As COVID-19 vaccine supplies remain unpredictable, the question of who should be getting the vaccine continues to be a hot topic.
In Nova Scotia, the priority so far is given to health-care workers who have direct contact with patients and to residents, staff, and care givers in nursing homes. But a perfect vaccine rollout plan takes more than that into consideration.
“We need to keep vaccine equity at the forefront,” said Alyson Kelvin, virologist at Dalhousie University and the VIDO-InterVac lab in Saskatoon.
Kelvin and 18 other researchers from the U.S., Japan, and New Zealand, wrote a review paper to shed the light on the different COVID-19 vaccines and how they should be distributed to the most vulnerable.
The paper titled Development and Deployment of COVID-19 Vaccines for Those Most Vulnerable was published in the Science Translational Medicine journal last week.
One group Kelvin said should be prioritized in Nova Scotia is people living in remote communities who might not have accessible health care or food. She said this group is highly susceptible to developing COVID-19 with severe symptoms, especially if they live in poverty or have less access to food and medicine.
People living in these conditions could suffer from chronic infections that affect their immune system, which doesn’t only make them vulnerable to COVID-19 but can also potentially make the vaccine less effective, said Kelvin. It’s important for vaccine rollout plans to include people living in rural communities to understand more about how their bodies react to the vaccine and address any hesitancy they might have.
Those living in close quarters, such as prisoners and people living in group housing, should also be prioritized because the virus could spread easily in their conditions.
Amid vaccine shortages across Canada, Kelvin said there has been some consideration of removing some of the vaccine dedicated to vulnerable populations in Canada, such as Indigenous communities, towards areas that are hard-hit with COVID-19.
“I think this really needs to be reconsidered,” she said. “Vulnerable populations are still vulnerable and if we don’t continue with a strategic rollout, we won’t have proper coverage where we need it.”
On Friday, Dr. Robert Strang, chief medical officer of health, announced that vaccinations at Nova Scotia's long-term care homes will temporarily slow down as a portion of the province's Moderna COVID-19 vaccine shipments will be diverted to Canada's northern territories.
The paper which Kelvin co-authored also identifies both the elderly and children as groups that should be getting the vaccine. While prioritizing the elderly comes as no surprise, children might not be an obvious choice to some.
Kelvin said it’s not correct to assume that children are less susceptible to getting COVID-19 or spreading the disease.
There’s still a lot that researchers are trying to understand about COVID-19 and children, she added. Some studies have suggested that children with COVID-19 have high levels of virus in their bodies comparable to adults and could transmit the disease to others, sometimes without showing symptoms. Having children get the vaccine will protect them and others.
With multiple vaccines available, an equitable vaccine rollout could include using different vaccines for different groups based on factors such as age. For example, older people might not benefit from a viral-vector vaccine, such as the Oxford/AstraZeneca vaccine, as much as young people would.
"Being not as effective might be a difference between a brief hospital visit and succumbing ultimately to the disease," said Kelvin. "So older people might still be infected but their disease severity might be lessened by receiving a vaccine and that's something that we should be prepared for."
The Oxford/AstraZeneca vaccine uses a weakened version of the common cold virus, known as adenovirus, to carry instructions for our body. The weakened virus can’t cause illness, but once injected, the instructions teach our immune system how to fight COVID-19, when it needs to.
Whether there is indeed a vaccine that works better for a specific group still needs to be assessed, said Kelvin. But data so far has shown that mRNA-based vaccines, such as the Moderna and Pfizer-BioNTech vaccines, are inducing a protective response in older people.
Equitable vaccine distribution is not just about focusing on local vulnerable groups, said Kelvin. Policy-makers in Canada should make sure that low- and medium-income countries also get the vaccine.
They, as people in rural communities, are more susceptible to COVID-19 due to lack of access to health care and food. The disease could linger longer in their bodies because their immune system isn’t strong enough to fight it. This could cause COVID-19 to mutate and result in more variants, said Kelvin.
Variants such as the South African variant and the U.K. variant are concerning because they could be more infectious and cause higher mortality. It’s also not clear whether all the COVID-19 vaccines developed so far are effective against the variants.
Kelvin said she’s proud of Canada’s efforts to help less-wealthy countries access the vaccine.
Canada has contributed over $400 million into COVAX, a global initiative aimed to ensure equitable access to COVID-19 vaccines for every country in the world. Kelvin said while few countries have been able to get vaccines through COVAX so far, she’s optimistic that things “are moving in the right direction.”
Nebal Snan, Local Journalism Initiative Reporter, The Chronicle Herald