As more COVID-19 vaccines are approved in Canada, some Albertans are asking whether they may be able to pick which vaccine they receive – a possibility that medical ethicists are raising concerns over.
Health Canada has approved the Pfizer, Moderna, AstraZeneca and Johnson and Johnson COVID-19 vaccines for use in Canada.
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At this point, it isn’t clear whether a choice of vaccines will be available to Albertans.
“No decision has been made regarding whether Albertans will have a choice in the future on which vaccine they get,” reads a statement to Global News from Alberta Health.
“All vaccines go through a rigorous review process to ensure they are safe and effective before being made available to Canadians. We continue to assess the data and evidence and will update Albertans as soon as any decisions are made.”
The province will administer the AstraZeneca vaccine to those 50 to 64 years old, in accordance with a recommendation from the National Advisory Committee on Immunization not to give it to those over 65. But it said those in that age group may wait until May, when Phase 2D officially starts, to receive the Pfizer or Moderna vaccines.
Alberta’s chief medical officer of health Dr. Deena Hinshaw said Thursday that all approved vaccines are safe, effective and will reduce the risk of severe outcomes from COVID-19.
However, that isn’t stopping Albertans, such as Wayne Tabb, from being hopeful about getting to choose a vaccine.
Tabb, 45, said the past year has been challenging and stressful. He accepts that his age places him lower down in the priority list.
“It’s not going to be anytime soon. It is what it is,” he said.
But by the time his age group gets called, Tabb hopes there is a choice made available to him.
“Just being able to choose what I put into my own body is nice,” he said.
Tabb points to factors such as the different types of vaccines available and the number of doses required for those approved.
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“Being able to choose which one you get, I think, is fair,” he said, pointing to the Johnson and Johnson vaccine, which is a single dose.
“It would just be nice to have your voice heard and, yeah, maybe we could get our choice, right?”
Vaccines will protect you
David Evans, a professor in the University of Alberta’s Department of Medical Microbiology and Immunology, said allowing people to choose their vaccine could “tremendously complicate” the delivery of vaccines.
“Particularly with the vaccines that require special freezing and refrigeration – if they don’t get used up… it runs the risk of wasting vaccine,” he said.
“The faster we can get widespread use of any vaccine, the faster the virus that is circulating in the community will be driven down. Waiting until you see the vaccine you want is not going to help that.”
The Pfizer and Moderna vaccines have efficacy rates of more than 90 per cent; the AstraZeneca vaccine has an efficacy rate of 62 per cent. Despite a lower efficacy rate, there were no hospitalizations or deaths from COVID-19 in the trials with the AstraZeneca vaccine.
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Global trials for the Johnson and Johnson and vaccine found the shot to be 66 per cent effective at mitigating moderate to severe illness and 85 per cent effective at preventing the most serious outcomes. Notably, there were no deaths among participants who had received the J&J vaccine and no hospital admissions after 28 days post-vaccine.
Evans said any vaccine is better than nothing and Albertans should take whatever vaccine is offered to them.
“Vaccines won’t necessarily protect you from getting the disease, but if you do get it, they will protect you from the more severe consequences of that disease,” he said.
“Less of those people who have been vaccinated are going to the hospital, and even less of them are getting so sick as to die.”
The ethical concerns
Biomedical ethicist Jonathan Kimmelman from McGill University said it is important for Canadians to remember all vaccines approved in Canada are safe to deploy.
“I think it’s tempting to try and measure that lower efficacy one against the 90 per cent protection, but really what members of the public should be bearing in mind is zero per cent protection, which is going unvaccinated,” he said.
“Even 60 per cent (efficacy) is a pretty good vaccine and in the midst of a pandemic, for (a) disease that is life-threatening, I don’t think people should hesitate to get the vaccine if it has a lower level — an incrementally lower level — of efficacy.”
Public health ethicist Nicholas King, who is a professor in the biomedical ethics unit at McGill University’s Department of Epidemiology, said there is evidence that vaccinating as many people as quickly as possible, regardless of which vaccine is used, will help flatten the curve. However, he notes there are other considerations.
“There are questions regarding freedom of choice, but also really important questions around fairness and equity in the distribution of the vaccine,” King said.
He said there are concerns a two-tiered system could emerge where some populations have access to vaccines considered more effective while other populations have access to vaccines considered less effective.
“This raises a real concern that some people might be systematically given better or worse vaccines,” King said.
“From my understanding of the evidence, they are all effective and they are all good vaccines, but in terms of public perceptions, perceptions of fairness are really important to the success of a public health intervention.”
King said perceptions some vaccines may not be as good as others could contribute to people being hesitant to receive a vaccine, which could increase vaccine hesitancy overall.
He recommends health authorities be transparent and open about which vaccines are administered and to whom.
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As for Kimmelman, he cautions Canadians who may want to pick one vaccine over another
“Number one, we still don’t know a lot about a lot of aspects about these vaccines so I’m not even sure how well people can make informed choices,” he said. “From a government standpoint, the key imperative right now is to stem this pandemic, to get it under control.
“A 70 per cent effective vaccine, even if it has no other advantages over 90 per cent, it’s going to be enough to be able to open up our economy.”
Kimmelman argues that there are monetary implications of administering a vaccine program that gives people choices, saying every dollar deployed to facilitate those choices may be one dollar less for getting vaccines into arms.
“To me, that personal choice really has much less importance than public health objectives,” he said.