Let’s Get Ethical on COVID-19 Vaccine Distribution

​By Keshav Sharma

Keshav Sharma is a freshman at Queen’s University in Kingston, Ontario, Canada, who plans on majoring in Health Sciences.

The COVID-19 pandemic represents one of the most challenging global health crises witnessed in the modern era. It has placed  unprecedented strain on every aspect of society within the USA and across the globe. Healthcare sectors are attempting to curb the rapid growth of COVID-19 cases with limited resources, thereby increasing the demand for tremendous planning of various contingencies (i.e., the rise of community transmission of COVID-19 variants) and effective treatments. While some novel therapies are beginning to show promise, it is widely agreed upon by experts that a mass vaccination response will ultimately bring life as we know it to some degree of normal [1]. With the ongoing developments regarding the nature and mechanisms of SARS-CoV-2, the technical name for the COVID-19 disease, significant advancements have been made in the production and distribution of vaccines within the United States [1]. As of February 27, 2021, the FDA has authorized three COVID-19 vaccines from Pfizer-BioNTech, Moderna, and Johnson & Johnson for emergency use in the population [2]. Given the high demand for such a coveted resource and limited supply, ensuring that the COVID-19 vaccine is allocated in an ethical manner is integral to efficiently reducing the pandemic’s mortality and morbidity.

In order to create a sound ethical framework for current and future vaccination campaigns, it is important to identify goals for distribution and curate approaches for prioritizing specific groups within a population to guide vaccine allocation. Gupta and Morain (2021) propose three central tenets for vaccination campaigns: reducing mortality and morbidity caused by COVID-19 [4]; decreasing the pandemic’s impact on societal and economic infrastructure [5]; and lessening the impact of health inequalities among systematically disadvantaged groups [6]. 

Some strategies have been considered in vaccine allocation campaigns but they do raise issues within themselves. The first is to designate the highest priority to the most vulnerable groups to morbidity and mortality from COVID-19. Current epidemiological data suggests that prioritizing the most vulnerable populations would refer largely to individuals over the age of 65 and with existing illnesses such as hypertension, diabetes, cardiovascular disease, etc [7]. This would best fulfill the goal of reducing COVID-19’s significant health repercussions and at least partially reflect well on the shift of strategy from protecting the elderly to economic revival [3]. However, it will not change the rise in non-fatal cases, which will continue to place a strain on healthcare systems [3]. 

Another strategy is to give precedence to individuals with functional value to the pandemic effort. This would include front-line healthcare workers, individuals who perform life-saving services (i.e., EMS, fire services, police, etc.), and other essential workers from the food industry (i.e., delivery truck drivers) [3]. This strategy would align with the goal of minimizing the pandemic’s impact on the economy and societal infrastructure, seeing that workers are performing essential functions under the risk of infection due to the multitude of social contacts that they have compared to the rest of the population [8]. This does raise moral questions regarding the minimal impact that this may have on reducing morbidity and mortality given that the most vulnerable groups to severe infection may not necessarily be involved. 
These strategies, coupled with other major unknowns such as the efficacy and safety of vaccines in the long term (especially in children), disparities in reopening plans between states, and the need for more data on patterns for disease amongst specific subpopulations, makes it increasingly unlikely that there is a single way for ending the pandemic [3, 9]. The optimal and most ethical vaccine distribution framework will ultimately involve a combination of the aforementioned strategies and some new strategies. 
In all, these considerations highlight the importance of transparency in communicating decisions regarding vaccine allocation strategies as well as the reasons behind those decisions and how they reflect community values. This means a coordinated response from both national and state governments to determine specific approaches for vaccine distribution according to case distribution, demographics, and other social determinants of health (i.e., income, education, etc) [3]. These approaches can be actualized at a community level by designing a framework that allocates the first available doses of the COVID-19 vaccines by appointment to vulnerable populations (particularly the residents and staff in long-term care facilities; marginalized groups with high population density and low income; and essential healthcare workers at hospitals and other medical institutions) to ease the burden on distribution chains and ensure that the supply of vaccines can gradually increase to accommodate the rest of the public. This vaccine allocation framework can be extended further by assessing each state’s capacity for medical care, distributing and possibly producing the vaccine in the event of supply shortages, and how well the country has contributed to global vaccine development efforts [10]. 
With the COVID-19 vaccine soon to become a mainstay in our society, these recommendations, among others, may provide the necessary boost to the light at the end of the long tunnel that is the COVID-19 pandemic.


References

1. Schaffer DeRoo, S., Pudalov, N. J., & Fu, L. Y. (2020). Planning for a COVID-19 Vaccination Program. JAMA, 323(24), 2458–2459.
   
2. FDA (2021). COVID-19 Vaccines. U.S. Food and Drug Administration. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.  
   
3. Gupta, R., & Morain, S. R. (2021). Ethical allocation of future COVID-19 vaccines. Journal of Medical Ethics, 47(3), 137–141. 
   
4. Centers for Disease Control and Prevention. (2020, June 2). Interim Updated Planning Guidance on Allocating and Targeting Pandemic Influenza Vaccine during an Influenza Pandemic. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/pandemic-resources/national-strategy/planning-guidance/index.html. 
   
5. Kass, N. E. (2001). An Ethics Framework for Public Health. American Journal of Public Health, 91(11), 1776–1782. 
   
6. van Dorn, A., Cooney, R. E., & Sabim, M. L. (2020). COVID-19 exacerbating inequalities in the US. The Lancet, 395(10232), 1243–1244. 
   
7. Wang, D., Hu, B., & Hu, C. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA, 32(11), 1061–1069. 
   
8. The Lancet. (2020). The plight of essential workers during the COVID-19 pandemic. The Lancet, 395(10237), 1587. 
   
9. Yonker, L. M., Neilan, A. M., & Bartsch, Y. (2020). Pediatric SARS-CoV-2: clinical presentation, infectivity, and immune responses. Journal of Pediatrics. 
   
10. Liu, Y., Salwi, S., & Drolet, B. C. (2020). Multivalue ethical framework for fair global allocation of a COVID-19 vaccine. Journal of Medical Ethics, 46, 499–501. 
    

Image Source: “Should Ontario make a COVID-19 vaccine mandatory?” TVO. 7 Aug., 2020, https://www.tvo.org/article/should-ontario-make-a-covid-19-vaccine-mandatory

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