COVID-19 vaccine: Who has been overlooked in the vaccination rollout across Canada?
Now that Canada has approved two COVID-19 vaccines, one from Pfizer-BioNTech and another from Moderna, distribution plans across the country are starting to come into effect as Canadians wait and see when they will be vaccinated.
Federally, the National Advisory Committee on Immunization (NACI) has made recommendations for the groups of people in Canada who should be vaccinated with initial doses of COVID-19 vaccines. The four groups are:
Residents and staff of congregate living settings that provide care for seniors
Adults 70 years of age and older, beginning with adults 80 years of age and older, then decreasing the age limit by five-year increments to age 70 years as supply becomes available
Health care workers (including all those who work in health care settings and personal support workers whose work involves direct contact with patients)
Adults in Indigenous communities where infection can have disproportionate consequences
NACI believes the second stage of immunizations in Canada should include:
Health care workers not included in the initial rollout
Residents and staff of all other congregate settings (e.g., quarters for migrant workers, correctional facilities, homeless shelters)
Essential workers (e.g., police, firefighters, food production)
Each provincial and territorial government is ultimately responsible for deciding how their allocated vaccine doses will be distributed, including considerations about areas of highest risk on a local level, but they are all working within these general NACI guidelines.
As vaccines begin to be delivered and administered across Canada, some people are calling for more clarity on where certain groups of people fall in vaccine prioritization and how long these individuals will have to wait to be vaccinated.
Canadians living with dementia and their caregivers
Dr. Saskia Sivananthan, chief research & KTE officer at the Alzheimer Society of Canada told Yahoo Canada that not only should people with dementia be prioritized to receive a COVID-19 vaccine, but their caregivers should be as well.
“Just like we prioritize healthcare and frontline staff at hospitals and long-term care, and we do that because we know they're working directly one-on-one with residents or with patients, caregivers are working one-on-one,” Dr. Sivananthan said. “[They] are basically the only support system right now for people living with dementia in the community so they absolutely should be prioritized.”
Older seniors are on the NACI prioritization list and provincial vaccine rollout plans, but there have not been any specific considerations made for people who live with dementia, which Dr. Sivananthan indicated is a “big issue.”
“The dementia itself puts them at higher risk biologically,” she explained. “Most people who have dementia don't just have dementia, they have a whole bunch of other underlying chronic diseases, and the dementia makes it harder to manage those other diseases.”
She explained that about two-thirds of residents in long-term care facilities have dementia. These residents are set to be prioritized for vaccines across Canada, particularly now that the Moderna vaccine has been approved, which can be brought to long-term care facilities.
“If you're taking residents who have more moderate to late stage dementia, moving them out of their home, long term care is their home,...you're trying to move them to a different site to get the vaccine and they have to keep masks on, they have to not touch things,...that's going to be incredibly tough,” Dr. Sivananthan said.
As long-term care facilities began implementing restrictions on who could enter these homes at various points in the pandemic, that lack of interaction impacted the cognitive decline of these individuals with dementia. Their caregivers also perform essential roles in these settings, including helping with feeding and changing.
“Here's where that switch in thinking needs to happen, it’s that they're not just going in and visiting loved ones in long-term care, they're going in and they have a role in that caring, they are part of that team with the long-term care staff,” she said.
Not all dementia patients are in long-term care
Although many residents in long-term care have dementia, there are still many Canadians with dementia who live in the community.
“The first misconception of ideas is that people living with dementia, as dementia gets progressive, that everyone ends up in long-term care, and that's not the case,” Dr. Sivananthan explained. “The vast majority of people living with dementia actually do remain in the community, because they have family and they have caregivers, but they also have additional support.”
“Because they have dementia, it's harder for them to follow the...rules and regulations. It would be harder to get someone with dementia to keep a mask on the whole time, to wear gloves and wash their hands frequently.”
There are supports to people in the community living with dementia, including counselling services and day programs, but Dr. Sivananthan stressed that when the COVID-19 pandemic hit many of these services were cut off, leaving these caregivers “completely isolated.”
“We are getting distress calls from caregivers who are at the end of their rope,” she revealed. “They have no breaks, they have no breathing space because it's 24 hours, seven days a week.”
Teachers across Canada
The Canadian Teachers' Federation has called on governments to ensure that teachers are prioritized for COVID-19 vaccinations, specifically requesting to be immunized after vulnerable populations, healthcare workers and first responders.
“We believe that it's important for teachers to be on the priority list after those groups of people because teachers come into close contact with students and other adults throughout the day,” president of the Canadian Teachers’ Federation, Shelley L. Morse, told Yahoo Canada. “We're in schools with hundreds of people and even if our schools tried to maintain physical distancing, the fact is that there isn't enough room in a classroom with all of the desks in there for proper distancing.”
Both international and domestic resources for guidelines to follow to limit the spread of COVID-19 include physical distancing, wearing a mask when a safe distance cannot be maintained, limiting close contacts and avoiding spaces with inadequately ventilation.
“When the World Health Organization gives that description of how to reduce their risk of transmission, what they're describing is what teachers are in everyday in their classrooms and their schools,” Morse said. “Most schools are poorly ventilated, we can't properly distance [and] masks aren't mandatory all across Canada in all classrooms.”
Many jurisdictions, including Ontario, committed to trying to maintain in-class learning, as much as possible. At the same time, there has been little concrete guidance on when in the vaccination process teachers can expect to be immunized.
“If we're going to keep the schools open then why aren't we making sure that there is minimal risk,” Morse said. “We have a different standard in public than we have in our school buildings and when you think about how many students, how many people are in a school building all day long without proper ventilation, there's a huge risk.”
Morse added that Canada’s biggest population of students are in elementary schools and the COVID-19 vaccines currently approved are not authorized for use in children yet. The Pfizer-BioNTech vaccine is approved for use in individuals 16 years of age and older, and the Moderna vaccine is only approved for use in adults, 18 and older.
“If we have all of those people that we work with who cannot have the vaccine, that puts us teachers and education workers at a higher risk as well,” Morse said. “One less person posing a risk makes it better for schools and classrooms, and keeping our schools open.”
