How Ontario is prioritizing vaccinating essential workers

Ontario’s COVID-19 Vaccine Distribution Task Force is facing criticism for not prioritizing essential workers, but the group says they are and that there are still ethical considerations to take into account.

As phase two of the vaccine rollout is set to begin in the coming weeks, many Ontarians have looked at the chart outlining dates and wondered why essential workers, like teachers and grocery store workers, will have to wait until June for their turn.

“We've seen vulnerability in the vaccine discussion, be described around age and absolutely age is a layer of vulnerability, but there are other layers of vulnerability, we need to consider including people who live in low income areas and are essential workers,” Dr. Naheed Dosani, a palliative care physician and health justice advocate, told CTV’s National.

But a doctor on the task force says that the focus shouldn’t be on the dates, which come with an asterisk.

“Don't focus on the June in there because there's a big asterisk underneath there that says, this can be shifted based on vaccine supply,” Dr. Isaac Bogoch told CTVNews.ca in a phone interview on Friday.

Vaccine supply can be shifted for better or for worse. Vaccinations could happen sooner than anticipated, or if there are major supply chain hiccups, later than expected.

But experts are still concerned about an equitable rollout.

“I think overall we are focusing our vaccine rollout in a way that doesn't recognize the dire needs of particular communities that have been hardest hit by COVID-19,” said Dosani.

Currently, public health units are beginning to expand into age groups prioritized in phase two. Toronto has expanded mass vaccinations to cover people aged 60 and over. Phase two was set to begin with people aged 75 to 79. Public health units in COVID-19 hotspots are vaccinating people 50 years old and up.

Pharmacies are vaccinating people aged 55 and up using the AstraZeneca vaccine. This is expanding to 350 more pharmacies across the province to target more hotspot areas, some opening as early as Saturday. The additional capacity will have up to 700 pharmacies able to complete vaccinations and the province expects up to 1,500 pharmacies providing the inoculations by the end of April.

“You're stopping the deaths by really focusing on the older end of the spectrum and those who live in congregate settings, especially long-term care,” said Bogoch. “You're also helping people who might get infected during the conduct of their work, which are essential workers, people who can't work from home.”

He said that essential workers are being targeted in three ways throughout phase two.

“One [of the ways] is many essential workers that are 50 years and up can be vaccinated because the age bracket is lower in [hotspot] areas,” he said.

“There's many essential workers that will be vaccinated because there are more vaccines allocated to public health units, and the public health units can truly use those vaccines in ways that they see fit, including vaccinating essential workers,” he added.

“And the third thing is, stay tuned, because part of the phase two rollout is essential workers are going to be prioritized and vaccinated as they should be in stage two.”

‘THEY NEED SOME GUARANTEE’

Some Ontario doctors are worried about what will happen to patients in the meantime. Dr. Michael Warner, head of critical care at Michael Garron Hospital in Toronto said that he’s seeing patients who had no choice but to go to work and ended up spreading the virus to their family members. Without paid sick days and vaccinations, this will continue to happen, he says.

“Yesterday 17 people, including myself, and the 18th being the patient, went through a three hour experience, where I've never had a patient so close to death in my entire 12-year career, and we saved her,” he told CTV News Channel on Saturday.

But, he added, he shouldn’t have had to and Ontario’s Premier Doug Ford needs to step up to protect essential workers in Ontario.

“It didn't have to be this way. If the government would just do the right thing, and protect people. Protect the people who are actually being hurt by this, the people that the premier never talks about in his press conferences, and I'm tired of it and so are my colleagues,” he added.

Dr. Abdu Sharkawy, CTV News infectious disease specialist, is seeing similar things among his own COVID-19 patients. They need better protection, he told CTV News Channel on Saturday.

“They need some guarantee that they don't have to make a decision between having their families survive, and putting food on the table, or ending up in an ICU on a ventilator,” he said.

Sharkawy has been particularly concerned about teachers in schools with antiquated ventilation systems and students who sit together unmasked eating their lunches.

“They need vaccines, and what we've done right now just deciding that somehow they'll be OK, they'll be able to fend for themselves that, you know they'll come up in the queue whenever they can, unacceptable, unacceptable,” he said. “Teachers are going to die.”

SUPPLY ISSUES?

While it is important to get essential workers vaccinated, Bogoch said that it’s also important to continue vaccinating older populations and those at highest risk of dying from COVID-19.

Dropping age limits in COVID-19 hotspots aims to encompass more essential workers, as well as targeting their family members and close contacts who are at higher risk of severe illness or death. Expanding the pharmacy program means more equitable distribution of vaccines.

Right now, vaccine supply is the biggest hurdle, Bogoch said.

“We just don't have the vaccine to do it,” he said. “Because we vaccinated long-term care and community dwelling 80-year-olds and many community dwelling 70-year-olds.”

Since the beginning of March, nine long-term care residents have died from COVID-19, compared to 770 long-term care resident deaths in January, according to data published by Ontario. The COVID-19 ward in the hospital where Bogoch works has an average patient age of 65, a lot of them are older than that, some are younger, he added.

He described some of them as essential workers, some have family members who are essential workers and others don’t know where they were infected.

He is critical of those sharing stories of young people in intensive care units who could’ve been saved by a vaccination, he said that these stories don’t help and without vaccine supply, won’t change the pace of rollout.

“We don't need anecdotes to drive this, we need data to drive this,” he said. “We have an equitable and data driven pathway, essential workers are prioritized in stage two of this process. There's multiple ways that equity has been baked into the stage two roll out.”

The focus for Bogoch is who he’s not seeing in the ICU. That’s the elderly people who bore the brunt of the first two waves of the COVID-19 pandemic in the province. He said that this shows the vaccines are working to prevent deaths and hospitalizations in priority groups, and that that shouldn’t be seen as a failure. Without vaccinating those priority groups a third wave would have torn through long-term care homes again, he added.

“It's not exciting and it's not flashy, it's just the right way to do it. Vaccinate the people who are at greatest risk of death.”

But supply remains the biggest factor in who will get vaccinated and when.

“That doesn't mean there isn't a problem. That doesn't mean that we're in the midst of a third wave and a lot of essential workers are being infected. What it means is we don't have a ton of vaccines. We have to use the ones we have in a strategic manner”