#Who is next in line for the vaccine in Canada?

In early 2021, Canada will begin vaccinating essential workers. Who falls into that category, and in what order will they be vaccinated?

Right now, front-line health care workers and long-term care (LTC) residents and staff are at the head of the line to get COVID-19 vaccinations. Who comes after them, and who decides the order of the queue? 

These life-and-death decisions are being made by provincial governments across the country, based on advice from the National Advisory Committee on Immunization (NACI). It’s a national committee of experts—in areas including pediatrics, infectious diseases, epidemiology, public health, nursing, immunology—that provides independent advice to the Public Health Agency of Canada (PHAC) on everything from hepatitis vaccines to a 2018 update on immunization in pregnancy. In this pandemic year, NACI’s mandate expanded to provide recommendations as to how the country could quickly vaccinate the entire nation, using criteria that are ethical, equitable and feasible. 

NACI’s recommendations, published in November, start with Stage 1, in which vaccines are administered to those at high risk of severe illness and death, including front-line health care workers, LTC residents, those 70 and older and Indigenous communities.

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The NACI recommendations are used by the provinces to refine their own priority lists to suit local situations, explained Dr. Howard Njoo, Canada’s deputy chief public health officer on Dec. 9. Quebec, which has a persistently high number of COVID-19 cases and deaths in its LTC homes, has prioritized staff and residents in those settings for the first precious doses of vaccine. Ontario added a criterion to those recommended by NACI, prioritizing regions with the highest rates of COVID-19 infections. 

But the real questions will arise in early 2021. Anita Anand, the minister of public services and procurement announced that Canada had “secured regular weekly deliveries of approximately 125,000 Pfizer BioNTech doses per week starting in January.” As well, Canada has forecast large regular shipments of other vaccines, including the Moderna version, which still needs Health Canada approval. That’s when NACI’s Stage 2 recommendations will kick in.  

The Stage 2 cohort involves the rest of the health care sector, residents and staff in other congregate settings such as homeless shelters and prisons, and people deemed essential workers, such as police, firefighters and those working in food production facilities who have to maintain services deemed “essential for the functioning of society.” Ottawa expects three million Canadians to be vaccinated before opening access to all Canadians in the second quarter of 2021. But that is way too big a group for everyone to jump in line at the same time. So who goes first?

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The United States, which is ahead of Canada in its own vaccination schedule, is already grappling with deciding who is “essential.” For instance, ride service firms like Lyft and Uber are pushing to get their drivers into that cohort. In North Dakota, where huge meat packing plants mean that 60 per cent of its population fall into the “essential” category, government officials are struggling to satisfy everyone wanting the vaccines. As many as 90 million people could count as “essential workers” south of the border. 

Balancing the needs to so many groups can necessitate rejigging initial recommendations. On Dec. 20, the Advisory Committee on Immunization Practices, which advises the U.S. Centers for Disease Control and Prevention, decided that those aged 70 and older who live alone should vie with essential workers for the second round of vaccine doses (after frontline health care workers) rather than waiting until after those 90 million were vaccinated. 

Ultimately it falls to the provincial governments and then down to local authorities to decide who is essential in Canada. The provinces haven’t unveiled their detailed Stage 2 lists yet. Meanwhile, groups ranging from the Ontario Medical Association, which wants grocery store workers included in Stage 2, to teachers’ unions are pushing for the “essential” appellation. Stay tuned to see how provinces set their priorities.