Perhaps too early to start celebrating: Fairness and Equity in the Distribution of a COVID-19 Vaccine

By: Sonja Perisic

The world was roaring with the recent week’s announcement that Moderna, an American pharmaceutical company, has developed a vaccine more than 94% effective in preventing COVID-19. Canada has already secured up to 358 million doses of COVID-19 vaccines from a wide range of different manufacturers and has signed six contracts for tens of millions more vaccine doses with pharmaceutical giants, such as AstraZeneca, Moderna and Pfizer. Although promising news, what does this mean for the people that may have delayed access to it?  

The funding, procurement, logistics and distribution of a vaccine all raise significant questions about values, decision-making and ethics. Canadians are aware that there are a variety of potential recipients for a COVID-19 vaccine, but not all will receive access at once. Some citizens will come first in the population, depending on their risk of spreading the virus. However, this decision could also potentially depend on socioeconomic status, not unlike other decisions regarding public health. Many countries have already begun to calculate who is at most risk and who will get the vaccine first. But, will they get it right? Will their proposals stand up to the more difficult task of implementation? 

Two main proposals have emerged. One involves the proposition that health care workers and high-risk populations, such as people over the age of 65, should be immunized first. The second suggests countries receive doses proportional to their populations according to the WHO. From an ethical perspective, both of these proposals are flawed as they do not consider prioritizing the disadvantaged nor do they demonstrate equal moral concern for all individuals. Many global proposals thus far have prioritized the rich: wealthy nations have had the privilege of purchasing vaccines from private pharmaceutical companies to control their epidemics first before allowing developing countries the opportunity to treat as low as 3% of their population. Pharmaceutical companies are reluctant to invest in producing new vaccines for the developing world because they have little prospect of earning an attractive return. As a result, it could be a long time before an effective COVID-19 vaccine reaches the poorest populations. This should not come as a surprise, as research has shown that the pandemic has disproportionately affected poor populations, including their being less likely to be able to work from home or adapt to home-schooling. Limited or selective availability of a vaccine exacerbates these problems. 

Many countries purchasing masses of vaccine doses, including Canada, have yet to determine what their objective is. Ensuring a reduced number of premature deaths, addressing economic deprivation, protecting health systems or achieving any other objectives equitably require a lot more data on what rollout strategy would be most effective. So, what principles should policy makers employ? Should they distribute vaccines to countries with the goal of minimizing premature death, saving the most life years, ending a cycle of poverty, forestalling economic devastation, or something else? Though this question is far from resolved, we at least know this is true: policy makers should desist from prioritizing the rich and distributing vaccines in ways that fail to account for existing inequalities.  

The Canadian government is specifically concerned with how to allocate the vaccine domestically. The number of COVID-19 vaccine doses that each province will get is still unknown, which is a concern particularly for marginalized populations living in remote communities. Doug Ford suggests 40% of the vaccines will go to Ontarians, which casts doubt on the deployment of the vaccine to Indigenous communities outside of provincial jurisdictions. If such a portion is distributed to a province with the most populated urban centres, it follows that rural communities outside of the province will not benefit. Because poor global populations are already behind in receiving the best vaccines on the market, it is possible that distribution inequality occurs on a domestic scale as well, given the trend of the pandemic proving unfavorable for low-income individuals. Theresa Tam, Canada’s chief public health officer, says Nunavut, which, on November 18, began a two-week shutdown of schools and non-essential businesses, is dealing with a significant rise in cases. The territory reported 10 new COVID-19 infections on Wednesday, bringing its total active cases from 60 to 70. COVID-19 presents significant challenges for Nunavut’s health services, especially in those areas of the territory not equipped to manage what Tam called complex medical emergencies. These areas, among others, need access to a vaccine and could be put on hold for years. 

Essential workers and others who face increased risks related to COVID-19 should be vaccinated before everyone else, according to new recommendations submitted to the federal government. The National Advisory Committee on Immunization (NACI) recommends prioritizing the following specific groups: those at high risk of severe illness and death from COVID-19, including older populations, essential workers and caregivers who work with seniors. It is not yet clear whether the federal, provincial and territorial governments will follow these guidelines. Currently, there is no official rollout plan that indicates whether these recommendations will in fact be implemented. In order for a vaccine rollout to be successful, information will have to be easily accessible to the public, policy makers and stakeholders. As of yet, this information has been enigmatic—much like the rest of the decisions surrounding COVID-19. 

Sonja Perisic is a first year Master of Public Policy candidate at the University of Toronto’s Munk School of Global Affairs & Public Policy. Her interests are in environmental, social, and urban policy. Sonja holds a Bachelor of Arts (Honours) in English from the University of Toronto. 

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