Who in Canada will get the COVID-19 vaccine first?

It is expected that several months will pass between the release of the first doses of vaccine and the opportunity to vaccinate everyone.

This leads to the obvious question: Which Canadians or groups of Canadians should be given priority? Who should be out of line and who will have to wait?

One group of experts in medicine, pharmacy and public health has often addressed similar issues, though not on this scale. The National Advisory Committee on Immunization (NACI) is an experienced body that advises the Public Health Agency of Canada on issues related to vaccines. Over the past decades, they have made informed decisions about vaccines covering more than a dozen different diseases. Their advice has helped create a push to expand human papillomavirus vaccination programs to include boys.

Now they have turned their attention to COVID-19. On Tuesday, they released their first recommendations on the target populations that first need to be immunized against COVID-19.

NACI recommends giving priority to four specific groups:

1. Those at high risk of serious illness and death from COVID-19, including the elderly and other groups to be identified.
2. Those most likely to transmit the virus to those at high risk of serious illness and death from COVID-19, as well as workers whose activities are necessary to support the pandemic response. This includes those who live with members of the first group, health care workers, caregivers, and caregivers of the elderly.
3. Those who contribute to the maintenance of other important services for the functioning of society, including rank-and-file workers such as police officers, firefighters, and grocery store personnel.
4. Those whose living or working conditions put them at increased risk of infection and where infection may have a disproportionate impact, including indigenous peoples and those who live or work in places where distance and access to medical care is difficult.

The NACI report does not state that any of these groups should take precedence over the others, nor does it suggest that the examples given in the list represent a complete list of individuals who should be included in any of the groups.

The committee recommends making decisions about who gets vaccinated first among priority groups based on factors such as vaccine availability, the situation with COVID-19 in Canada, the results of the risk-benefit analysis, and the characteristics of the vaccine itself.

Dr. Teresa Tam, Canada's chief public health officer, said the NACI recommendations are "just a starting point" when it comes to determining which groups to prioritize for vaccination.

"We know that Canadians will understand the need to prioritize certain groups in the first weeks of COVID-19 vaccination until there is enough medicine for everyone who wants it," she said.

Tam expressed a cautiously optimistic view that the vaccine could be approved for use in Canada by March 2021.