Let’s clear up the confusion over talk of a ‘preferred’ vaccine

by Raywat Deonandan
May 5, 2021

This article was published in The Ottawa Citizen on May 5, 2021.

I’m fond of citing a paper from 2007 about lessons learned from SARS that we should apply to the next pandemic. Its number one recommendation was that there should be transparent communication between all parties, including to the public. And yet this is where we have stumbled throughout every step of this emergency.

The latest such stumble comes from NACI (the National Advisory Committee on Immunization), who stated that the mRNA vaccines (Pfizer and Moderna) are “preferred” but that those who “do not wish to wait” for an mRNA could accept one of the viral vector vaccines — AstraZeneca or Johnson & Johnson — if “the benefits outweigh the risk for the individual.”

NACI’s role is to quantify risk and reward with respect to vaccination, and to advise decision-makers via the Canadian Immunization Guide, which is a guidance document meant for use by health-care professionals and vaccine program managers. In times of pandemic, however, NACI’s words are being parsed and interpreted in real time by an audience with whom the committee had never before had to deal directly: the general public.

Communicating with the public is starkly different from offering guidance to health-care professionals. Words such as “preferred vaccine” are, frankly, triggering, and introduce an element of classism into the fracas. Who mostly got the “less preferred” vaccine? Essential workers. Poor people. Racialized people.

Predictably, those Canadians who had dutifully accepted the AstraZeneca vaccine, after having been told by health leaders to “get the first shot that is offered,” feel betrayed. As someone tweeted to me, it’s like the Boomers made GenX take all the risks while keeping “the good stuff” for themselves — like wanting others to eat the no-name cookies before opening up the Oreos for themselves.

I have four immediate thoughts about this latest episode in the ongoing daytime soap opera that is our vaccine rollout and its endless communication missteps.

First, it’s important to take a moment to appreciate what an astonishing thing it is to have a choice of which life-saving vaccine to accept in the middle of a deadly pandemic. Most parts of the world don’t have that luxury. So while the government messaging is often confusing, let’s be thankful for the luxury of that confusion.

Second, “preference” isn’t simply a matter of choice. It’s also a matter of circumstance. The AstraZeneca jab is in many ways the vaccine of the world. It is inexpensive, easily made (compared to the mRNA doses), and can be transported and stored with less consternation. For many parts of the globe, it is the preferred vaccine as it will drag large populations out of this crisis.

Similarly, the Johnson & Johnson vaccine famously only requires one dose, so is ideal for the homeless, the nomadic, or migrant workers — any group for whom scheduling the second dose could be difficult, if not impossible. Clearly, for them J&J would be the preferred vaccine.

Third, preference and choice are luxuries not only for those with access to multiple formulations, but also to those who can afford to wait for their favoured brand. Many communities in Canada cannot wait. Hot-zone neighbourhoods, essential workers, and poor and racialized people who are at great risk of COVID infection cannot afford to wait.

Maybe you prefer Perrier to tap water, but when you’re dying of thirst, you’d best take the first glass of water offered.

Fourth, those Canadians who received the AstraZeneca vaccine should not feel cheated or coerced. Every day spent unvaccinated is a day in which they could have contracted COVID and possibly be fighting for their lives in an ICU ward. This is especially true if they live in a hot zone or are essential workers.

The lesson from all of this, as it has been from the very beginning, is that the pandemic is all about equity. Some groups are more likely to be exposed and infected, to be rendered unemployed, to be hospitalized and die, to lack access to a vaccine, and now to be unable to wait for a “preferred” vaccine, however problematic and incorrect that term might be. Ill-considered messaging does not alleviate the strain of inequity, and might indeed serve to exacerbate it.

There are no second-class COVID vaccines in Canada. They all get the job done.


Raywat Deonandan is an Epidemiologist and Associate Professor with the Faculty of Health Sciences, University of Ottawa.