Trust, transparency key for Manitobans to accept decisions on who gets vaccine first: experts
Government must be clear and consistent when explaining why certain groups are chosen over others
Once a COVID-19 vaccine is approved in Canada, provincial health leaders face the difficult choice of who should get it first.
Health experts say those choices will likely leave some people feeling dissatisfied, but convincing them to accept the priority list depends on getting them to trust the decision-making process.
"They need to be communicating it with as much transparency as possible," said Michelle Driedger, a professor in the department of community health sciences at the University of Manitoba.
While the federal government is in charge of acquiring the vaccine, the provinces have the responsibility of deciding how to get it into people's arms.
There will be differences in the execution of the immunization campaign because provinces have different challenges and resources, but there should be no variation in who gets priority access to the first doses, said Françoise Baylis, a medical ethics researcher at Dalhousie University.
"I truly believe if we cannot do that, we will undermine the trust that we need to deal with this public health crisis," she said.
No vaccine has yet been approved for use in Canada, but once that happens, the country is expected to receive enough vaccine doses for roughly three million people within the first three months of 2021.
On Friday, the National Advisory Committee on Immunization — the federal committee tasked with planning the rollout of the vaccine across the country — recommended that residents and staff in long-term care homes should get the first doses, followed by all Canadians over the age of 80.
The government of Manitoba has created a task force to plan for the immunization campaign here, which is "currently working with federal, provincial and territorial counterparts on priorities for COVID-19 vaccination," a spokesperson for the provincial government said in a statement.
It's guided by the national committee's "recently-released recommendations on key populations, and our previous experiences with pandemic response and vaccination campaigns," the spokesperson said.
Manitoba has enough supplies to administer two doses of the vaccine to every resident, Premier Brian Pallister said this week. A freezer capable of storing vaccines at extremely low temperatures — a requirement for the vaccine from Pfizer, one of the front-runners for approval — has been delivered and installed, with another four on the way, he said. Together they can hold about one million doses of vaccine.
The province has purchased 20 portable ultra-cold freezers so that, as the vaccine supply from the federal government expands over the coming months, it can be stored and made widely available.
What about Indigenous people?
After long-term care residents and seniors have been vaccinated, the federal advisory committee recommends that front-line health workers get it next, followed by people living in remote Indigenous communities.
That last recommendation led Manitoba Premier Brian Pallister to question who is responsible for getting the vaccine to those communities.
On Thursday, Pallister said the federal government planned to hold back a portion of Manitoba's allotment of vaccines for First Nations, which he claimed would leave Manitoba with fewer doses for the rest of its population compared to other provinces, due to the higher proportion of First Nations people in the province.
"We need the federal government to recognize our unique needs here by providing an additional allocation of vaccines for Manitobans to use in First Nations communities first ... because this is their constitutional responsibility," he said.
WATCH | Pallister calls on feds to provide extra vaccine doses for First Nations:
Driedger says Pallister's concerns don't take into account the many Métis communities that exist alongside many First Nations.
"Particularly in the more remote northern or remote and isolated communities … in many instances, you'll have a First Nations reserve and you'll have Métis communities in very close proximity," she said.
"Those Métis citizens are experiencing much of the same kinds of socioeconomic and other barriers to access."
Clarity, consistency foster trust
Whoever governments ultimately choose to receive the first vaccine doses, the list of early recipients needs to be consistent across the country, "so that Canadians are not being treated differently by virtue of geography," Baylis said.
"What we're looking at here … is a commitment to justice, a commitment to minimizing harm, a desire to build trust amongst Canadians," she said.
Federal, provincial and territorial leaders will need to sit down and come to an agreement about who gets the vaccine first. That decision needs to be based on solid scientific and ethical reasons, and those reasons need to be clearly communicated to the public, she said.
In Canada, a commonly used framework for making decisions about vaccine programs was developed in 2004 by three researchers at the University of Montreal.
In addition to practical considerations about the cost and feasibility of developing a vaccine, the framework lists a number of questions that decision makers must answer regarding issues of equity and ethics.
It asks, for example, whether the program is "equitable in terms of accessibility of the vaccine for all target groups" — including the most vulnerable populations.
Research has shown that being clear about why certain groups have received priority over others goes a long way to reducing conflict over the decision, Driedger said.
"Even if they're not happy with the ultimate decision, as long as they understand the process and they have confidence that the process is being done fairly, then for the most part, people can accept that," she said.
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