Shift in vaccine strategy could save more lives: report
Making those in higher-risk areas a priority alongside older residents would have bigger impact than plan based on age alone, science table says
A vaccine strategy that prioritizes the province’s hardest-hit postal codes — in addition to Ontario’s oldest residents — will save more lives and flatten the curve more quickly than a rollout that only targets age, according to a new brief by the COVID-19 Science Advisory Table.
The province is starting to unveil details for Phase 2 of its vaccination rollout into the broader community and has so far announced a number of priority groups who will be first in line, including people aged 80 or older.
But a vaccination strategy that also prioritizes neighbourhoods with the highest COVID-19 rates would have a bigger impact than targeting people based on age alone, according to the new brief — preventing an additional 3,767 cases, 702 hospitalizations, 145 ICU admissions, and 168 deaths by the end of May, according to modelling projections.
The report, which was released Friday, found that younger people in Ontario’s highest-risk neighbourhoods are not only more likely to get infected with COVID-19, they are at higher risk of death and hospitalizations — in Ontario’s highest-risk postal codes, for example, residents in their early 50s have seen higher fatality rates than people over 80 living in the least-affected areas.
To address these disparities, the report suggests using death or hospitalization rates to determine age groups that
should be prioritized for vaccines in high-burden areas. For example, if the eligibility cut-off is a death or hospitalization rate of 400 per 100,000, then people in their early 70s in the worstaffected neighbourhoods would become eligible for vaccination.
These high-risk postal codes are predominantly areas with higher concentrations of essential workers who are more likely to be lower-income or racialized. So a vaccine strategy that targets both age and postal code would not only be more equitable, it would maximize the impact of Ontario’s limited doses and flatten the epidemic curve more quickly, said Dr. Peter Juni, one of the report’s authors and director of the Science Advisory Table, which provides evidence to inform the province’s pandemic response.
“This pandemic is completely socioeconomically driven. And what we need to now avoid is the (scenario) where those who suffered the burden are not among those who get the vaccine,” said Juni, who described the new report as “the most important thing I’ve done in the last seven months.”
“If we do not address this problem, we will struggle much more with the third wave in the presence of the variants. So if we are able to protect those who are most vulnerable, this will also benefit everybody.”
The report found that both hospitalizations and community deaths from COVID-19 have been strongly linked to a person’s age and neighbourhood, defined by the first three digits of a postal code.
As of Jan. 16, half of all hospitalizations and deaths outside of long-term care or retirement homes were in just 10 per cent of Ontarians, according to Juni — either those aged 70 and older, or people 55 and over who live in 74 neighbourhoods hardest hit by COVID. This represents 15 per cent of Ontario’s 509 neighbourhoods.
When looking at just the 10 per cent of neighbourhoods with Ontario’s highest COVID-19 rates, they have accounted for 21 per cent of all coronavirus deaths in the community, according to the report. Some of these neighbourhoods include Toronto’s northwest corner, large swaths of Peel Region, and pockets of Scarborough, York Region and Windsor-Essex.
In these worst-affected postal codes, the death rate for people 80 and older was 27 times higher than an 80-plus person living in Ontario’s least-affected postal codes.
Even people in their early 40s had double the death or hospitalization rate compared to a senior over 80 living in neighbourhoods with Ontario’s lowest COVID rates.
When comparing an 80-plus person in Ontario’s worst-affected neighbourhoods with the youngest age cohort in the least-affected neighbourhood, the risk of death or hospitalization was a staggering 380 times higher — “absolutely crazy,” according to Juni.
“I think it’s been really clear that not everyone’s in the same boat; not every 80-year-old is the same,” said Kemi Jacobs, executive director of the Delta Family Resource Centre, which serves communities in Toronto’s northwest. “(We) have been really strong about trying to ensure that we have vaccines in our communities as soon as possible because of the high rates and the conditions, which make it very hard for people to take precautions.”
Juni said experiences in other jurisdictions around the world have already shown that vaccine rollouts that only rely on age cut-offs have resulted in inequitable outcomes, with the wealthiest and least-affected neighbourhoods getting vaccinated first.
Using postal codes is a simple way of targeting people at highest-risk without overcomplicating the vaccine rollout, he added. “You show me your driver’s licence (which includes both age and postal code) and I can tell you whether you’re already able to get the vaccine or not.”
Juni said the Science Table’s findings have been presented to Ontario’s vaccine task force and policy-makers, and he’s “confident that the content in the science brief informed the approach to vaccine prioritization.” Final approvals need to be made by cabinet, however.
On Wednesday, retired general Rick Hillier — who is leading the province’s vaccine task force — seemed to allude to the Science Table brief’s findings in a press conference. “We can take advantage of the work that the Science Advisory Board has done, where they delineated that certain age groups and certain neighbourhoods are much higher risk and we want to be able to respond to that,” he told reporters.
Hillier also announced that a website and phone line for booking vaccination appointments will be going live on March 15, with vaccinations starting a week later for people in the 80-plus category. The schedule for the next eligible age groups are: April 15 for people 75 and up; May 1 for Ontarians in their early 70s; June 1 for 65-plus and July 1 for anyone over 60.
Report co-author Dr. Isaac Bogoch, an infectious disease specialist at University Health Network and adviser to the vaccine task force, said the Science Table’s findings provide a compelling argument for selectively vaccinating younger age groups in the highest-risk postal codes.
Bogoch said targeting high-risk neighbourhoods will promote a more equitable distribution of vaccines in the next phase of Ontario’s rollout, but more measures are required to ensure doses go to people who need them most.
Some examples cited in the Science Table brief include partnering with trusted community organizations, mobile vaccination clinics, simplified registration processes that do not require internet access or English literacy, and including options that do not require pre-registration or official documentation.
Bogoch concedes that some people may find it unfair that younger Ontarians could be getting vaccinated ahead of others, just because of their postal code. But he believes the evidence strongly demonstrates that this approach isn’t only more equitable, it will snuff out Ontario’s epidemic faster — an outcome that will benefit everyone.
“If you take that granular approach to vaccination, you can significantly alleviate more cases, more hospitalizations and more deaths,” he said. “You get more bang for your buck, and you get it in a shorter time frame.”