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TORONTO – When the first doses of COVID-19 vaccines finally arrive in Canada, the country will face a number of tough questions that ethics experts fear we haven’t spent enough time to answer.
For example, which groups should get vaccinated after the most vulnerable? How long will it take everyone to get their photo? And what happens if a person refuses to be vaccinated?
Time is running out to answer these questions. Pfizer’s vaccine candidate, which is more than 90 percent effective according to the company’s preliminary results, could be approved for use in Canada before Christmas, according to Health Canada’s chief medical consultant.
Kerry Bowman, a bioethics and assistant professor at the University of Toronto’s medical school, said the lack of clarity on a number of key issues involving Canada’s launch is “starting to make people very anxious.”
“Because we don’t have a clear plan yet. Or if we do, it’s not available and transparent to most Canadians,” Bowman told CTV News.
WHO GETS VACCINATED FIRST?
Federal health authorities have not released a complete list of which order the vaccine will be delivered to. For now, four key groups have been given priority to receive the vaccine, according to the recommendations of the National Advisory Committee on Immunization.
These groups include those at risk of serious illness and death (such as the elderly or those with pre-existing conditions), essential workers who are most likely to transmit the disease (such as health care workers), those at risk living in communities that they may experience disproportionate consequences (such as isolated indigenous communities) and other workers providing services that contribute to the “functioning of society”.
The committee deliberately left these definitions broad so that policymakers charged with charting provincial roll-outs could define them as they see fit.
But after those groups, who comes next?
Research suggests racialized Canadians are at a greater risk than white Canadians of having pre-existing conditions that could put them at risk for serious COVID-19 outcomes.
Employers whose businesses have been sidelined due to COVID-19 will also be among those most eager to get vaccinated. A recent Statistics Canada survey suggested that 5% of companies were actively considering bankruptcy or closure this fall. Anxieties are highest among the arts, entertainment and hospitality sectors, with nearly 30% worried that they will have to resort to layoffs, bankruptcy or closure within six months.
Whatever happens, there will inevitably be a period of time in 2021 when the limited supply of vaccines will create a society of rich and poor. Those months will be busy, says Alison Thompson, a University of Toronto ethicist.
“This is very troubling because then we have a society that is really a two-tier society that is based on some sort of biological foundation,” he said.
CAN YOU REFUSE THE VACCINE?
It is impossible for anyone to be forced to take the COVID-19 vaccine once it is available. But the rejection could have real-life consequences.
“People who don’t want the vaccine, we all know, have the absolute right not to have it. I mean, it’s their bodies without a doubt, “Bowman said.” But that’s an ethical concern because what is likely to happen to people within that group is that more and more opportunities may be slowly being excluded. “
For example, people who are not vaccinated may not return to the workplace or may face other restrictions involving group meetings.
To make things more complicated, the vaccine will not be readily available to certain groups. Pregnant women and children, who are not involved in clinical trials of experimental vaccines, will be excluded from vaccination until more clinical trial data are available.
This exemption can be cumbersome, but it’s standard in this type of evidence for security reasons, Thompson said.
“Pregnant women are often excluded from clinical trials of many pharmaceutical products, including vaccines, due to the risk to the fetus they carry and to their own health,” she said.
PASSPORTS OF IMMUNITY?
The idea of ”immunity passports” was launched early in the pandemic as some governments expressed optimism that people who recovered from COVID-19 and tested positive for anti-virus antibodies could have more freedom to travel or return to work.
However, the World Health Organization rejected the idea, saying there was still not enough evidence on the efficacy or longevity of immunity through antibodies.
Vaccines may give new attention to the notion of “immunity passports” – a possibility that Thompson says needs to be carefully managed.
“I think we have to think very carefully about how we use people’s immune status to guarantee them access to work and travel and things like that,” he said.
WHAT HAPPENS IF SOMEONE SUFFERS SIDE EFFECTS?
All vaccines currently under study are tested for both their efficacy and safety. Before reaching the general public, Health Canada must approve that the vaccine is safe enough for public use. Even so, there is a possibility that some individuals may experience long-term side effects from a COVID-19 vaccine, Bowman said. It is simply too early to know for sure.
“I’ve never heard of a vaccine that is 100% bulletproof and I don’t think this will be any different.”
However, he added: “It all looks very good so far.”
In the event that anyone suffers from the negative side effects of the vaccine, some advocates believe they should be compensated financially. At least 19 countries already have programs in place that compensate people injured by vaccines, but Canada does not, with the exception of Quebec.
Thompson said it’s time for Canada to consider its national compensation program.
“There are things we can do on the part of the government to really help people see (vaccines) as more reliable,” he said, pointing to such a program.
CAN YOU CHOOSE WHICH VACCINE YOU WANT?
With several vaccine candidates in the race to be approved first, with Pfizer and Moderna leading the pack, it is possible that Canada may have several vaccines on the market in 2021. However, experts told CTVNews.ca last week that there they are health benefits. to receive more than one type of vaccine. When it comes to personal choice, Canadians are unlikely to have the option of choosing which vaccine they want.
“I suspect the choice won’t be a problem when the vaccines arrive in Canada. There will be a strategy to launch vaccination, prioritizing the most vulnerable and frontline workers, ”said Dr. Eleanor Fish, a professor of immunology at the University of Toronto.
Faced with so many looming questions, Bowman said it’s important to “get it right”.
“Much of the vaccine distribution is ethically related now,” he said. “It will be a challenge.”
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