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Ethical dilemma: Who should get a COVID-19 vaccine first? – CTV News

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TORONTO —
Developing a COVID-19 vaccine is a huge undertaking. Scientists around the world are working to find a way to immunize humans against a virus that nobody knew anything about even six months ago, and get the vaccine into production in a far shorter timeframe than the research process normally allows.

But once they succeed, public health leaders will be left with major dilemmas of their own – ones less about the practical aspects of stopping the novel coronavirus than the ethical problems that accompany a vaccine.

Should the focus be on decreasing the number of cases, or the number of deaths? Is protecting those most at risk of suffering serious complications worth letting the virus continue to run relatively unchecked in the population at large? Will all parts of Canada have to follow the same rules, or does it make sense to use different strategies in different regions?

In short, who gets to be at the front of the line?

HEALTH-CARE WORKERS, THEN WHO?

There is actually widespread agreement on who should be vaccinated first: health-care workers, both to show appreciation for them putting themselves in harm’s way by treating COVID-19 patients and to avoid staffing shortages in the sector by immunizing workers to the disease.

Once all the health-care workers have been vaccinated, though, it’s not at all clear who should be next.

“After health-care workers, it gets a little tricky,” Alison Thompson, an assistant professor specializing in public health ethics at the University of Toronto’s Dalla Lana School of Public Health, told CTVNews.ca Wednesday via telephone.

Normally, the goal of a vaccination program is to promote herd immunity – building up enough resistance to the virus that it is unable to spread, and thus dies out. Due to the urgency of the COVID-19 pandemic, though, Thompson said there might be an argument for minimizing the number of deaths in vulnerable populations before embarking on a herd immunity campaign.

A decision to focus on vulnerable groups comes with its own predicaments. Should seniors be prioritized over those who have underlying health conditions? What about employees in risky workplaces, or those whose immunity to the virus has been weakened by poverty and poor nutrition?

There’s another problem, too: vaccine candidates are being rushed through the research process. What normally takes years of development is being compressed into a timeframe that could be less than 12 months.

Although clinical trials of potential vaccines will still involve watching for signs of safety concerns, the shortened research period means long-term effects will not be fully understood when a successful vaccine is first given to the public

If the immunocompromised are among the first to be given a vaccine, Thompson said, complications could ensue.

“If you do target vulnerable populations … after health-care workers, it can cause problems,” she said.

“Their vulnerability to the virus can, perhaps, also make them more vulnerable to safety and effectiveness issues which we won’t know about.”

LEARNING FROM HISTORY, AND AI

One group of Canadian researchers is looking to take the decision out of human hands to a certain extent. Professors at three universities in Ontario and Nova Scotia are building an artificial intelligence model that they believe will be able to analyze all the factors at play and provide guidance on how to most effectively deploy vaccines.

Daniel Ashlock, a math professor at the University of Guelph, said in a press release that the model will be made freely available to public-health decision makers, potentially as soon as late this summer.

“Knowing who, how and where to vaccine first is critically important to mitigating the spread of the virus,” he said, suggesting that the tool could be used to determine whether vaccinating grocery store workers or vulnerable populations will have a greater effect on public health, for example.

When making those sorts of decisions, public health officials may also look to guidance that was created in preparation for another pandemic – one of influenza.

The Public Health Agency of Canada (PHAC)’s planning guidance for a flu pandemic, which was last updated in 2018, includes 28 questions meant to inform decisions around who to vaccinate first, covering everything from the characteristics of the vaccine itself to what is happening elsewhere in the world to political considerations.

For a flu vaccine, it suggests likely target groups – in no particular order – could include those at highest risk of suffering a severe outcome from influenza, healthy children and adults who can help build up herd immunity, health-care workers, others working or living in high-risk settings, and those most likely to transmit the virus to those most likely to die from it.

The document also notes the inherent risks of pandemic vaccinations, including that a vaccine might not be 100 per cent effective, that availability could be limited and that not everyone might be willing to receive the vaccine.

Thompson said the basic principles of the vaccination strategy outlined in the documents could be applied to a COVID-19 vaccine. She said some of the specific advice might not be relevant, including the suggestion to prioritize vaccinating healthy children.

“There are still so many questions about the role of children in transmitting this virus,” she said.

HOW MUCH CAN THE FEDS DO?

There are also questions around how much PHAC and the federal government will be able to mandate. The flu pandemic guidance specifically notes that it “is not an actual response plan” and that provinces and territories ultimately have jurisdiction over most aspects of pandemic response, while the federal role is largely limited to procuring supplies, overseeing research and building a national consensus.

Thompson said she would like to see the government work toward a national strategy with full buy-in from each province and territory, especially because of the amount of “cross-border activity” and travel happening within the country.

“It may not make a lot of sense from an epidemiological perspective to not do that, but it also morally might be problematic if one province’s or territory’s strategy is not equitable with the rest of the country,” she said.

Dr. Theresa Tam, Canada’s chief public health officer, has said that the government has no plans to order provinces and territories to make vaccinations mandatory. Alberta, for one, has said that it will not require vaccinations.

Tam said June 2 that the government has begun procuring the supplies it will need to conduct “mass vaccinations” and planning for how vaccines will be administered once they are approved for use.

What remains to be seen is how easy it will be for Canada to obtain a vaccine that is developed outside the country. The Canadian Center for Vaccinology at Dalhousie University in Halifax is conducting a clinical trial of one vaccine candidate, but no other potential vaccines have been approved for trial here. If another vaccine is found to be safe and approved for manufacturing first, Canada may find itself as one of many countries jockeying to import it before production can ramp up.

“Whoever does get the vaccine first is going to have a lot of power,” Thompson said.

Many countries, including Canada, China and the U.S., have vowed to consider a vaccine a global public good and make it available wherever it is needed most.

That creates other ethical concerns, as the need to protect Canadians will be balanced against the concerns of those in countries where proper physical distancing threatens the accessibility of food and water, Thompson said.

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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