Initially, there will not be enough approved vaccines available to all individuals who would benefit from them. So, this raises multiple ethical and scientific issues about how to fairly prioritize populations for access to the vaccine. At the global level, richer, more-developed countries may be in a position to receive the vaccine first and to receive more of it, but this is ethically not acceptable nor is it scientifically sound. Similarly, at the local level, disadvantaged communities, certain occupations, and individuals with other serious health conditions are at risk of being left unprotected.

The U.S. National Academy of Sciences is working on a project called A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus which will consider criteria to achieve equitable access to different groups of potential vaccine recipients. The study committee will take into “…account factors such as population health disparities; individuals at higher risk because of health status, occupation, or living conditions; and geographic distribution of active virus spread. In addition, the committee will consider how communities of color can be assured access to COVID-19 vaccines in the U.S. and recommend strategies to mitigate vaccine hesitancy among the American public.”¹

Global public health efforts include The COVID-19 Vaccines Global Access (COVAX) facility, headed by the WHO, the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance, which have been organized to help ensure access for low- and middle- income countries. ²

Persad, et al. have presented a thoughtful framework which provides guidance towards developing a process for allocating proven safe and effective COVID-19 vaccines which seems equitable and is likely to be perceived that way as well. They discuss three ethical values and when examining the benefits of this approach, it’s important to think in terms of both direct and indirect effects. “First, benefitting people and limiting harm is a universal value. Second, prioritizing disadvantaged populations is likewise fundamental. And third, equal concern precludes consideration of differences such as gender, race, or religion, when doing so would not help prevent harm or prioritize disadvantaged groups.”³ Based on these values, they prioritize as first (as do others such as the National Academy of Sciences) in-person healthcare workers followed by “other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with poorer COVID-19 outcomes.”³

There are many complexities to getting this “right”, but guided by ethical values, scientifically-sound data, and practically efficient strategies, it can and must be done for our health now and in the years to come.

References:

1. National Academies of Sciences. A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus. August 2020.

2. Smith T. M. Why distributing a SARS-CoV-2 vaccine will be a global challenge. AMA. Online September 17, 2020.

3. Persad G, Peek M, Emanuel E. Fairly Prioritizing Groups for Access to COVID-19 Vaccines. , JAMA, online September 10, 2020.