Canada’s vaccine rollout plan should give higher priority to citizens at highest risk
The SARS -CoV-2 pandemic is magnifying health inequalities for low income individuals and families. Global in scope and predicted to be long-lasting, these effects have attracted little policy attention in Canada.
Although the majority of COVID-19 deaths occur among those over age 65, young and middleaged adults experiencing socioeconomic disadvantage compared with their wealthier peers are at much higher risk of infection. CBC Canada data link elevated rates of infection to visible minorities, with low levels of income and education, living in low-income neighbourhoods. In urban settings, these individuals and families occupy smaller living spaces in high density areas and travel using public transit — all challenges to physical distancing. They are likely to work for low pay in high risk settings such as hospitals, long-termcare facilities, public transit, grocery stores, farms or factories where virus spread is accelerated. They are less likely to be supported with paid sick leave and may opt to work when sick to avoid being fired. They exhibit higher rates of diabetes, obesity and cardiovascular disease — conditions that increase the risk of severe illness and death from COVID-19.
The lockdown measures introduced to impose physical distancing are accompanied with their own harms, including loss of education, employment and income, food insecurity, medical care delays and the loss of social protections for children at risk — all of which will translate into negative health outcomes over time. Virus containment measures have affected lower-skilled workers to a larger degree as they don’t have the option of working from home. The effects on post-secondary education are just starting to be understood with evidence from the U.S. indicating reduced enrolment among disadvantaged groups and, for enrolled students, lower rates of graduation possibly due to difficulties with virtual learning requirements such as access to the internet, technology and a quiet, private space to study.
Most troubling about the impact of the pandemic on disadvantaged groups is that the harms linked directly to the virus (infections and death) are magnified by the harms associated with measures meant to prevent its spread. In other words, in these groups, the combined adverse effect of the virus and the mitigation strategies is much greater than the sum of their separate adverse effects. This is in stark contrast to wealthier segments of the population able to work from home with no loss of income and in many instances escaping tiresome commutes.
Not only are the harmful pandemic effects multiplied in some parts of the population, but the UN has warned that increasing levels of poverty and inequality could last for generations. Loss of education and employment opportunities reduce social mobility and an individual’s ability to improve their circumstances and those of their children. Decreased access to services when the need is greatest could lead to chronic and long-lasting negative consequences for families that are passed down to future generations.
Growing inequality is playing out on a global scale. The UN has estimated that pandemic-related school closures have led to 86 per cent of primary school age children in low development countries not getting an education, compared to 20 per cent in developed countries. Analysts estimate many people in low-income countries might not get vaccinated until 2023 or 2024.
The distribution of a vaccine presents an opportunity for countries to redress some of the inequality by designing a rollout that prioritizes those at most risk for negative consequences from the virus. Already Ontario has identified those in long-term-care facilities as a priority but what about those living in shelters, community housing and multiple-family residences?
Greater government response is needed to build supports that will last the duration of a vaccination program and beyond. The injustice of specific groups bearing the burden of this pandemic must be recognized and explicitly targeted. Subsequent waves of infection threaten to draw attention away from these issues while governments try to effectively respond. Dedicated time and resources must be invested into identifying, quantifying and beginning to formulate policy that focuses on and supports the most vulnerable.
The injustice of specific groups bearing the burden of this pandemic must be recognized and explicitly targeted