Unvaccinated may be first in line for Paxlovid COVID-19 pills in Canada

Canada’s top doctor says those who are not vaccinated against COVID-19 could be prioritized for a newly-approved treatment that is in short supply.

Pfizer’s anti-viral pill, Paxlovid, was approved by Health Canada Monday for use in adult patients with mild or moderate COVID-19 who are at higher risk of developing serious illness and requiring hospitalization and critical care. The drug cannot be prescribed to anyone who is already hospitalized, and must be prescribed within five days of the onset of symptoms.

Pfizer has said trials have shown the drug can cut the chance of hospitalization or death by 89 per cent in adults when taken shortly after initial symptoms.

NEW: Procurement Minister confirms the first delivery of the new Pfizer COVID pill is already in Canada. First delivery arrived this weekend, ahead of the regulatory approval that came this morning #cdnpoli https://t.co/mwoprgvKoO

— Cormac Mac Sweeney (@cmaconthehill) January 17, 2022

And with health officials repeatedly warning that those who are unvaccinated are far more likely to require hospitalization or treatment in ICU, Chief Public Health Officer Dr. Theresa Tam was asked whether vaccine status would affect the decision around who gets the treatment.

“This is a scientific and rational use of a drug that is in short supply. We know that the unvaccinated are at higher risk of getting severe outcomes and getting hospitalized and ending up in the ICU. So, this is the evidence, and we’re following that evidence,” she said.

“I think that as healthcare providers, you don’t pick and choose which patients you have coming into the hospital and getting treated. I think this approach shows that we are prioritizing treatments to those most in need.”

Related articles: 

• Health Canada approves Pfizer antiviral COVID-19 pill

• Expert explains how the COVID-19 antiviral pill works, who it works for

• Quebec’s ‘anti-vax tax’ leads to spike in 1st doses despite legal concerns

The most recent federal data on hospitalization comes from December 2021. It showed unvaccinated people between 12 and 59 years old were 31 times more likely to be hospitalized with COVID-19 than fully vaccinated people. For those 60 and over, the unvaccinated were 15 times more likely to require hospital care.

Tam said the guidelines for who to prescribe the limited supply of the drug to is “based on clinical risk factors, and health equity considerations.” While risk is the first criteria, those living in long-term care or in underserved rural or remote communities are also being prioritized, as are those 60 and over who are First Nations, Inuit, or Metis.

“I would like to provide a reminder that no drug, including Paxlovid, is a substitute for vaccination or public health measures,” Tam said.

“As always, vaccination, including a booster dose, is the best way to protect yourself, your families, and your communities against severe outcomes from COVID-19.”

A national discussion about healthcare for the unvaccinated was reignited last week when Quebec’s premier announced his plans to charge a “significant” fee to those who haven’t been immunized.

François Legault said the fee would be a contribution to cover healthcare costs. Less than 10 per cent of those eligible in the province have yet to get a first dose, but roughly 50 per cent of ICU beds are being occupied by the unvaccinated.

“Right now, these people, they put a very significant burden on our healthcare network,” Legault said.

“And I think it’s normal that the majority of the population is asking that there be consequences. The vaccine is the key to fight the virus, this is why we’re looking for a health contribution for adults that refuse to be vaccinated for non-medical reasons.”

While a poll suggested just over 60 per cent of Canadians were in favour of the move, the legality of a so-called “vaxx tax” has been called into question.

The Canadian Civil Liberties Association has condemned the proposal as unconstitutional.

“We have universal, public health care in Canada. We do not fine individuals who make poor diet and exercise choices, those who choose higher risk occupations or recreational activities. Some essential services – like basic health care for those who are ill – transcend such individual choices,” wrote Director Cara Zwibel in a statement.

“This is a divisive measure that will end up punishing and alienating those who may be most in need of public health supports and services. We know that some of those who remain unvaccinated are individuals who face serious barriers to accessing health care, and many have a low level of trust in the system because of negative experiences in the past. The government should abandon this divisive and constitutionally vulnerable proposal.”

Related articles: 

• Unvaccinated adults in Québec to pay ‘significant’ fee, says premier Legault

• Trudeau doesn’t rule out possibility of Canada anti-vax tax

• Proposal for mandatory vaccine policy troubling for civil liberties group

Asked about the controversial proposal, Prime Minister Justin Trudeau said he couldn’t comment without more information.

“We’ve received that proposal with interest by the Quebec government, but there’s a lot more details that we have to hear on how this would work before I can make any comments on it,” he told reporters. “I continue to work with health experts to look at how we can encourage more and more people to get vaccinated, to get their boosters.”

In the days after Legault’s controversial proposal, Quebec saw thousands of people registering to get their first dose of a COVID-19 vaccine.

With files from HanaMae Nassar and Cormac Mac Sweeney