Disabled people must be prioritized in the vaccine rollout

At every stage of the pandemic, governments across Canada have enacted policies that have contributed to the needless death and debilitation of disabled people, particularly those confined in institutional settings. Now, amidst nationwide outbreaks in institutions, disabled people are once again being left to die through failures in vaccine rollouts, ableist triage protocols and proposed changes to the Health Care Consent Act.

Consider the decision to maintain poverty rates of provincial disability support ($1,350 in Ontario, $1,093 in Manitoba, and $1,182 in British Columbia) while the Canada Emergency Response Benefit proved that people need, at minimum, $2,000 per month to survive. These meagre payments have forced some to apply for Medical Assistance in Dying (MAiD), simply because they “cannot afford to keep living.” Meanwhile, discussion about the plight of disabled Canadians has been markedly absent in the House of Commons in recent months, aside from debates around the expansion of MAiD, which has been widely critiqued by the disabled community.

Disabled people are disproportionately dying from COVID-19, yet they remain excluded from policy responses to the virus. Studies in the United States and the United Kingdom have found that disabled people, particularly those with intellectual or developmental disabilities, are two to three times more likely to contract COVID-19 and die, especially among younger demographics. In Canada, there has yet to be disaggregated data released on the impacts of the pandemic upon disabled people. This statistical dearth is setting the stage for a vaccination rollout that will leave many vulnerable people behind.

Global vaccine access

As countries roll out their vaccination plans, it is becoming clear that disabled people are not being prioritized for access in the same way as other at-risk groups. And, despite growing calls for global vaccine justice, as wealthy countries, including Canada, continue to hoard vaccine doses while defending intellectual property rights for corporations. Canada has purchased enough vaccines to inoculate our entire population six times over, whereas just one in 10 people in the Global South are anticipated to be vaccinated in 2021.

The same capitalist system that created “vaccine nationalism” produced the conditions of mass debilitation in which 80 percent of the global disabled population live in the Global South. Disability theorist Helen Meekosha explains that the “production of impaired peoples continues as a result of a multiplicity of phenomena including: war and civil strife, nuclear testing, the growth of the arms trade, the export of pollution to ‘pollution havens’ and the emergence of sweatshops.” The ‘production’ of disability is especially significant during the COVID-19 pandemic, as many of these conditions put people at high risk of serious complications from the virus.

Prioritizing disabled people’s access to the shot will mean making the vaccines public, and putting an end to for-profit models of health care delivery in Canada and beyond.

Vaccine rollout

Across Canada, the US, the UK and Australia, subnational governments are scrambling to put together their vaccination rollout strategies. All of these countries have relied on an age-based model which does not make adjustments for health conditions and disability. While governments often point to the simplicity of this approach, abundant evidence calls for the inclusion of disabled people in priority access groups. However, in many jurisdictions, decades of cuts to public health units, poor planning and supply shortages mean the delivery of shots will be delayed. In Québec, for example, the provincial government’s decision to complete mass vaccinations without the second booster shot has jeopardized the province’s stock of vaccines.

Disability advocates including Alice Wong have been calling for greater inclusion in vaccine rollout plans using the hashtag #HighRiskCA. Commenting on the recent changes to the vaccine rollout in California (which does not account for disabled people), Wong explains, “Age is not the only factor in determining risk. This decision by the Newsom administration is an act of violence and erasure toward groups disproportionately impacted by the pandemic. It is racist, classist, and ableist.”

These oversights are magnified by a belief—widely held by Western capitalist states—that mass vaccinations will be a “cure-all” solution to the crisis, despite warnings from virologists that many known antiviral drug treatments are still being overlooked in a mad scramble to deliver immunizations.

Manitoba

Mark Carreiro was a 36-year old disabled man who was institutionalized for two decades at the St. Amant Centre in Winnipeg. He died after contracting COVID-19 during an outbreak, yet today congregate living settings are exempt from early access to vaccines.

