COVID-19: Who should get vaccinated first and why?

An expert in health spending explains three factors considered when deciding who is at the front of the line.

The Government of Alberta has announced a timeline for a multi-phase rollout of a COVID-19 vaccine.

Aside from the challenging logistics of distributing and administering millions of doses of the vaccine across the province, the ethical dilemma of who gets vaccinated first was also considered. 

Dev Menon, a professor in the School of Public Health, is an expert in the field of health technology assessment. He advises governments on how best to invest limited resources to see the greatest return of health benefits for Canadians. 

Menon explained there are some key factors that would have been considered when deciding which Albertans will receive priority access to the COVID-19 vaccination. 

1.  The reason for vaccination

Menon says there needs to be a clear purpose for vaccinating people. A goal to reduce infections, versus a goal to improve the economy by safely allowing all businesses to resume at capacity would have different priority groups at the front of the line. 

“Assuming the objective is to reduce the number of infections, those who are in situations that make them prone to contracting the virus and spreading it could be considered a priority group.”

Health workers, for example, would be a top priority. “Airplane safety directions of putting your own mask on first before attempting to help others is an analogy that applies here,” said Menon. 

Other priority groups could include Albertans in long term care, those who are forcibly confined, those experiencing homelessness and others in housing situations that prevent isolating if necessary. 

2.  The values we hold as a society

Menon acknowledges that there will be some who disagree with priority decisions based on their own values, preferences and beliefs. But, generally, as a society we share values such as wanting our elderly to be well cared for and wanting to protect those at greater risk. 

“Social values are important when deciding who has priority,” explained Menon. “We must balance resources with society’s preferences for quality of life.”

3.  The trade-offs

Decisions are made weighing the financial cost of resources and the human cost of one population or illness being prioritized over another. 

“Health care dollars are limited, but the need to vaccinate Albertans against COVID-19 is great,” Menon said.

Deciding to invest in a vaccine and vaccination programs will trigger a corresponding decision to not invest in something else. “It’s one or the other.” 

Dev Menon is the senior advisor to the Health Technology and Policy Unit in the School of Public Health, supporting the Government of Alberta in making health technology decisions. He also co-leads Promoting Rare-Disease Innovations through Sustainable Mechanisms (PRISM), consulting citizens to understand society's values and preferences for investing in rare diseases.

He was awarded the Dr. Jill M. Sanders Award of Excellence from the Canadian Agency for Drugs and Technologies in Health for his many contributions to establishing the field of health technology assessment in Canada.


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