Head Tale

Today we announced the expansion of our #COVID19SK vaccine delivery plan to target remaining healthcare workers, first responders and staff working in pharmacies and grocery facilities.

You can learn more by visiting https://t.co/2EjdJrzTzt. pic.twitter.com/LdX5fhA1JY

— Government of Saskatchewan (@SKGov) April 12, 2021

There has been a lot of debate about the most effective order of vaccination roll-out and how to balance the need to vaccinate to prevent death (mostly older people) and to prevent spread (basically, people working in settings where they might have a higher risk of exposure for various reasons – can’t avoid close contact, work in a maskless environment, prolonged exposure, etc.)

In many ways, it’s a debate about vaccinating those living in a long-term healthcare facility (who are at great risk because of their advanced age) and the people who work in a long-term health care facility (who are more at risk of spreading the virus as they move around in their day-to-day lives when not at work.)

Of course, in that example, it’s not one or the other as the obvious best solution is to vaccinate residents and workers to minimize both death and risk of spread.

But how does that translate into the larger world where vaccine supplies are limited and different groups have different arguments for why they should be vaccinated earlier than others?

With a few exceptions for healthcare workers (but not all, only those considered “Phase One” which doesn’t even include everyone working in hospitals) and people who are considered medically fragile, Saskatchewan otherwise chose to initially use a straight age-based vaccination plan – starting with people who were 80+ and working downwards.

This is the easiest solution but I’m not convinced it was the best as it fails to take into account such nonsensical situations as a retiree who is 65 and more than capable of staying home getting vaccinated ahead of a 55 year old grocery clerk who may not be considered medically fragile but might be more at risk because they’re overweight and is more likely to be exposed to Covid than the retiree.  Or a 62 year old union rep who is working from home getting vaccinated over the 42 year old bus driver they represent who’s been going to work every day without a break for over a year.  Or a nurse who might be working with Covid+ patients normally so gets vaccinated because of where her home position is even though she’s on maternity leave but the person who is the same age and works 12-hour days at the Robin’s Donuts on a hospital’s main floor doesn’t qualify.

How Saskatchewan’s appointment system works is you enter your health card and birth date and that’s how they screen for age only – again, simple and easy.

And Saskatchewan has recently started to open up vaccinations more to other essential workers including teachers and others.

But if I was king of the world, I’d have a few more criteria to winnow down who qualifies in a more granular fashion to assist with the decision-making given limited vaccine supplies.  I’d have the form designed to screen for a few additional factors besides age to see if you qualify for early vaccination or not:

• if you’re at an elevated risk due to multiple factors (eg. everyone who works in a hospital, corrections officers)
• if you interact with a large number of people in a day (teachers, retail workers)
• if you work in a environment where clients are often maskless (dental offices, early childhood educators, restaurant workers)
• if you work in a place where its hard to social distance (factories, transit including taxis, airlines, and buses)
• if you’re a first responder and/or regularly work with people in crisis (EMT, fire fighters, police, social workers)

On the other hand, my system would make it clear that people who are able to stay at home/work from home would either be considered a lower priority (or maybe could opt to *be* a lower priority and “donate” their spot to someone who does fit the criteria?)

At any rate, I’m mostly spitballing as a layperson but again, if I was the king of the world, I would let medical and scientific experts develop a priority list using mathematical models and in complete transparency.  I would remove all politicians from the decision-making (see early criticism of Premier Scott Moe whose hometown just happened to be given early doses.  Did they have an outbreak?  Yes.  Did it look like a conflict, especially when other towns who’d also had outbreaks didn’t get special treatment?  Yes again. Same thing when he was one of the last age groups to get vaccinated at the drive-thru clinic before vaccines ran out then many people ended up going out of town for vaccinations.)

I might even try to include weighting within categories – a nurse on an ICU ward would get weighted more heavily than a nurse in a hospital but who doesn’t regularly interact with Covid + patients who would get weighted more heavily than a nurse who is able to work from home.). One report I saw said staff in a dentist office were one of the highest risk groups overall so maybe they get more weighting than others who might also work with clients who go maskless?

Maybe to prevent people lying on their vaccination application since more categories means more grey areas instead of pure birthdate which is pretty hard to lie about, you would do random audits of people wanting to get vaccinated.  Or require proof when they show up that they fit in one of the identified categories.

Oh, and finally, I’d find a way to make this less of a car-based process – there are numerous people who simply can’t get to a drive-thru vaccination clinic because, duh, they don’t have a car! So I’d make sure there were options for people who don’t have vehicles (and if there are, I’d make sure they are well-publicized as I don’t remember hearing anything about them myself.).

And as much as I hate to say it, library workers would likely not be a high priority by any math (though, if libraries are open, they’re very similar risk factors to places like grocery stores, retail outlets, and occasionally, places where it is hard to social distance.)