Jen Gerson: And another thing...
I woke up angry: on vaccine supply issues, and why I am too young to get the AstraZeneca jab.
I woke up Friday morning still feeling agitated — which doesn't usually happen to me on a column day because by that point in the week, I have usually purged my soul with word fire. And yet, I woke up, drank my tea and realized that I was still bothered. I still have some things to say about our country and vaccines.
So I've decided to pop off this quick addendum to Friday’s column to address all of the things that are still angering me.
1) Blame Shifting
The last few weeks have been rife with various levels of government blaming each other for lack of timely vaccine roll out. As citizens are already rightly livid with their provincial governments and, bizarrely, eager to give their federal one a pass, a kind of myth has taken hold that the provinces are sitting on loads of vaccines in freezers while the federal government provides ample supply.
The data just doesn't back that up, and this Twitter thread explains why.
Andrew Morris @ASPphysicianThere are currently 1.2M doses in freezers. There was roughly 700K yesterday. Vaccine clinics all over the GTA are claiming they have no access to vaccine. Something isn't adding up. This is not "we just got our supply". Someone needs to be accountable. https://t.co/FBkI0sfpJT
The vaccination campaign in some places has been confusing and chaotic, and there’s anecdotal evidence that vaccine hesitancy may be a factor slowing uptake, certainly. There are two problems, here: supply issues, and administration issues — and they’re two different sets of problems with different proximal causes.
Calgary economist, and national treasure, Trevor Tombe's own analysis also underscores this very point.
Our supply isn't arriving in one smooth wave, but rather in fits and starts — which sometimes gives the impression of large vats of unused vaccine. That is, until we work our way through those shipments over the course of a few days. But as you can see from the chart above, all of the provinces are distributing their vaccine supply at about the same pace; further, our rolling stock is roughly in line with international averages. What this tells us is that each of the provinces is doing roughly the same job getting the vaccines they have into what arms are willing to take them.
Ontario is a sinking ship at the moment, with critical leaks port, starboard and bow; but as a country, the limiting factors hampering vaccination efforts are vaccine hesitancy, and a late and limited supply.
I mean, come on guys; only three months ago, Canada was roundly condemned for dipping into a vaccines intended for the developing world.
We've spaced out two-dose vaccines from three weeks to four months. You don't have to be on the right-hand side of the bell curve to figure out that this is a desperate, and highly experimental, gambit to stretch a critical shortage of vaccine supply, which is a federal purview. The National Advisory Committee on Immunization has said so explicitly, even suggesting that we will likely reduce the four-month delay to something closer to the manufacturer’s recommendation as more vaccine becomes available.
I'm not saying that this decision was necessarily a bad call — it makes perfect mathematical sense to ensure more people are at least partially vaccinated in the short term. But you can't argue with a straight face that this is ideal.
2) Mashing the Panic Button
OK, so we have to manage a vaccine supply that is trickling in. What we have received so far has overwhelmingly gone to the most vulnerable Canadians (ie; older Canadians). Meanwhile, we're now seeing a surging number of COVID-19 cases. The median age of cases appears to be about 35. So our public-health authorities are responding with the only lever they seem to know how to pull — the panic lever.
We wrote a dispatch about this point last week, but it's not a coincidence that we are now being inundated with headlines warning about young people entering ICUs in droves with far more dangerous COVID-19 variants.
A lot of other context is also being glossed over. For example, we would expect the average age of ICU patients to skew younger in a scenario in which the elderly have been vaccinated and case rates are spiking among the younger population. A shifting average age profile is a predictable artifact of the success of our early targeted vaccination efforts. (Vaccines work!)
Secondly, looking at the locations of outbreaks, and the median age of the victims, I don't think it's a stretch to point out that a lot of the spread among the young is concentrated among essential workers. Blame shifting to young people who are vulnerable to COVID-19 due to work conditions they cannot control is a deflection for government failures, and a morally reprehensible one at that.
Thirdly, these stories often omit co-morbidities. We have long known that even young people with co-morbidities like diabetes and other chronic conditions like asthma seem to be particularly vulnerable to the virus. I’ll take a moment to point out that pregnant women also seem to be hitting the ICUs in droves, and considering pregnancy is its own metabolic disorder, this tracks. If you’re packing baby, get thee to a pharmacy.
Ugly odds will dictate that a few very unlucky individuals are going to get hit. It's not a risk worth messing around with, certainly, so stay home. However, this virus does not appear to be particularly dangerous to most healthy young people who get it.
And the problem with hitting the panic button this hard this often is that it's now impossible to communicate nuance and relative risk — which undermines public-health’s ability to explain the concerns (or lack thereof) with the vaccines they hope to inevitably stick into everybody's arms. Think about this: if COVID-19 variants are so incredibly dangerous to all young people, then how can the NACI justify continuing to recommend AstraZeneca only to those over the age of 55, despite the marginal risk profile of that vaccine? (Nick Kadysh recently made this point at The Line.)
