Fairly Prioritizing Groups for Access to COVID-19 Vaccines

Abstract

The supply of any successful vaccine for coronavirus disease 2019 (COVID-19) will initially be limited. Who should have access first? The US National Academy of Medicine (NAM) has proposed a framework for COVID-19 vaccine allocation. 1 Others have discussed distributing vaccine among countries. 2 This Viewpoint delineates how ethical values should guide prioritization of a COVID-19 vaccine among populations within the US. The discussion may be relevant to other countries as well.In vaccine prioritization, ethics interacts with important scientific and practical questions. These include whether a vaccine will prevent SARS-CoV-2 transmission and what medical factors affect vaccine effectiveness, dosing, and durability, as well as COVID-19 infection rates and outcomes among those not vaccinated. To the extent that a vaccine does not prevent transmission, but just reduces the severity of illness, its effect and distribution should resemble therapeutics that only protect direct recipients. 3

The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020

“…¶ Although there is considerable overlap between groups ** (10), the initial supply will not be adequate to vaccinate the entirety of all four groups; for example, there are approximately 100 million health care personnel and essential workers (Table 2). Published frameworks for COVID-19 allocation and ACIP discussions indicate a clear consensus that the first allocation of COVID-19 vaccine supplies should be directed to health care personnel (1,(5)(6)(7)(8); discussion of allocation to the other three groups is ongoing. As additional vaccine supplies become available, other groups may be vaccinated concurrent with health care personnel.…”

“…This consideration is particularly relevant because the COVID-19 pandemic has highlighted long-standing, systemic health and social inequities. Although various frameworks for COVID-19 vaccine allocation demonstrate differences in their structure (e.g., based on varying combinations of different goals, objectives, criteria, and other structural elements) and emphasis (e.g., inclusion of global and national considerations), nearly all reference values and principles similar to those which ACIP considers fundamental (5)(6)(7)(8). ACIP viewed the following characteristics as critical for its ethical approach to COVID-19 vaccine allocation when supply is limited: simplicity in structure and definitions; acceptability to stakeholders; and ease of application, both at the national and state, tribal, local, and territorial levels.…”

“…review of the epidemiology of COVID-19 and consultation with experts in ethics and health equity to inform the development of an ethically principled decision-making process. The Work Group reviewed the relevant literature, including frameworks for pandemic influenza planning and COVID-19 vaccine allocation (3)(4)(5)(6)(7)(8); summarized this information; and presented it to ACIP. ACIP supported four fundamental ethical principles to guide COVID-19 vaccine allocation decisions in the setting of a constrained supply.…”

COVID-19 vaccines - are we there yet?

“…There is general agreement that front-line workers, such as healthcare staff, and individuals at the highest risk of severe disease, particularly the elderly, should be prioritised to receive COVID-19 vaccines once available. [25][26][27] A key question is how well vaccines that show protection in young, healthy individuals will work in people who have chronic medical conditions or are immunocompromised, and in older people, particularly those who are frail or living in residential care. Up until 2020, the only vaccine with high levels of protection in older people (>70 years) is a recombinant shingles vaccine which uses a novel adjuvant.…”

Vaccine Prioritisation Using Bluetooth Exposure Notification Apps

“…elderly individuals receiving the Pfizer/BioNTech vaccine. These groups were recommended for vaccine prioritisation [4,3] based on the high rate of mortality and other severe outcomes experienced by elderly individuals [13] and the principle of reciprocity, which states that those who accepted the greatest risks to mitigate the effects of the pandemic, should be vaccinated first [36].…”