vaccines in various stages of development, and none is ready to join these two. This means the storage and administrative requirements (deep freezing) will severely constrain options for vaccine delivery until well into 2021.
Second, consensus exists on placing residents in senior care at the front of the line, along with front-line health workers, specifically those treating COVID-19 patients or likely to have close contact with symptomatic people. A strong case also exists for administering vaccines to everyone over 18 living in remote Indigenous communities. The issue is not one of indigeneity, but living circumstances. Close living and poor sanitary conditions create the risk.
Then things get complicated. Front-line workers such as retail clerks and transit drivers all have claims, but calling individuals to self-identify can easily overwhelm systems, as happened the first day vaccinations were announced and the phone lines in Manitoba collapsed under the weight of 100,000 callers. The suggestion to use pre-existing conditions to set vaccination priority will not work. How severe must that condition be to gain eligibility? And can one create a list without revealing medical data when a younger person receives the vaccine before an older resident?
Since the risk of illness and death increases with age, driver’s licences and health registration data support the creation of a priority list by age. Both British Columbia and Manitoba have indicated that they will use age as the eligibility criterion once special populations have received their shot. This could have started in early December, but this vaccination hiatus offers the chance to get it right.
With accurate numbers of those eligible in each age group, it should not be too difficult to allocate slots to potential recipients and create notifications of appointments, rather than having us call in or check in on the web.
Do not underestimate the complexity of an apparently simple age-priority system of vaccination. Myriad details need resolution, such as how to vaccinate rural residents who cannot travel to vaccination sites. And certainly, some will try to "game" the system. Finally, until government can approve effective vaccines that do not have the strict storage requirements of the Pfizer and Moderna shots, rural residents could remain largely on the sidelines.
A mutating virus threatens to overwhelm the drive toward herd immunity. This could trigger government to impose a third lockdown, which will deepen the economic and psychological malaise. Already, the economic recovery is faltering in the U.S. and in Canada. Canada’s woeful performance will also be a political hazard for incumbent politicians when it’s observed that the UK has vaccinated its entire population by June.
The next few months will be trying for government, and for citizens. A third wave looms.
Gregory Mason is an associate professor of economics at the University of Manitoba.