3) And Why Can't I Get AstraZeneca?
And here comes the real zinger. As has already been pointed out, the risk of the vaccine is tiny compared to the risk that most young women accept every day when they pop a birth control pill. We are well into the territory of informed consent. Hell, I'd gobble that vaccine tomorrow if I could — but I can't.
I'm going to speculate here and note that the 55+ age recommendations on AstraZeneca laid out by the NACI seem to be as much about relative risk as they are about vaccine supply. If you open the gates to a larger pool of potential recipients by lowering the age cut off, our supply issues are going to become increasingly obvious.
There’s no point rushing to ease eligibility requirements if you can't supply that younger, lower-risk population anyway. So several weeks ago, the 55+ recommendation was a logical response to emerging reports of rare blood clot disorders: older people had a lower probability of developing these clots, and a much higher probability of suffering serious complications from COVID-19. So it made perfect sense to prioritize AstraZeneca for older Canadians, and then ask younger Canadians to wait for the (presumably) lower-risk mRNA vaccines until they landed.
That is — until enough older people get so spooked by AstraZeneca that we started hearing stories of cancelled vaccine appointments, and doses potentially going to waste. Over the last week, according to the scuttlebutt, the provinces have been asking the NACI to lower the age eligibility to younger Canadians, fearing the vaccines we do have will expire for lack of use.
No surprise then: Over the weekend, federal Health Minister Patty Hajdu passed the buck, noting that the provinces were free to immunize whomever they wanted, and that Health Canada had licensed AstraZeneca for everyone over the age of 18.
“NACI provides advice to provinces and territories,” she said. “They can adjust their use for AstraZeneca as per their desire and the advice from their own public-health authorities and medical expertise.”
Ontario is now planning to do exactly that by lowering the age requirement to anyone over 40 while the NACI continues to dither over the official recommendation. Late on Sunday, Alberta said it would do the same.
And if anyone is wondering what the purpose of a National Advisory Committee on Immunization is if the provinces should just be making their own damn decisions in accordance with Health Canada’s approval regardless of NACI’s guidelines, the answer is: yes.
Is everyone having fun yet? Do you, too, hear the sound of Yakety Sax playing in the background? The best part is that all this confusion and blame shifting is only going to further contribute to the fears already metastasizing about the safety of AstraZeneca.
Meanwhile, my Twitter feed is filled with Liberals trying reframe Ls into Ws with statements like this:
Look, a “diversified portfolio” of entirely hypothetical vaccines that will arrive sometime between now and whenever is worth exactly nothing to a country that needed to have jabs in arms last month. The only metric of success that any federal Liberal ought to be worried about right now is: “how much safe and effective vaccine can we deliver?” and “how quickly?” Nobody cares whether we are purchasing that supply from one company, or 300. We’re not trying to stage a deadlier version of It’s a Small World, here. The diversification of our vaccine portfolio is not a relevant metric: all any normal person cares about is putting shots in arms and getting back to normal.
By the same measure, I also don’t care how much we have to pay for that vaccine. We’ve already spent hundreds of billions on COVID-19 recovery and relief, and every month that the crisis continues, the more expensive it becomes. In that light, I am struggling to give even the tiniest bit of shit about whether we paid $4 per dose of AstraZeneca, $8 or $15. Let Big Pharma bilk us! We’re a rich country. Being a rich country has benefits — we can afford to pay exorbitant rates to be at the front of the line for a limited supply of a drug we can’t make at home.
5) The Comms Problem
The politics of this have created a disastrously perverse incentive for Liberal communicators, and their political adjacencies. One in which they inadvertently undermine the effectiveness of the vaccines that they did not deliver sooner. (See Friday’s column for a galling example of this.)
We can't rely on vaccines to get us out of this wave of COVID-19 because the Liberals were unable to procure large supplies of vaccine quickly enough to prevent this wave of COVID-19. And given our lack of domestic capacity to make these things, maybe that outcome was always inevitable. Fine. But don't cover for that fact with misleading communications that make the vaccines look inadequate. The vaccines are not the problem.
All anyone can ask of our authorities right now is that they be straight with us. If the truth is: "Look, we are a middle-of-the-pack country unable to procure enough vaccine to avoid a third wave. So we all need to hunker down for a few more weeks because we’ve been unable to expand our ICU capacity significantly over the past year, for some reason. We'll all have a vaccine soon, and, yeah, it sucks that we're watching the U.K. and the U.S. get back to normal so quickly, but we're doing the best we can."
Well then, so be it.
But once you start warping reality to cover for our manifold failures, the effects of that communications-based ass covering will inevitably compound. This isn't politics as normal. The outcome of this kind of gamesmanship risks vaccine hesitancy and fear even as we do, eventually, come into the supply that we so desperately need to end this pandemic.
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