Ableism and the National Advisory Committee on Immunization COVID19 Vaccination Framework
On February 16, I wrote to the National Advisory Committee on Immunization (NACI), the group overseeing the COVID19 vaccination framework (Figure 1). I commented on their February COVID19 vaccination framework that fails to prioritize those individuals with serious medical illnesses, who we know have poorer outcomes, including higher mortality rates.
The increased risks presented by health conditions such as hypertension, diabetes and heart disease have been discussed widely. However, there are other conditions with higher risks, especially those associated with immunosuppression.
In my letter, I described the risks COVID19 presents to those individuals with primary immunodeficiency, who once hospitalized, have a risk of death of 30–50% according to at least one report. I presented high quality publications that demonstrated:
1. Recently diagnosed cancer patients are at a 7-fold increased risk of contracting COVID19.
2. Cancer patients with COVID19 have a 2-fold increased risk of hospitalization, and 3-fold increased risk of death (v. COVID19 patients who are cancer free).
There are ample publications on the serious risks COVID19 presents to those with chronic kidney disease, or recent organ transplant recipients who are immunosuppressed. As a physician, I understand there are other conditions such as underlying lung disease from Cystic Fibrosis, or congenital conditions such as Down’s Syndrome that place such persons in significant peril, if infected. The latter group have prevalent immune defects and underlying congenital heart disease.
While some immunosuppressed individuals will derive only partial immunity from vaccination, certainly this is better than none whatsoever. The mRNA vaccines especially will pose little risk to these individuals.
Israel has a successful vaccination strategy that includes those citizens with serious medical problems up front with seniors 65 years and older. Indeed, these individuals have the highest mortality rates after seniors age 80 years and higher. Why has Canada prioritized 30-year old healthcare workers/first responders with good PPE above those who are most vulnerable to the virus?
An ugly word comes to mind: Ableism. What is it? It’s treatment that favours able bodied individuals at the cost of those who are disabled. It does not have to be intentional. I believe vaccination committees have grossly overestimated the risks associated with healthcare worker infections, especially among those under age 50, save those working in COVID19 units. Why have the very serious risks posed to the most vulnerable individuals amongst us been discounted? As physicians, we are obliged to offer the best care possible to our patients. In this matter, I am afraid we have failed.
Israel’s strategy has been a tremendous success. A drop in critical illness by 92% is noteworthy. I have no doubt that everyone involved on federal or provincial vaccination committees are working hard and carefully considering their ethical frameworks. However, I wonder if fears of the virus are driving some decisions? Let’s get those at greatest risk vaccinated first. If necessary, limit healthcare worker vaccinations to those age 50 and older to provide prompt vaccination of the most vulnerable among us. I am pleased, that Ontario seems poised to include those with serious illness and their caregivers with phase 2 of the vaccine roll-out, simultaneous to those seniors aged less than 80 years. This is a just and ethical approach. It is my hope that NACI revises their COVID19 vaccination framework.
The comments I make here are my own.
