All things considered, it's a good problem to have: eight months into managing the COVID-19 pandemic, Public Health officials in New Brunswick now must start sorting out who to vaccinate first.
It won't be easy, given that the number of New Brunswickers old enough to be considered high-risk far exceeds the number of doses coming in the first wave of vaccines early next year.
The province could receive enough doses for 60,000 people early in January.
But the number of people over the age of 60 — the point at which the risk of serious COVID-19 impacts increases dramatically — is more than 200,000.
Chief Medical Officer of Health Dr. Jennifer Russell said choosing who will be at the front of the line will be a complicated calculation.
"That's the point of prioritizing," she said. "We know there's not going to be enough, and this is going to be the most complex immunization program ever delivered in this country and around the world."
Federal distribution plan based on population
The federal government has agreed to distribute the first batch of vaccines, due in the first three months of 2021, using a formula roughly based on population.
With enough doses for three million people, that would translate into about 60,000 New Brunswickers vaccinated by April.
Russell said she and her counterparts federally and in other provinces have agreed on a general plan that will be hammered into place in time for expected regulatory approval of the first vaccines next month.
Distribution could begin as early as January.
"I think long-term care nursing home facilities would be priority one, certainly, as a very vulnerable section of our population," said Premier Blaine Higgs.
The New Brunswick Association of Nursing Homes said there are 4,800 beds in its member homes.
"I think you would move quickly into the health-care workers and protecting them, and then the likely next step would be seniors," Higgs said.
Nursing home workers would account for 4,800 doses
First responders would also be near the top of the list, Higgs said.
"And then you just kind of work through the age demographics."
Vaccinating unionized nursing home workers around the province would require more than 4,800 doses.
That's how many members of the Canadian Union of Public Employees work in more than 50 nursing homes, according to union spokesperson Simon Ouellette.
Vulnerable people should be prioritized, but so should the people who work with them. - Simon Ouellette, CUPE spokesperson
Five long-term care or nursing homes have been hit by outbreaks in New Brunswick.
Some nursing home workers, including maintenance and cleaning staff, must move from room to room, creating the risk of becoming a super-spreader, Ouellette said.
"Vulnerable people should be prioritized, but so should the people who work with them."
There are also 1,875 doctors in the province, according to Dr. Jeff Steeves, president of the New Brunswick Medical Society. The New Brunswick Nurses Union estimates 6,400 nurses are in the workforce now.
Those doctors include emergency department and critical care physicians who are potentially exposed to COVID-19 frequently.
"Those most exposed to those being ill are going to need it first," Steeves said.
People with chronic conditions on high-priority list
And there are 950 ambulance paramedics who are "seeing folks that they don't have a really good understanding of when they initially respond about what may or may not be wrong with them," said Chris Hood, executive director of the Paramedic Association of New Brunswick.
"The association feels strongly that to protect the members, who are obviously in short supply, and to protect the public that they serve, they should be one of the first groups to be done," he said.
Russell said New Brunswickers with chronic conditions are also "somewhere on that list" of high-priority patients.
According to the New Brunswick Health Council, 11.6 per cent of adults in the province have been diagnosed with asthma and 11.4 per cent have been diagnosed with diabetes, two conditions that COVID-19 can quickly make life-threatening.
Russell said Indigenous people will also be a high priority because COVID-19 has had a disproportionate impact on them.
But it's possible the federal government, which has responsibility for Indigenous issues, will hang on to a small percentage of vaccine doses and do that itself, along with immunizing some military members and federal inmates.
She said the goal is to have 75 per cent of the province vaccinated, enough to create herd immunity in the population. She doesn't see that happening until next fall or later.
Cardy wants schoolchildren to follow high-priority groups
Higgs said Thursday that the fact some people will want to wait to ensure the vaccines are safe could make the process easier.
"There's a number of people that want to be vaccinated early, and there are probably others that want to kind of wait a bit," he told CBC's Power and Politics. "So it may not be a rush to the front of the line immediately."
Last week Education and Early Childhood Development Minister Dominic Cardy said he would support immunizing schoolchildren soon after the high-priority groups are done.
"We're seeing, unfortunately, in the last few months, a significant increase in the number of young people who are becoming not just infected with COVID-19 but are then passing it on," he said.
"Younger people get less sick, but they can be just as efficient a disease vector as anyone of any age, so I'd certainly argue that. I think that would make sense."