Province defends age-based approach to COVID vaccine rollout

Critics say health care workers and other front-line employees at risk of virus exposure should have priority in vaccine sequence

A nurse draws a dose from a vaccine vial in Prince Albert. Photo courtesy SHA.

Premier Scott Moe and Chief Medical Health Officer Dr. Saqib Shahab defended the province’s vaccine rollout plan Thursday after coming under heavy criticism for a plan that differed from one presented to health care sector employees before Tuesday’s announcement.

The new plan sees phase 2 of vaccinations, which is set to start in the spring, rollout based on age alone.

The previous version of the plan, presented to the province’s doctors, included phase two beginning with health care workers not covered in phase one along with medically vulnerable populations, people living in shared settings and urban Indigenous people. General population rollout would follow the vaccination of all health care workers, including security and housekeeping, along with dental care providers and pharmacists.

None of those priorities were included in the plan presented Tuesday.

Instead, health care workers outside of the less than 10,000 who work directly with COVID-19-positive patients and at testing sites will have to wait for their age demographic to be called, along with other frontline workers such as grocery store employees and police officers who have also advocated for priority access to vaccines.

The reason, the government said Thursday, is a limited supply.

“I’ve heard over the course of the last while concern from a number of health care workers about not being included as part of the phase two sequencing,” Moe said.

“Some other groups have come forward to advocate what they should as well be vaccinated sooner. I understand totally why they might feel that way and if we had more vaccines … we would be able to look at getting everyone vaccinated a lot more quickly. We are dealing with a very scarce supply of vaccines, so sequencing by age is the best way to vaccinate as many people as possible and to do so as quickly as possible and in a way that reduces the severe outcomes as much as we are able.”

Moe said, though, that the Ministry of Health is re-evaluating other groups in the health care sector at high risk of coming in contact with COVID-19 patients to be included in the first phase of vaccine access.

“It isn’t going to be all of the groups across the health care sector,” Moe said.

“There are a number of folks in the health care sector who are going to be under the mass vaccination age priority, but we want to have another reevaluation to ensure that all of those who should have access to a vaccine early (can be provided) access.”

Earlier Thursday, NDP leader and family doctor Ryan Meili expressed his disappointment in the province’s new vaccination rollout plan. He accused the government of making a political decision and of going against national guidelines for vaccine distribution.

“It’s important to keep (health care workers) safe, both because they’re at higher risk and exposure,” he said.

“We need them to stay healthy in order to help others when they’re sick. It’s an obvious priority group, and very, very strange that (Health Minister Paul) Merriman thinks that’s not the right thing to do.”

Meili said it was a “mystery” why the schedule put together by the Saskatchewan Health Authority and presented to doctors and nurses was changed “at the last minute.

“This non-evidence-based and unwise approach is purely political. The case of health care workers is open and shut — there is no argument to be made to not include health care workers as a priority group.”

Speaking to the Herald Thursday, Saskatchewan Medical Association president Dr. Barb Konstantynowicz said her members understand the need to vaccinate the most vulnerable but are concerned that without vaccines in their arms, the need to quarantine and isolate if exposed to a COVID-19 case  will continue to create health care backlogs.

“We had an opportunity to see what committees that are working on vaccine rollout were thinking in terms of their original plans,” she said.

“In that plan, there was a very nuanced and very carefully thought out rollout not only to the most vulnerable patients, but in addition to that, the most vulnerable health care providers. I think it would be a good move for the Ministry of Health and the premier to reconsider, and to re-evaluate and review. I would greatly appreciate them receiving the terms of the vaccine rollout.”

Meili acknowledged that health care workers are a priority in phase one of the vaccine rollout, but that other doctors, nurses and pharmacists, even if they can be exposed to COVID, aren’t included beyond their age groups.

“That’s not what the guidelines are saying. It’s not the evidence-based approach.”

NDP health critic Vicki Mowat said the premier spent the week “insulting health care workers and families” and “needs an attitude adjustment.”

Meili said everyone he’s spoken to about the change was “furious.” He dismissed the argument that the change was due to a lower number of vaccines.

“I don’t understand why having fewer vaccines is a reason to do it wrong,” he said. “It doesn’t make sense with fewer or with more vaccines.”

Instead, Meili said, it’s due to politics.

“I think there are whole lot more people that are 50-59 or 60-69 than there are health care workers, so he’s counting the votes.”

It’s an allegation Moe flatly denied.

“They’re wrong. That is a statement the NDP shouldn’t have made and they should retract.”

Moe was joined Thursday by Shahab, who spent large portions of the press conference explaining why the province made the change to its vaccine rollout plan. Like Moe and Merriman, he said it’s due to the number of vaccines available.

An age-based rollout, he added, is also easier to implement and can get more vaccines into more people more quickly, based on their risk of a negative outcome such as a hospitalization or death.

Vaccinating by age also makes it harder to cheat and easier to know when it’s your turn.

“Age is the best way to sequence,” Shahab said.

“If you get into too many variables, it gets hard to figure out if you should come now or later.”

It’s also harder to lie about your age and game the system than it is to lie about being a front-line worker, he said.

Further, with a less reliable supply of vaccines, he argued, the focus is on reducing risk of negative outcomes. Once the vaccine supply is more sufficient, he said, age groups should move through mass vaccination clinics quickly and the province can re-evaluate if other factors, such as profession or risk of exposure, should be incorporated.

Shahab also argued that the national documents critics cite, the National Advisory Committee on Immunization (NACI), is based on a larger, more consistent supply. He said in situations where vaccine supply becomes less reliable, the focus, even from NACI, becomes on reducing severe outcomes.

“People at highest risks of severe outcomes are always the priority from a clinical perspective,” he said.

In COVID, that risk is age.

He showed a document detailing severe outcomes by age in Saskatchewan so far. Severe outcomes became more common in each five-year bump in the age category. Mortality, he said, rises with each decade.

“If you have a severely-constrained supply … you have to look at the epidemiology of the virus,” Shahab said.

“Everyone agrees … that age is the primary determinant, especially when you have limited vaccine supply.”

He added that vaccinating the more vulnerable populations first will also reduce the number of cases that result in hospitalization, thereby protecting more health care workers and preventing the system from being overwhelmed.

“It is unfortunate that right now, supply only allows for 10, 15, 20 per cent of health care workers to be accommodated in these specific, high-risk areas,” he said.

“As supply picks up, we will continue to look at opportunities to include health care workers who work in other clinical areas at lower risk of exposure who can mitigate risk through PPE. Their risk is certainly higher than the general population, so that will have to be accommodated linked with age-based … or other criteria. Our limitation is the severe limitation on supply.”

Phase two, though, is still a long way off, especially with news this week of further delays in the supply of vaccines manufactured by Moderna.

Phase one, which includes residents over the age of 70, long-term care residents and staff and any health care workers working directly with COIVD-19 patients, is only about 12 per cent complete.

Moe said disruptions to the supply of vaccines are having other impacts as well, such as in parts of southern Saskatchewan where no one has been vaccinated.

Those regions, he said, were scheduled to have already received first doses. However, when Pfizer and Moderna began to reduce deliveries as they faced supply chain issues, those doses were redirected to other regions where people who received a first dose of the vaccine were due for their second shot.

Had those reductions not happened, he said, areas that have yet to get any vaccine would have seen the first phase of vaccinations begin.