We encourage every practice to further focus on key populations within your list of eligible patients. This is particularly important when we open up to phase 3 and 4 where the criteria are broader and we are more likely to want to ensure those at more risk get immunized earlier.

Equitable Prioritization within each Phase

COVID-19 Immunization is not like the Flu Immunization

We cannot treat COVID-19 immunization like another flu immunization. Especially in primary care, we need to advocate for and ensure equitable immunization of our patients. Those who are at higher risk for contracting COVID-19 and who have worse outcomes are those who are generally less likely to advocate for themselves.

An open booking approach (e.g., email notification or open online booking) does not ensure an equitable immunization process. Those who are already marginalized may not have access and may miss an online call for immunizations. Thus, we need to be proactive in our prioritization of eligible patients.

Equitable Prioritizing of Eligible Patients

As primary care providers with our long-standing, trusted relationships with our patients, we can help improve equitable access to immunization. At each stage of the overall immunization program, we can be proactive to help reach out to those who are harder to reach through public health measures. In your office, begin by reaching out early to people before each new phase to ensure all people have a chance for immunization.

Most EMRs will not have sufficient data needed for this step. Instead, we suggest you review as a team (whoever is in your team who knows the patients including your office assistants, nurses, etc.).

Prioritizing based on Risk of Exposure

Think beyond the standard public health categories of long-term care:

  • Patients who are essential workers with exposure risks or those whose in-person work is essential as they cannot get time off.
  • Patients living in multi-generational and multi-family homes that are not considered “congregate living”.
  • Patients in other supportive housing units or temporary housing with shared services (kitchens, etc.)
  • Patients living with others at even higher risk who are not (yet) immunized or who have declined to be immunized.

Consider race, ethnicity, culture, language, immigration and refugee status. Diverse populations have differential access to healthcare. Lower immunization rates have been observed in immigrant children and seniors. Immigrant/refugee populations or migrant workers may have differential exposure risks.

PHAC has summarized vulnerable populations in general here (and the PDF on this page has multiple language options that may be helpful).

Prioritizing based on Additional Medical Risk

If you have not done so when identifying patients for eligibility, you can also use medical risk factors to prioritize. See the previous section that describes how to do this with eligibility criteria. You can add these, if you have not before.

Once you have identified and prioritized, it is time to plan your immunization clinic.

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