The Manitoba government has been criticized for its lack of preparedness and slow rollout of its vaccination program. At the time of writing, less than 40 percent of the doses received have been administered. What’s more, the Pallister government waited until January to post a job for a provincial director of immunization, which they have called a key role in helping to protect Manitobans during the pandemic.

Winnipeg’s Riverview Health Centre is one institution in the province where disabled people are currently warehoused. Riverview is a 387-bed institution that features a number of programs, including rehabilitation, palliative care, and long-term care. It has 257 rooms and a Complex Continuing Care Program for adults of all ages whose care needs cannot be met in traditional personal care homes. Due to the varying needs of Riverview’s residents, there is inconsistency between vaccine distribution for people in different programs within the same institution. Indeed, those warehoused in Riverview under the Complex Continuing Care Program were not included in the initial vaccine rollout within the facility.

St. Amant, where Carreiro died of COVID-19 after an outbreak was announced, warehouses approximately 150 disabled children and adults. To date, there have been no announcements of specific measures to vaccinate disabled people incarcerated in these two institutions.

Québec and Ontario

Ontario and Québec are in the midst of the worst of the second wave of COVID-19. They are foregoing additional public health measures such as closing down non-essential manufacturing plants in favour of mass vaccination—and it’s not going to plan. Both provinces released their critical care triage protocols two weeks ago in anticipation of ICUs reaching 200 percent capacity, placing disabled and older communities at greater risk of death by neglect.

In Ontario, the same reliance on institutions has resulted in outbreaks across the province, and these have been exacerbated by vaccine rationing in congregate care settings. Further, the largest outbreak in the Ottawa region has resulted in a third of the residents at Edgewood Care Centre—a residential service home in Ottawa where between 120-130 disabled adults are confined—contracting COVID-19. Despite being classified as a long-term residential institution, these residents are not included with long-term care and retirement homes in the first wave of the vaccination rollout.

Québec has garnered international attention for its failure to follow vaccination protocols and for not administering the second booster shot within two weeks. Disabled and older people in institutions who received the first dose have protested the decision to delay the second one.

Triage protocol

Governments need to do a better job of caring for disabled people during the vaccine rollout. Their failure to account for this vulnerable demographic is especially egregious in the face of provinces needing to implement triage protocols as ICUs reach capacity.

Triage protocols determine which patients get access to life-saving medical interventions when there are not enough beds or services available. Disabled people have been protesting the introduction of the triage protocol for nearly a year, recognizing that the medical field consistently underestimates the quality of life for disabled people. Within capitalists societies disabled lives are too often both neglected and deemed not worth saving. The very fact that triage protocols are necessary illustrates the failure of decades of neoliberal governance that has decimated the public health system, and left us unprepared nearly a year into the pandemic.

Complementing the triage protocol, the Ontario legislature is considering suspending the Health Care Consent Act through an order in council. This executive order would allow for doctors to withdraw treatment without the consent of the patient, or their family. Disability justice activists are concerned about the impact this will have on Black, Indigenous, poor, queer and disabled people, given Canada’s long history of medical coercion.

During outbreaks in multiple long-term care institutions, management sent out emails encouraging families to sign do-not-resuscitate orders, claiming there was no use offering life-saving care. Potential changes to the Health Care Consent Act would place undue ethical and moral authority on medical practitioners. In the words of disability justice leader Sarah Jama, “In the same way there is a silent brotherhood in policing, there is a silent brotherhood of medical professionals who at times protect their own when harm is caused.”

In the rush to vaccinate the country, equity and inclusion must be key priorities. What’s more, we must mourn those who have been killed by institutionalization, pandemic profiteering and government inaction, and fight to keep each other safe.

Megan Linton is a disabled, occasional writer and graduate student based in Winnipeg and Ottawa. Her research interests focus on sexual citizenship, institutions and disability, with a commitment to disability justice. Find her tweeting about sex and disability @PinkCaneRedLip.

Allen Mankewich is a disabled man living in Winnipeg. You can find him on Twitter @AllenMankewich.