Why Manitoba's vaccine rollout isn't prioritizing those with underlying health conditions

WINNIPEG -- The Manitoba government released the full plan for its COVID-19 vaccine rollout on Wednesday, but the plan does not mention people with underlying health conditions as a prioritization group. It's a decision one medical ethicist says is 'morally puzzling.'

“There will be a vaccine for everyone who wants it in Manitoba, but depending on your situation you may need to be patient,” said Dr. Joss Reimer, medical lead for the Manitoba Vaccine Implementation Task Force, at a news conference.

Reimer explained the province is first prioritizing health-care workers in direct contact with patients, residents in high-risk congregate living facilities and adults in Indigenous communities.

It’s not until the second phase, expected to begin in April, that the province will begin to administer the COVID-19 vaccine to the general public, beginning with those over the age of 80. Eligibility for the vaccine will then take an age-based approach, working its way from older ages through the younger ones. The plan does not make mention of underlying health conditions as a factor in who takes priority for immunization.

When asked why those who are immunocompromised do not take precedence over people in their 20s and 30s, Reimer said research shows that taking an age-based approach is best at encompassing those with underlying health conditions.

“Not only do you capture people based on their age alone, but you capture most of the people with those health conditions that lead to the severe outcomes as well,” she said.

Reimer added that there’s no approach that will put Manitobans in perfect order in regards to their risk for severe outcomes, but an age-based approach captures the highest proportion.

“It’s certainly not going to be perfect for every individual in Manitoba, but it does show us that is the way that we can capture the most high-risk people in the right order,” she said.

However, Reimer noted, nothing is set in stone.

She said as science evolves and the province learns more about vaccine rollouts, things could potentially change.

“We are always open to changing things as information comes in. This is a global pandemic and the whole world is learning together about what to expect from these vaccines,” she said.

“And so we want to be ready to learn from our colleagues in other provinces in other countries, and apply those learnings in Manitoba.”

CAN THOSE WITH COMPROMISED IMMUNE SYSTEMS GET VACCINATED?

At a technical briefing on Wednesday, Reimer said initially the National Advisory Committee on Immunization (NACI) guidelines did not recommend that those who are immunocompromised receive the vaccine routinely.

“But they have softened that language and we now, as of last week, we have guidance available for people who are immunocompromised for a variety of reasons to be able to get the vaccine,” she said.

She said one of the more reassuring things is that those who are immunocompromised are not shown to have a significantly increased risk of severe outcomes.

“Certainly, they would be somewhat higher than the baseline population, but it hasn’t been a substantial increased risk compared to what we would have maybe expected for most infections.”

QUESTIONING THE APPROACH

Arthur Schafer, a University of Manitoba medical ethicist, said he thinks many Manitobans will be puzzled by the province’s age-based approach.

“So a healthy 80-year-old is going to get the vaccine ahead of a 40-year-old who has a seriously compromised immune system,” he said.

“That’s morally puzzling. Why wouldn’t people with a compromised immune system, regardless of their age, be near the top of the list?

He said this points to the more general ethical issue regarding how the province agreed upon this set of criteria.

“Are the criteria being used in Manitoba the same as those being used in Ontario and B.C.?” he said.

“If we’re different, how are we different, and why doesn’t the public know?"

He said during a pandemic, there needs to be public trust and a government that is operating in an open, honest and transparent manner.

Schafer said he thinks the province should inform the public of who is involved in decision-making, and what types of debates they are having.

“These are going to be life and death decisions for Manitobans, so I think we are entitled to know who is making them,” he said.

- With files from CTV’s Danton Unger and Touria Izri.