Alumni News: Global health experts propose ethical framework for vaccine allocation

In this Policy Forum, Ezekiel Emanuel and leading ethicists from around the world outline a proposal for a new, three-phase plan for vaccine distribution for COVID-19 -- called the Fair Priority Model -- which they say is "the best embodiment of the ethical values of limiting harms, benefiting the disadvantaged, and recognizing equal concern for all people." As the COVID-19 pandemic continues and the world awaits a vaccine, questions remain about a single, global distribution framework for a vaccine or vaccines that first become available. The World Health Organization (WHO) has advocated distributing a vaccine proportional to a country's population, but this, say Emanuel and colleagues, is a flawed approach because it "mistakenly assumes that equality requires treating differently situated countries identically." The authors also highlight questions that remain about any distribution plan that would prioritize countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country, an approach they say might end up giving the vaccine in large part to the wealthy, as one consideration. They say more research is needed into what prioritizing the impacts of these groups may be. Emanuel and colleagues emphasize three fundamental values they believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and giving equal moral concern for all individuals. Their Fair Priority Model, as they call it, addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as economic destruction. The authors say it will be up to political leaders, the WHO, and manufacturers to implement this model. And to those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," they argue such a framework still has broad relevance; it would be reasonable, they say, for countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. "When a government reaches the limit of national partiality, it should release vaccines for other countries," they say.