‘Whose life is more valuable?’ Health workers say vaccine rollout reveals inequities in system
For months, hospital staff and community health teams have worked side by side to deliver COVID-19 “pop-up” testing in Toronto’s northwest corner, one of the city’s hardest-hit regions. But in recent weeks, a painful fissure has emerged.
At some mobile testing sites, select people have now been vaccinated, while others have not — even though they’re all doing the same front-line work.
The only difference? Whether they’re employed by hospitals, where the province’s
first vaccine doses were distributed, or community health centres, where staff are still waiting to learn when their turn will come.
“You can imagine what that feels like (for staff ). You know, whose life is more valuable?” said Cheryl Prescod, executive director of the Black Creek Community
Health Centre, which has been running pop-up testing sites in the city’s northwest corner since July. “It’s not fair and I’ve gone to bed at night losing sleep over it.”
“It’s absolutely inequitable,” said Angela Robertson, executive director of Parkdale Queen West Community Health Centre. “It feels like a slap in the face; we will call you when we need you, but we will not consider you for essential resources that become available for your safety.”
The first weeks of Ontario’s vaccine
rollout have been plagued with controversy, including concerns over “queue jumping” at some hospitals where executives, volunteers or staff on leave have been vaccinated — even before many long-term-care homes and front-line workers in hot spots.
Hiccups are expected in a complex and unprecedented immunization campaign, where many factors are beyond the province’s control. Recent shipment delays of the Pfizer vaccine, for example, have stalled the immunization campaign, just as highly transmissible new variants have started spreading in Ontario.
But advocates say many issues were preventable and the equity issues were foreseeable. And while nobody is happy about the delayed Pfizer shipments, there is now an opportunity for the province to rework its vaccine rollout plan and ensure early mistakes aren’t repeated, said Sarah Hobbs, CEO of the Alliance for Healthier Communities.
“If this is how we handled the first phase, what is Phase 2 and 3 going to look like, where we know for sure we need to be prioritizing marginalized folks?” Hobbs said. “I want us to learn from this moment.”
The province developed an ethical framework and guidelines for the vaccine rollout, where it identified priority populations and provided a “risk matrix” to determine which health workers and patients should be prioritized. The first doses were then given to hospitals to distribute to staff, as well as residents, workers and caregivers at long-termcare facilities and retirement homes.
But the past month has demonstrated that these guidelines aren’t good enough, with several hospitals interpreting them in different ways or deviating from the ethical framework, Hobbs said. The province’s 34 different health units will soon start distributing vaccines more broadly, and she worries the same inconsistencies and ethical lapses will just repeat themselves all over again.
“How (is the government) holding people accountable?” Hobbs asked. “This is a question I have, and I haven’t been able to find any answers.”
Ontario’s Health Ministry did not respond to this question when asked by the Star, nor did it answer questions about what it is now doing to address issues that arose in the first phase of the rollout.
But in an emailed statement, the ministry said that due to limited supplies of the vaccine, initial distribution will focus on “our most vulnerable Ontarians who have higher risk outcomes from contracting the virus” and are at higher risk of spreading it.
“The ministry is aware that there have been isolated incidents of individuals not in the identified priority populations who have been vaccinated,” the statement said. “These are unfortunate and unacceptable incidents and the ministry continues to work with its health system partners to ensure the guidance and information provided is clearly understood by all partners regarding the prioritization of populations for COVID-19 vaccines.”
The early stages of the vaccine rollout have followed the same harmful patterns seen throughout the pandemic, with equity issues put on the backburner and marginalized communities struggling to access everything from PPE to COVID-19 testing, said Kate Mulligan, assistant professor at the University of Toronto’s Dalla Lana School of Public Health and policy director for the Alliance for Healthier Communities.
“Whenever there’s an emergency issue or a rush, we have to rely on pre-existing systems. And we know they’re very inequitable,” said Mulligan, who is also a member of the Toronto Board of Health.
“It’s not to say that it’s intentional,” she continued. “That’s the whole nature of systemic inequities; you don’t notice the pre-baked power imbalances that are already a part of it.”
While there is an urgent need to vaccinate people as quickly as possible, this is not an acceptable excuse for neglecting equity concerns, especially since the data clearly shows which populations are at greatest risk, said Camille Orridge, a longtime advocate for health equity and senior fellow at the Wellesley Institute.
“None of this is new. It’s not a speed question,” she said. “It’s a ‘who you value and prioritize’ question.”
Orridge and other advocates question why the province didn’t create a system that could have allowed high-risk community health workers to access surplus vaccine doses, which in some cases have gone instead to lower-risk hospital employees, like researchers and administrators.
They also question why Toronto’s first non-hospital vaccination clinic was only for city employees and held downtown at the Metro Toronto Convention Centre, rather than in the city’s hardest-hit regions, like Scarborough or the northwest corner.
According to City of Toronto spokesperson Brad Ross, the “proof-of-concept clinic” at MTCC was meant to test a vaccination operation with “a sample group of people we could readily identify and communicate with.” This included city staff on the front lines, including public health nurses administering vaccinations and those working with homeless populations, he said.
This process “would then allow a playbook to be developed and used once vaccine becomes more readily available,” Ross said. But for Orridge, a “playbook” designed using the city’s own employees at a downtown location doesn’t reveal any lessons about how to vaccinate people in marginalized communities, where the needs are greatest and the barriers are many. “That’s not a true proof of concept,” she said.
Equity blind spots have also hurt the province’s efforts to quickly vaccinate those in the long-term-care sector, advocates say.
At SEIU Healthcare, the largest union representing health workers in the longterm-care sector, roughly 40 per cent of members said financial issues are one of the top barriers in accessing vaccines, said president Sharleen Stewart.
Many LTC staff are low-wage earners and aren’t getting paid for the time — or transportation costs — required to travel to offsite vaccination clinics, which could be an hour-long bus ride away, she said. Even with many vaccines now being administered directly in long-termcare homes, some staff have to come in on their day off, and might have to pay for child care. And many LTC workers don’t have paid sick leave but worry about adverse side effects, which are rare but could require them to stay home from work, she said.
On Dec. 29, SEIU sent a letter to the province asking for measures to address these issues and “support the effective uptake of the vaccine by health care workers,” including the provision of paid sick leave. The letter was also signed by AdvantAge Ontario and the Ontario Long Term Care Association, and addressed to Health Minister Christine Elliott and Long-Term-Care Minister Merrilee Fullerton. Neither has responded, Stewart said.
Sabina Vohra-Miller, co-founder of the Vohra Miller Foundation and member of the South Asian Health Network, said she’s recently had discussions around equity issues with members of the province’s vaccine task force and health ministry, and is happy these conversations are now underway.
But she wonders why they weren’t happening months ago. “This work has to be done,” she said, “and it had to be done yesterday.”