Bioethics in a Pandemic: Vaccine Distribution

After months of stay-at-home orders, quarantine protocols, social distancing, and back-to-school planning, the ever- present question on everyone’s mind is, When will we get back to business as usual?  For many, the answer involves discussion of a safe and effective vaccine, including when it will be available and who will be able to get it. Even though a vaccine likely won’t be available until 2021 at the earliest, experts are already thinking about how to distribute it.  This post is the first in a blog series that will consider the various bioethics issues and principles related to the COVID-19 pandemic.

Last month, the directors of the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) charged a group of independent scientists and ethicists with developing guidelines to determine who should get the first doses of an FDA-approved COVID-19 vaccine. 

The goal of the guidelines is to provide an equitable and transparent framework for the CDC to use in distributing the first doses of vaccine. The committee’s project description includes the following questions:

• What criteria should be used in setting priorities for equitable allocation of vaccine?
• How should the criteria be applied in determining the first tier of vaccine recipients? As more vaccine becomes available, what populations should be added successively to the priority list of recipients? How do we take into account factors such as:
  • Health disparities and other health access issues
  • Individuals at higher risk (e.g., elderly, individuals with underlying health conditions)
  • Occupations at higher risk (e.g., health care workers, essential industries, meat packing plants, military)
  • Populations at higher risk (e.g., racial and ethnic groups, incarcerated individuals, residents of nursing homes, individuals experiencing homeless)
  • Geographic distribution of active virus spread
  • Countries/populations involved in clinical trials
• How will the framework apply in various scenarios (e.g., different characteristics of vaccines and differing available doses)?
• If multiple vaccines are available, how should we ensure equity?
• How can countries ensure equity in allocation of COVID-19 vaccines?
• For the US, how can communities of color be assured access to vaccination?
• How can we communicate to the American public about vaccine allocation to minimize perceptions of lack of equity?
• What steps should be taken to mitigate vaccine hesitancy, especially among high-priority populations?

There seems to be broad consensus among governing officials and public health leaders alike that health care professionals and other essential workers should receive priority given their heightened risk of exposure and critical role in providing essential services. But even this consensus still generates questions. Here are a few that we would pose to the committee:

• What professions and roles are included in essential work?
• Once health care professionals and other essential workers are vaccinated, should the elderly and immunocompromised be prioritized, given their increased risk of severe reactions to the virus?
• What about younger adults and school-age children, given the possibility of asymptomatic viral transmission?
• Or, do we prioritize residents of regions experiencing a surge in cases in order to prevent community spread?
• How do we ensure equitable distribution? Will people who are uninsured, experiencing homelessness, or otherwise lacking easy access to a vaccine be prioritized?
• To what extent will the U.S. provide assistance and resources internationally, especially to countries with less developed health care infrastructure?

A draft of the guidelines is expected by the end of August, at which time the public will have an opportunity to provide comments.  As we mentioned, this post is the first in a series considering the various bioethics issues and principles related to the COVID-19 pandemic, check back for more soon!

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