'Ethical guidelines can help steer and support decisions around prioritization of limited resources.'
With three vaccine makers—Pfizer, Moderna and AstraZeneca—now reporting that their COVID-19 shots are 90% or more effective, governments are starting to make decisions about how to distribute the first doses, which will be in limited supply. In the U.S., that initial group will include health care workers, essential workers like law enforcement personnel and first responders, adults with chronic health conditions, and adults over 65 years of age.
In a report published Monday in the Morbidity and Mortality Weekly Report (MMWR), the U.S. Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP) laid out four ethical principles that it says should guide how to distribute the first limited doses of any authorized vaccine to those groups.
“During a pandemic, ethical guidelines can help steer and support decisions around prioritization of limited resources,” the authors write. “Consideration of ethical values and principles has featured prominently in discussions about allocation of COVID-19 vaccines. This consideration is particularly relevant because the COVID-19 pandemic has highlighted long-standing, systemic health and social inequities.”
Those principles include maximizing benefits, which means focusing on people at highest risk of COVID-19, as well as people who are critical to keeping others protected and healthy, such as health care workers. Another important principle is justice, to ensure that everyone, regardless of their economic or social situation, can have access to the vaccine. Related to this is the importance of mitigating health inequities, which are especially apparent with COVID-19, since people of certain racial and ethnic backgrounds are more severely affected by the disease.
Those making decisions about how to distribute any authorized vaccines, the ACIP concludes, should keep in mind ways to even out such disparities and ensure that differences in access or health outcomes are not exacerbated. Finally, the group urged transparency in explaining how prioritization decisions are made, so the public understands the data and evidence on which they were based.
Such transparency could go a long way toward rebuilding the public’s trust in the scientific process behind the vaccines, which has been eroded by confusing and conflicting messages in recent months. Revealing the reasons why certain decisions about allocating limited vaccine doses are made could start to increase people’s confidence in public health advice and its ability to support the health of not just individuals, but populations as well.