We need a clear plan for the partially vaccinated

OPINION: Will Canadians still have to avoid their families after getting the first dose? It’s time for some good, solid public-health guidance
By Matt Gurney - Published on Mar 08, 2021
The Centers for Disease Control announced guidelines for vaccinated Americans on Monday. (Frank Gunn/CP)

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Monday's high COVID-19 case count notwithstanding — it's apparently a data quirk, more than anything — we have had lots of good news on the pandemic front lately. In recent weeks, Canada approved two new vaccines, which joined the two already approved. The supply situation for three of the four is improving. We are seeing real-world benefits from the vaccinations we've already completed. The stay-at-home order has ended in Toronto and Peel and been replaced with ... well, basically the same thing, under a different name, but still. Toronto says that, within 10 days, it will have enough vaccine to have three mass-vaccination sites operating nine hours a day, seven days a week.

Though we aren't out of this quite yet, this is the best news we've had in a while.

And that's why I've decided to rain on everyone's parade and flag an issue that could soon screw this up for everyone.

We are, in a sense, perhaps soon to be victims of our own success (such as it is). Last week, the National Advisory Committee on Immunization, or NACI — an acronym you need to pronounce really, really carefully — recommended that "in the context of limited COVID-19 vaccine supply jurisdictions should maximize the number of individuals benefiting from the first dose of vaccine by extending the second dose of COVID-19 vaccine up to four months after the first." Since the first shot confers so much protection, it makes sense to have the maximum number of people with substantial defence, relative to the option of having half that many people fully protected. Highly vulnerable groups should probably still get the double dose, but for the rest of us — those with a lower-risk profile for severe illness — the first-doses-first strategy makes sense. It will give us a real fighting chance to beat the pandemic in the short term, and as the vaccine supply firms up, we may well be able to complete the second doses much faster than the four-month-maximum separation.

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But for the sake of argument, let's take the four-month separation as a working figure. Now imagine that you or a more vulnerable loved one has gotten the first shot of a planned two. Imagine further that several weeks have passed, allowing the first dose time to begin to confer its immune-boosting effects. And imagine that ... the government says that you still can't do anything until you get that second shot. And that that second shot isn't for four months. The euphoria you'd feel after that first jab would instantly be replaced by the heavy weight of another five or so months of sitting around, waiting.

Sorry, but that just isn't going to work.

As this pandemic has ground on, it has been remarkable to see how little experience with actual human beings our public-health leadership seems to have accumulated. If humans were computers, and we could be programmed to simply follow advice and recommendations, we'd have beaten COVID-19 in several very dull weeks. But we aren't. We are weird, meat-brained mammals who aren't good at doing what we're told and routinely act against our self-interest, both individually and collectively. That's okay! Some of the best moments in life are the ones that probably aren't being narrated right out of a public-health playbook. But, suffice it to say, if your plan for dealing with a pandemic doesn't account for people being people, it's not a great plan.

And I am very concerned about what our plan for the partially vaccinated is going to look like. I think people will mostly follow the rules, if the rules make sense and are effectively communicated. The problem is, this is a discussion about Canadian public policy. Making policy that makes sense and backing it up with clear comms shouldn't be impossible bars to clear, and yet we so routinely wipe ourselves out, clothesline-style, running smack into them at warp factor eight.

The Centers for Disease Control announced guidelines for vaccinated Americans on Monday. Fully vaccinated individuals may gather indoors, without masks or distancing, with other fully vaccinated individuals. Fully vaccinated individuals may gather with non-vaccinated individuals if the latter are in a lower-risk category for severe illness. A vaccinated parent, in other words, could meet with their grown and non-vaccinated children, provided said children were healthy. This is good, solid, clear guidance — it will allow at least some routine family life to begin while the U.S. continues its vaccination campaign. We are going to need something like this in Canada, fast.

I don't know what the best medical advice will be. But I do know that it's going to be very difficult to tell Canadians that, after getting the first dose and following a long year apart, they’ll still have to avoid their family. If the first dose is good enough to base an entire first-doses-first strategy around, a lot of people are going to conclude it's good enough to permit some resumption of normal life.

Not all normal life. We are still some months away from a true return to normal: the fall still seems like a reasonable target, one in line with the federal government's original predictions. But a gradual and cautious return to some elements of normal life seems within reach. If it isn't, the various public-health experts in Canada had better start saying so now. And if it is, they'd better lay out what that looks like — clearly, effectively and early — so that Canadians can get mentally adjusted to what the next phase of this weird struggle is going to look like.

In the absence of that information, people just won't stay home. They'll start making their own best guesses. We have time to avoid that. But not as much time as our governments might prefer.

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