How should we conduct pandemic vaccination?

Abstract

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed?In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term.

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“…The extent of indirect effects is however more challenging to anticipate, as they arise from reduction in susceptibility and transmissibility as well as on vaccine coverage. Protecting those with the poorest outcomes does not conflict with relying on indirect effects, as long as it is an effective way to deliver interventions [33] .…”

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“…The vaccine distribution strategies should also be adjusted based on distinct objectives, e.g. saving the most population, focusing on the groups at greater risk, and guaranteeing societal benefits [ 161 ]. If the situations have to deal with tight resource constraints, process integration technologies that incorporate mathematical programming would be a favourable option [ 162 ].…”