Ontario Releases Ethical Framework for COVID-19 Vaccine Distribution

Framework will guide vaccine prioritization in future phases of the province’s implementation plan

The Ontario government has released an Ethical Framework for COVID-19 vaccine distribution which was developed in partnership with the COVID-19 Vaccine Distribution Task Force to guide further vaccine prioritization and distribution across the province. The province continues to vaccinate vulnerable populations and those who care for them through Phase One of its three-phase implementation plan as additional vaccines become available.

Details were provided on December 30, 2020 by COVID-19 Vaccine Distribution Task Force members Dr. Dirk Huyer, Ontario’s Chief Coroner and Coordinator, Provincial Outbreak Response, and Dr. Maxwell Smith, bioethicist and assistant professor at Western University.

“This ethical framework is a clear demonstration of our commitment to Ontarians to be transparent,” said General Rick Hillier (retired), Chair of the COVID-19 Vaccine Distribution Task Force. “We know that people are eager to get vaccinated and this framework helps ensure that we do it in an ethical, effective and compassionate way.”

Phase One of Ontario’s three-phase vaccine implementation plan began on December 15, 2020 at two hospital sites, and increased to 17 additional sites the following week, with the delivery of 90,000 Pfizer-BioNTech doses. With Health Canada’s recent approval of Moderna’s COVID-19 vaccine, the province can expect about 50,000 additional doses before the end of the month.

“One of the most important aims of the COVID-19 Vaccine Distribution Task Force since its beginning has been to ensure that the most promising vaccines are distributed to Ontarians safely, fairly and as quickly as possible,” said Dr. Huyer. “Our Ethical Framework will support the prioritization of vaccines in a way that enhances confidence and trust in Ontario’s COVID-19 immunization program.”

The Ethical Framework includes the following principles to guide COVID-19 vaccine distribution:

Minimize harms and maximize benefits, to reduce overall illness and death related to COVID-19, protect those at greatest risk of serious illness and death due to biological, social, geographical and occupational factors, protect critical infrastructure, and promote social and economic well-being;
Equity in the distribution of vaccines without bias or discrimination, to reduce disparities in illness and death related to COVID-19, and ensuring benefits for groups experiencing greater burdens from the COVID-19 pandemic;
Fairness, to ensure that every individual within equally prioritized groups has the same opportunity to be vaccinated, and to ensure inclusive, consistent processes that are tailored to unique needs of Ontario’s many and varied communities when making decisions about vaccine prioritization;
Transparency, to ensure the principles and rationale, decision-making processes and plans for COVID-19 prioritization are clear, understandable and communicated to the public;
Legitimacy, making decisions based on the best available scientific evidence, shared values and input from affected parties including those historically underrepresented, to ensure decisions have the intended impact, and to include participation of affected parties in the creation and review of decisions and decision-making processes; and
Public trust, to ensure decisions and decision-making processes are informed by these principles to advance confidence and trust in Ontario’s COVID-19 immunization program.

“The COVID-19 Vaccine Distribution Task Force developed this framework to ensure that its feedback and recommendations are consistently guided by fundamentally important ethical values like equity, fairness and transparency,” said Dr. Smith. “We are continuing to ensure that diverse perspectives are captured in our feedback and recommendations, so that all Ontarians who want to get vaccinated against this deadly virus are accounted for. Vaccines are the most effective way to prevent infectious diseases and are our best defense to help us get back to our normal lives.”

While the Health Canada approval and rollout of two vaccines represent progress in the fight against COVID-19, Ontarians are reminded that staying home and following public health guidelines is currently the best way to protect yourself and others from COVID-19. This includes limiting trips outside the home except for essential purposes, practicing physical distancing of at least two metres when going out, wearing a face covering when physical distancing is a challenge or when it is mandatory to do so, and washing your hands frequently and thoroughly.

Quick Facts

Ontario has launched a new webpage detailing the province’s three-phase immunization program, information on COVID-19 vaccines, safety measures and approval standards, as well as daily updates on the number of Ontarians vaccinated.
The province’s decision to identify key populations to receive the vaccine first is based on the advice of medical experts and ethicists, and recommended by the COVID-19 Vaccine Distribution Task Force and aligned with the National Advisory Committee on Immunization’s recommendations.
On December 9, 2020, Health Canada approved the first COVID-19 vaccine in Canada, manufactured by Pfizer-BioNTech, and on December 23, 2020 approved the COVID-19 vaccine manufactured by Moderna. Health Canada approved the vaccines after independent and thorough scientific reviews for safety, effectiveness and quality. Health Canada will continue to monitor the safety and effectiveness of the vaccine. To date, more than 19,000 people have been vaccinated against COVID-19 in Ontario.
The province will shift to Phase Two of its vaccination implementation plan, which is expected to begin later in the winter of 2021, when more vaccines become available to Ontario. During Phase Two vaccinations will continue for health care workers, long-term care homes, retirement homes, home care patients with chronic conditions, and additional First Nation communities and Indigenous populations, including Métis and Inuit individuals. The task force will use the Ethical Framework and the best available data to identify further priority populations within this phase, based on available vaccine supply.
Ontario will enter Phase Three when vaccines are more widely available for everyone who wishes to be immunized. Prioritization within this group will be grounded in the ethical framework, be data driven and informed by available vaccine supply. While vaccines will not be mandated, people will be strongly encouraged to get vaccinated during this phase.
To help everyone stay safe, download the COVID Alert app. It is free to use and is available from the Apple and Google Play app stores. This app lets users know if they may have been exposed to the others who are infected with the virus.