Who should get the COVID-19 vaccine first?

Credit: CC0 Public Domain

When effective COVID-19 vaccines are developed, their supply will inevitably be scarce.

The World Health Organization (WHO), global leaders, and vaccine producers are already facing the question of how to appropriately allocate them across countries.

And while there is a vocal commitment to “fair and equitable” distribution, what exactly does “fair and equitable” look like in practice?

In a new paper, researchers have proposed a new, three-phase plan for vaccine distribution—called the Fair Priority Model—which aims to reduce premature deaths and other irreversible health consequences from COVID-19.

The research was conducted by nineteen global health experts from around the world.

Though little progress has been made to describe a single, global distribution framework for COVID-19 vaccines, two main proposals have been made:

Some experts have argued that health care workers and high-risk populations, such as people over 65, should be immunized first. The WHO, on the other hand, suggests countries receive doses proportional to their populations.

From an ethical perspective, both of these strategies are “seriously flawed,” according to the team.

In their proposal, the researchers point to three fundamental values that must 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.

The Fair Priority Model 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.

Of all of these dimensions, preventing death—especially premature death—is particularly urgent, the authors argue, which is the focus of Phase 1 of the Fair Priority Model.

Premature deaths from COVID-19 are determined in each country by calculating “standard expected years of life lost,” a commonly-used global health metric.

In Phase 2, the authors propose two metrics that capture overall economic improvement and the extent to which people would be spared from poverty.

And in Phase 3, countries with higher transmission rates are initially prioritized, but all countries should eventually receive sufficient vaccines to halt transmission—which is projected to require that 60% to 70%t of the population be immune.

The WHO plan, by contrast, begins with 3% of each country’s population receiving vaccines, and continues with population-proportional allocation until every country has vaccinated 20% of its citizens.

The team argues that, while that plan may be politically tenable, it mistakenly assumes that equality requires treating differently-situated countries identically, rather than equitably responding to their different needs.

In reality, equally populous countries are facing dramatically different levels of death and economic devastation from the pandemic.

The team also objects to a 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.

They say that preferentially immunizing health care workers—who already have access to personal protective equipment (PPE) and other advanced infectious disease prevention methods—likely would not substantially reduce harm in higher-income countries.

Similarly, focusing on vaccinating countries with older populations would not necessarily reduce the spread of the virus or minimize death.

Moreover, low- and middle-income countries have fewer older residents and health care workers per capita than higher-income countries.

One author of the study is Ezekiel J. Emanuel, MD, Ph.D. at the University of Pennsylvania.

The study is published in Science.

Copyright © 2020 Knowridge Science Report. All rights reserved.