Manitoba, B.C. vaccination strategies include plans for health-care workers left out in Sask.'s Phase 1

The Saskatchewan government's vaccination plan has similarities to plans released in B.C. and Manitoba, but some distinct differences as well.

Both B.C. and Manitoba are organizing their vaccinations by age. But unlike Saskatchewan, they plan to expand vaccination to wider groups of health-care workers in March.

Saskatchewan's plan leaves many health-care workers out of Phase 1 of its plan. They'll have to wait until they are eligible according to their age.

Premier Scott Moe has said the path out of the pandemic is through vaccination, but the path has been bumpy, due to a lack of vaccine supply and questions about the vaccine delivery plan.

The province announced Tuesday its second phase of vaccinations, which it will organize by age, starting with those 60 to 69. 

Others who will be part of the initial vaccinations include adults and staff in group homes for people with intellectual disabilities and shelters, and extremely clinically vulnerable adults.

Phase 2 will continue with vaccinations for people age 50 to 59, moving down in 10-year increments.

The current plan does not include priority exceptions for a wide variety of health-care workers who are not covered by Phase 1 vaccinations, or other groups who have lobbied to be included on a priority basis, such as police and teachers.

"I've heard over the course of the last while some concerns from a number of health-care workers about not being part of the Phase 2 sequencing," Moe said Thursday.

"Our officials are now working on any revisions that may be necessary to potentially include some additional categories of health-care workers in Phase 1."

Changes from 'planning document'

The plan released Tuesday differs from one shared at a Saskatchewan Health Authority town hall meeting with physicians in January.

On Wednesday, Health Minister Paul Merriman called the slides shared during that presentation "a planning document." 

Merriman said the government did not believe "micro-targeting" certain groups for priority vaccination was the best course.

The document shared on Jan. 14 included vaccination three stages for the second round of vaccination — Phases 2a, 2b, and 2c.

Phase 2a included home-care providers, vaccination team members and vulnerable populations, like residents and staff in non-federally regulated correctional centres.

Phase 2b included physicians, registered nurses and licensed practical nurses, dentists and pharmacists. 

Phase 2c indicated "outreach as general population rollout."

Moe did not say who made the final decision or why the government presented one plan to physicians, only to present an entirely revised one to the public Tuesday.

The reaction to the updated plan has been swift, from both the Saskatchewan Medical Association, which represents 2,600 physicians, and the Saskatchewan Union of Nurses, which represents 10,000 registered nurses.

"Working non-stop since March of 2020, the beginning of the pandemic, to find out that we're no longer a priority on the vaccination list is unacceptable," Saskatchewan Union of Nurses president Tracy Zambory said.

The medical association's president, Barb Konstantynowicz, said vaccinating those at highest risk of illness and death is important, but so is protecting health-care system capacity by vaccinating workers. That's been recognized across Canada and internationally, she said.

"Patients can't get the care they need if health-care workers are quarantining. Our health system is strained as it is," she said.

Vaccine shortages prompted changes: SHA

A Saskatchewan Health Authority official said the changes were prompted by vaccine supply shortages.

"All of our planning to date is entirely dependent upon vaccine supply," the official said.

Saskatchewan Chief Medical Health Officer Saqib Shahab defended the plan.

"If you get into too many variables, it becomes very hard to figure out if you should go now or later," he said.

"At the end of the day, with the supplies we have, I think the biggest impact is moving down based on age. Obviously, it's not an easy decision.

"But where are you getting the most impact out of your vaccine right now with constrained supplies? It really is based on age."

More than 88 per cent of all COVID-19 deaths in Saskatchewan have been people age 60 and over.

Shahab said as vaccine supply increases, "other considerations will have to be looked at very closely."

The initial goal is to prevent the "worst outcomes" over the spring and into summer, which means preventing hospitalizations and deaths, he said.

Moe said that even if more health-care workers are included in Phase 1, that wouldn't mean those left out will get any priority in Phase 2.

"There are going to be a number of folks in the health-care sector that are going to be under the mass vaccination age priority," he said.

On Tuesday, public health physician Dr. Cory Neudorf called the distribution plan "clear and transparent."

"I think the age-based approach ... really fits with their goal of wanting to protect the most vulnerable and those at highest risk," said Neudorf, an epidemiology professor at the University of Saskatchewan.

It also fits with the goal of preventing "that serious illness and death that's going to end up causing the most serious impact on people of Saskatchewan, and also on the health-care system."

Strategies vary across Western Canada

One of the criticisms of the Saskatchewan plan is that it does not mirror the guidelines from the National Advisory Committee on Immunizations.

The NACI recommended the initial doses of vaccine go to:

• Residents and staff of congregate living settings that provide care for seniors.
• Adults 70 and older, beginning with adults 80 and older, decreasing by five-year increments to age 70, 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.

The guidelines are not requirements, and provinces are making their own decisions on who to vaccinate and when, while all are dealing with the same unpredictable and slower-than-expected supply of vaccine.

The Saskatchewan government's vaccine delivery page indicates Shahab reviewed the NACI guidelines and "modified them for Saskatchewan's demographics and logistical requirements."

Alberta is currently vaccinating priority groups similar to Saskatchewan, but has yet to unveil its mass vaccination rollout. A provincial government website says Alberta will "continue targeting populations at risk" from April to September. Its most recent timeline for mass vaccinations is fall 2021.

Last month, British Columbia was the first to announce its plan.

Like Saskatchewan, its initial phase prioritizes residents and staff in long-term care, those living in remote Indigenous communities, and health-care workers dealing with COVID-19-positive patients.

The plan expands to include members of the public age 60 to 79 beginning in April.

Its fourth phase for general public vaccinations, including those aged 18 to 59, is not forecast to start until July.

"I receive mail a couple of inches thick from advocates saying their particular sector … deserved a higher priority," B.C. Premier John Horgan said on Jan. 22.

"All of the arguments were very compelling. But the science is pretty clear ... age is the dominant determinant factor on severe illness and death."

B.C. plans to expand immunizations to hospital staff, community general practitioners and medical specialists not covered in its initial phase.

Manitoba's plan also moves in 10-year increments. It has targeted April 1 as the start date for people age 60 to 69. 

Under the province's plan, only front-line health-care workers providing direct patient care in high-risk settings, like critical care units, residents and staff of personal care homes, and people at risk living in First Nations communities are getting shots for now.

Both Manitoba and B.C. have said they may add essential workers to earlier phases if vaccine supply increases.