With a limited supply of Pfizer’s new COVID-19 treatment, Paxlovid, bound for Canada, the country’s top doctors have identified groups that should be first in line to get the pills — including unvaccinated older Canadians.
Giving unvaccinated Canadians access to this COVID-19 medication isn’t only the right thing to do, it’s smart public health policy, says one bioethicist.
“It would be ethically unjustifiable, and it would not be scientifically sound to withhold this limited drug from unvaccinated people,” said Dr. Kerry Bowman, a bioethicist at the University of Toronto.
In clinical trial data submitted to Health Canada, the drug was found to reduce risk of hospitalization and death by 89 per cent, according to Dr. Supriya Sharma, Canada’s chief medical adviser.
Ethically speaking, Bowman explained, it’s “very dangerous” to make “judgments” about choices patients make, as well as “about how much health care they can receive based on the choices that they made.”
“It would be a dangerous precedent, and it’s not in alignment with the Canada Health Act,” Bowman said.
As for the science, keeping people out of the hospitals — unvaccinated or not — is key to emerging from the pandemic, he explained.
“From a triage point of view, (vaccination status) is not relevant information…we don’t want highly sick people in the intensive care unit with COVID that don’t have to be there,” Bowman said.
“And so if, in fact, you could avert some of the unvaccinated entering our ICU and taking up space, which is what everyone’s upset and complaining about, all the more reason to do that.”
Very few courses of this treatment are arriving in Canada in the weeks ahead. Canada has already received an initial shipment of 30,400 treatment courses, Procurement Minister Filomena Tassi said on Monday, and 120,000 more are expected to be delivered between now and the end of March.
There are over 330,000 active cases of the COVID-19 confirmed across the country right now, though that’s considered to be an underestimate.
But far from being the best option for all of those active cases, Paxlovid is only an effective treatment option for a small group of people in Canada to begin with, according to Health Canada. To receive a course of the COVID-19 treatment, an individual must be over 18, and must first test positive for COVID, either with a PCR or a rapid antigen test.
The person must also be within their first five days of having symptoms, and be sick enough to need the medicine without being so sick they need to go to the hospital.
“Paxlovid is just yet another piece of the puzzle that helps us manage this illness in people who may be at more risk,” said Dr. Gerald Evans, an infectious disease specialist at Queen’s University in Kingston, Ont. “For instance, those very small few who are not vaccinated at the moment.”
Evans added that if you are fully vaccinated, you probably shouldn’t be concerned about others having access to Paxlovid before you.
“If you’re fully vaccinated, you don’t need this drug,” Evans said.
“The effectiveness of vaccination is clearly better than it is for a new antiviral medication like this that’s come out. So being fully vaccinated, you’re way ahead of the game.”
Some individuals who are fully vaccinated might find themselves needing the treatment, such as “an elderly person with a solid organ transplant,” Evans said, but those people are the exception, not the rule.
Who gets priority access to Paxlovid?
The final priority list will be up to the provinces and territories to decide, Health Canada said on Tuesday, but the federal government has provided those regions with “interim implementation considerations” for the first batches of Paxlovid that have arrived.
“(The) first consideration is prioritizing individuals who are at the highest risk for severe illness and hospitalizations,” said Anne Génier, a spokesperson for Health Canada.
Those individuals, Genier added, include immunocompromised Canadians, those over 60 who live in certain at-risk settings and aren’t fully vaccinated, and those over 80 “whose vaccinations are not up to date.”
Global News contacted every province and territory to determine the criteria they’ll use in deciding who gets first access to the limited supply of Paxlovid.
In Quebec, people who are immunocompromised will be given priority access to the treatment, regardless of their vaccination status, a spokesperson told Global News. New Brunswick’s government, meanwhile, said Paxlovid “will only be provided to individuals who are among the public health priority groups for the time being.”
Nova Scotia, Ontario, Alberta and British Columbia did not provide specifics on their priority groups. However, Ontario, Alberta and B.C. all said they are currently working to determine eligibility and would have more details to share in the near future.
Manitoba did not directly answer Global News’ question. Newfoundland and Labrador, Prince Edward Island, Saskatchewan, Northwest Territories, Nunavut and Yukon governments did not respond by the time of publication.
At the end of the day, Paxlovid is just another tool in the pandemic toolbox, said Evans.
“I don’t think this is a game changer,” he said.
“What this is about, is yet another very effective tool we can use in a portion of the population.”