Leading With Your Jab – Vaccine Distribution And Public Policy
Top 5 Issues
The prospect of safe and effective vaccination distribution, at the provincial, national, and international levels, offers optimism that the worst of the COVID-19 pandemic in Canada will soon be behind us. Many individuals are rightly eager to get vaccinated, and questions about government policies concerning COVID-19 vaccinations are front of mind. However, it can be difficult to decipher and assess the decisions which are driving public policy across Canada.
In order to help you better understand these issues, below is a list of the top 5 issues facing public policy leaders that we are watching closely, as policymakers decide how to best administer the vaccine, keep people safe and healthy, and prepare for life in Canada after COVID-19.
Prioritization and Sequencing
Policymakers are faced with a complex ethical and practical question: what is the fairest and most effective way to distribute a limited supply of vaccines?
There are striking inconsistencies amongst provinces in answering this question. Indeed, provinces have implemented conflicting prioritization policies, as each province has independently identified its own priority groups based on factors as varied as age, comorbidities, race, geography, or occupation, among others. Some provincial policies are motivated by concerns that relate – at least in part – to equity issues, for instance, prioritizing people who are homeless, incarcerated, racialized, or living in remote communities. Policymakers are also considering whether to implement measures to mitigate equity concerns in vaccine rollout by limiting designer vaccine shopping, as individuals who work from home may have the luxury to wait for the vaccine they prefer compared to those working in crowded settings or living in close quarters. On the other hand, policymakers may choose to encourage people who consider themselves to be low-risk to defer their vaccinations in favour of those who work in crowded settings or live in close quarters, recognizing that there are multiple vaccines that have been approved by Health Canada. We are watching how policymakers continue to allocate scarce vaccines, and the tradeoffs that they make
Prime Minister Trudeau has announced that every Canadian who wants to be vaccinated will be able to do so by the end of September 2021. Though encouraging, this statement nevertheless raises some uncertainty about what it means to be a “person who wants to be vaccinated”. Many Canadians, rightly or wrongly, want to be vaccinated only under certain circumstances, such as being able to choose their particular vaccine, or being guaranteed a second dose within a particular timeframe. If a large mass of people want to be vaccinated but decline their first opportunity to receive a vaccine for any these reasons, does the September 2021 deadline remain realistic? And what good does it do the Canadian economy or our society and social infrastructure to have sufficient supply, but insufficient demand?
Policymakers are working to implement a safe and effective COVID-19 vaccine rollout, but are faced with the additional challenge of misinformation about vaccines and fear of the vaccine’s long-term effects among the population. At-risk individuals making decisions about whether or not to be vaccinated based on misinformation or fear complicates certain policy considerations, such as whether to administer as many first doses as possible while delaying second doses. At-risk individuals who are skeptical of receiving a first dose without being guaranteed a second dose may thus decline the first dose, resulting in the unintended effect of preventing at-risk populations from receiving the significant immunization benefits that come with a first dose.
While vaccine supplies are being administered almost as quickly as they are received, we are watching inventory levels and vaccine penetration rates in different geographies and groups.
Easing of Lockdowns
Front of mind for policymakers is the question of the scope of immunization in the population that is sufficient to gradually, safely, and hopefully permanently ease lockdown measures. Vaccines are distributed linearly, while the virus can spread exponentially, so at what point will decision makers deem it safe enough to reopen fully and for good?
Policymakers that do not have a background in public health are hesitant to deviate from the advice of public health officials, who are trained to favour a zero to low-risk public health approach. These policymakers are understandably afraid to make premature decisions that could lead to serious illness and death, or result in more and deeper lockdowns. However, a zero risk approach may unnecessarily extend and deepen the costly societal and mental health disruption that the pandemic has caused.
We are watching how different provinces and municipalities ease lockdowns as vaccine penetration increases, what impact this has on the various key metrics of infection numbers, positivity rates, hospitalizations, ICU levels, and mortality rates and levels, and what these different policymakers learn from each other.
International challenges related to tracking the virus, transnational protocols, and the flow of goods, people, and services continue to be top of mind for Canadian policymakers. Global supply chains have been significantly impacted because of COVID-19 and new or improved policies will be necessary in order to mitigate the effects already felt, as well as to mitigate future harm.
The recent announcement that the US will loan Canada 1.5M vaccine doses has also brought additional questions regarding vaccine diplomacy. It is unclear what will be the terms of the arrangement between the two countries with respect to this loan and future vaccine loans or sales.
The movement of people across both international and intra-Canadian borders remains uncertain and confusing. One must quarantine in a hotel upon arrival to Canada by air from the United States, but not by land, and movement between and within Canadian provinces is a checkerboard of different policies and restrictions.
Policymakers are also considering how to effectively track vaccinations administered in other countries. For example, will an Ontario vaccination certificate be considered sufficient evidence of immunization at the US border, or will some other program be developed requiring additional verifications? And will a single vaccination of two required doses be sufficient to liberate certain restrictions, or will full vaccination be required?
Creating and maintaining vaccination records for individuals that can be verified both within Canada and abroad is a main consideration for policymakers. Vaccine passports for domestic and international travel and “Digital ID” verification for certain other domestic purposes are both potential public policy responses.
The implementation of a “Digital ID” program for vaccine verification implies that those without proof of vaccination in a post-pandemic world would be restricted or limited in some way, whether it be through travel, employment opportunities, accessing other spaces (e.g. shopping malls), or other activities.
We will be watching what technology solutions in Canada emerge, as well as solutions and regulatory approaches in other jurisdictions.
Lastly, mindful of the new strains of the virus that causes COVID-19, the role and use of these vaccines in a post-pandemic world remains uncertain. For example, will we need regular booster shots, like we do annually for the flu or on a different cadence for other diseases (e.g. measles)?
We will be watching closely the effectiveness of vaccines against new coronavirus strains, and how COVID-19 infections and related metrics (including hospitalizations) track not only through to September 2021, but beyond and into 2022 and 2023.
If you’re concerned about how vaccine programs and policy changes affect your business, or about programs that may be available to you, then we would be pleased to help. We’re in this together.