Neighbourhoods — not lottery — should decide who gets COVID vaccine, experts say

A vaccine lottery like the rollout in Hamilton for seniors inevitably puts the wrong people in line first, warns Ontario's COVID-19 Science Table.

Those who need it least are more likely to get the vaccine first," said Dr. Peter Juni, one of the authors of a science brief calling on vaccine rollouts to instead prioritize neighbourhoods as well as age.

The problem ... is that if you just leave it to randomness it won't be randomness," he said. Those who have higher socioeconomic status and better education typically come first."

More than 5,600 Hamilton seniors age 85 and over have registered so far for vaccination, which started Monday. Who gets the coveted 250 spots a day at the vaccination clinic at the West 5th Campus of St. Joseph's Healthcare is chosen randomly. There are also a further 200 spots at roving community clinics.

Hamilton Public Health Services didn't answer questions about why it chose the lottery despite the Science Table's advisory on Feb. 26.

Instead, the city is running mobile pop-up vaccination clinics Thursday and Friday for seniors who are clients of Compass Community Health Centre, Urban Core or Centre de Sante.

Community health centres are specifically geared to providing primary care to vulnerable populations, such as community members without a family doctor, newcomers to our community, and others who face barriers such as language, culture, physical disabilities, homelessness and poverty," public health said in a statement. Appointments were booked through outreach by the participating community health centres."

Juni said it's not difficult to prioritize neighbourhoods and the difference it makes can be staggering.

The Science Table estimates nearly 18 per cent more hospital admissions can be prevented when neighbourhoods as well as age are taken into account in vaccine rollouts. It also predicts 10 per cent more deaths prevented and nearly 20 per cent more intensive-care unit admissions (ICU) prevented.

This vaccine strategy will maximize the prevention of deaths and long-term morbidity, and best maintain health-care system capacity ... as compared with a strategy that prioritizes vaccination based on age alone," states the brief.

The NDP is also calling for neighbourhoods to be prioritized, saying in a statement that sending vaccines into those hardest-hit communities can help stop the spread and save more lives."

Countries like Canada that don't have as much supply have to vaccinate as smart as we can," said Juni, who is a Canada Research Chair in Clinical Epidemiology of Chronic Diseases associated with the University of Toronto and St. Michael's Hospital.

The top 20 per cent of neighbourhoods that experience the highest burden of COVID-19 during the pandemic will also continue to be at highest risk in future with the situation we have with the variants of concern, resulting most likely in a third wave," he said. People in these neighbourhoods have more difficult living situations, lower income, less social security, are more likely to be essential health-care workers and are characterized by a lower socioeconomic status and higher racial and ethnic variations."

As a result, A person who is 50 years old and is living in one of these high-risk neighbourhoods has a higher risk of experiencing death or hospitalizations from COVID-19 than a 75-year-old living in a low-risk neighbourhood."

Juni says it's well known that those with higher socioeconomic status and education have better access to health care.

People with lower socioeconomic status, immigrants and people with lower education have worst prognosis in terms of everything," he said. It is directly related to lesser access to health care and this also manifests very strongly when it comes to vaccinations."

There is also the issue of how difficult it has been to register for the vaccine in Hamilton with many families questioning how seniors with little support could have done it on their own.

Seniors who visited St. Joseph's or Hamilton Health Sciences in the last six months were registered automatically - but with no confirmation sent, many families didn't trust this method.

The COVID hotline has had issues for six straight days due to high call volume and many families describe making hundreds of calls to get through.

Is there not a better way?" said Megan Dickson who registered her parents-in-law and husband's aunt. It's just ridiculous.

In fact, she worried that people capable of sending an email, registering online or even dropping off a paper form were tying up the hotline.

The people who require getting through on the phone - without 10 people in their lives to be making the calls for them - are the people who should be able to get through," she said. I hope that this changes, they could change the process this afternoon if they wanted."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com