Nicholas Kadysh: The world isn’t fair. Neither is COVID. We won’t change that

We talk a lot about equity in our pandemic responses. How’s that working out for the working poor?

By: Nicholas Kadysh

The world is not fair. Let’s just get that out of the way. It’s not fair, and it’s not going to become so.

Diseases, not being a product of man but a fact of nature, are also not fair. Malaria kills nearly a million people every year, overwhelmingly children. In almost every year (except this one), influenza will take the lives of about 7,000 people — and it will almost always kill the very old and the very young. COVID, too, has no sense of fairness about it: it kills the very old, true. But then it also sometimes kills young, healthy people in the prime of life. For reasons yet to be understood, it doesn’t tend to kill the very young — a fact that has kept parents everywhere from descending into abject madness over the past year. But as anyone who’s lost a loved one to the disease will tell you, it’s not fair, or “equitable.” It just is.

Canada’s response to COVID, though, is all about equity. We’re positively awash in equity in Canada in 2021. Vaccine rollouts should reflect equity by targeting high-risk populations. No-show lists are problematic, because they might not be equitable. The Ontario plan for vaccine distribution features equity prominently. Equity and fairness — who could be against that?

Which is why I was concerned to read in Reuters that Canadians were flying to the U.S. to get their vaccination, having decided that the vaccine rollout here in Canada did not meet the mark for either equity or fairness. They’re voting with their feet.

And just how have we done on those metrics? The focus on equity was meant “to reduce disparities in illness and death related to COVID-19” according to the Ontario plan; the third wave, which is rapidly abating across the country, overwhelmingly affected working-class people in ethnic minority communities. So, yeah, not great. 

But what about fairness? Fairness, here, means “to ensure that every individual within equally prioritized groups has the same opportunity to be vaccinated, and to ensure inclusive, consistent processes.” As anyone who has played the “Ontario Vaccine Hunt” game will attest, the process has not been consistent. I don’t think I’d even call it a “process,” except in the very loosest sense of the word — it’s more of a mad scramble.

OK, so our vaccine rollout hasn’t been very equitable. But our equity really shines when it comes to the big, important stuff: confining seniors to LTC unnecessarily, because it wouldn’t be equitable to force LTC staff to get vaccinated. Not getting to work on vaccine passports early, because we got angry at a few cases of queue-jumping back in January. Closing schools in Timmins because of outbreaks in Toronto. While governments have been aiming for the equity high score, they’ve been coming up a bit short at actually managing the pandemic.

Looking at it a bit closer, it seems our obsession with equity is maybe not so helpful. Making it harder for Canadians wishing to get vaccinated in the U.S. in May of 2021 isn’t helping anyone. The U.S. is literally offering vaccine doses to tourists; every dose which goes to a Canadian in the U.S. frees up a dose for Canadians here — and almost by default, the Canadian being jabbed at home will be less privileged — less able to travel at a whim — than the ones jetting south for Disney and a dose. It’s a win-win. Denying this is just a creative reason to prolong the pandemic.

For more on equity, we turn now to Dr. David Williams, Ontario's now outgoing chief medical officer of health:

Laura Stone @l_stone

Williams says Ontario doesn't want people getting second dose while others are queuing up for first dose, but also don't want vaccines sitting around...considering moving up second doses, but no firm commitment. "We want it done as soon as we can and we'll let you know on that."

Is it fair that some people, somewhere are getting second shots when someone elsewhere hasn’t gotten their first? Of course not, but that’s a terrible bloody reason for not doing it. I can’t believe I have to say this, but some people aren’t actually all that interested in getting a vaccine. Others are at incredibly low risk. These decisions must be made with science and practicality in mind; telling an 80 year old that they have to wait another few months because we haven’t quite gotten to all the 15 year olds yet is madness. 

But it’s equitable, right?

The virus isn’t being fair to the 80 year old. The world isn’t being fair to Canada. And lest we forget, we’re not being fair to the world either: not some months ago our government made the decision to access the COVAX facility — meant for the world’s poorest countries — for additional doses. We were the only G7 country to do so. That wasn’t fair, or equitable, and we did it anyway. It lays bare the truth: we’re not so equitable when it counts. 

So, again, the world isn’t fair, and it’s not going to become fair. More and more, equity is just the lie our governments tell us when they don’t feel like making the tough decisions.

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