An Equity-Focused Comprehensive Analysis of COVID-19 Vaccine Rollout and Prioritization Strategies Across Six Canadian Provinces: Addressing the Needs of Vulnerable and High-Risk Populations

Objectives: This study examined how six Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Quebec) adapted guidelines from the National Advisory Committee on Immunization to prioritize COVID-19 vaccines equitably for five key populations at high risk: Black communities; First Nations, Inuit, and Métis populations; non-medical essential workers; individuals experiencing homelessness; and individuals with disabilities. The objective was to compare timelines, justifications, and contextual factors that influenced provincial prioritization for early vaccine access. Methods: A mixed-methods approach was used to investigate how provinces operationalized equity in their vaccine rollout plans. Environmental scans (December 2020 – May 2021) gathered data on prioritization and distribution from provincial reports and media articles. Key informant interviews (December 2021 – April 2022) with provincial experts provided context on decision-making and justifications for prioritizing key populations. Data analysis employed the “Reach” component of the RE-AIM framework, with qualitative analysis of interviews following an interpretive descriptive approach. Results: Provinces used age-, risk-, and health status-based approaches to select priority populations. While all provinces consulted the National Advisory Committee on Immunization guidelines and various ethical frameworks to guide their decisions, deviations occurred due to local contexts. First Nations, Inuit, and Métis populations were prioritized earliest in all provinces, while Black communities received the least prioritization. Key subgroups, such as urban First Nations, Inuit, and Métis, unsheltered homeless individuals, and homebound disabled persons, were often overlooked. Factors that emerged as key drivers of priority population selection were data availability, population size, and geography. Conclusions: This study fills gaps in the literature by highlighting key contextual factors unique to each province that drove provincial justifications for their prioritization decisions. We provide several examples of the importance of data availability and early community-led partnerships when designing a successful mass vaccination rollout.