Who Gets It First?
The Ethics of COVID-19 Vaccine Distribution
Lia Sprouse
We're all living in COVID right now. We've all been cooped up for months, avoiding interaction and trying not to let the pandemic play too much on our minds. We all want a vaccine. But what does the road to that shot look like? And is the current prioritization mechanism ethical? How can we divide up society into groups to decide that all-important question: who gets it first?
Figure 1. Healthcare worker in PPE. Van Beusekorn, Mary. "Studies: 1% of Healthcare Workers had COVID-19." CIDRAP, 21 May 2020, https://www.cidrap.umn.edu/news-perspective/2020/05/studies-1-healthcare-workers-had-covid-19. Accessed 17 December 2020.
Figure 2. Vial of Pfizer coronavirus vaccine. Peña, Christian. "Healthcare Workers Warn of Potential COVID-19 Vaccine Scam Phone Calls." NBC News, 16 December 2020, https://www.nbcnews.com/business/consumer/health-experts-warn-potential-covid-19-vaccine-scam-phone-calls-n1251397. Accessed 17 December 2020.
Background
Worldwide, COVID has infected over 74 million people. As of December 17, there have been 17 million cases in the United States and over 300,000 deaths. Hospitals are strained, people are dying, and the need for a vaccine is pressing (Grady).
Two vaccines are of current interest.
Moderna: 94.5% efficacy rate
Pfizer: 90% efficacy rate
Both of those statistics are outstandingly high (Thomas).
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The problem is that between Moderna and Pfizer, we will only have a maximum of 20 million doses by the end of December 2020 with a US population size of over 300 million. Widespread accessibility is likely months away (Grady). There will be more demand for the vaccine than supply; thus, an allocation plan has to make hard, discerning ethical choices as to who gets it before production ramps up and the general population can be inoculated.
This site constitutes an investigation into several groups that all have the potential to be prioritized for a vaccine. I'll discuss the ethical pros and cons of prioritizing a certain group for vaccines over another, relevant ethical principles, and ethical conflicts that arise when conflicting priorities come to a head.
Two Fundamental Truths
According to Brown virologist Joseph H. Wu, any vaccine allocation plan must have two goals: direct protection of individuals and indirect protection of their community. Rather than try to allocate vaccines themselves, he argues, we should try to allocate the vaccine's benefits. Essentially, if vaccinating a certain less vulnerable population would lead to decreased overall deaths, we should choose to vaccinate them over a higher-risk population with less potential for decreasing overall harm. Wu also emphasizes that whatever vaccine procedures are established MUST be kept publicly transparent and consistent in order to keep public trust in a vaccine high (Wu). Allocation procedures mean nothing if the public won't take a vaccine; thus, the most important factor for limiting harm is getting as many people as possible to take the vaccine. Ethical approaches can't ignore that.
Ethical Principles and Conflicts
Beneficence
Maximizing the amount of good you do for a group of people. In terms of a vaccine, this means allocating in a way that will reduce overall deaths.
Nonmaleficence
Do no harm. In terms of a vaccine, this means vaccinating the people most at risk.
Justice
Providing people with what they deserve. In terms of a vaccine, this means prioritizing disadvantaged groups.
Ethical issues with regards to COVID vaccine distribution arise when two of those principles come into conflict, as you'll see in the bulk of this site.
Figure 3. Representation of a SARS-COV-2 virus. Gustavo, Solomon. "The Daily Coronavirus Update: 21 More Deaths, First Vaccines Administered in Minnesota." Minnpost, 15 December 2020, https://www.minnpost.com/health/2020/12/the-daily-coronavirus-update-21-more-deaths-first-vaccines-administered-in-minnesota/. Accessed 17 December 2020.
Before You Explore
Take the two quizzes below. One button links to The New York Times's interactive vaccine tracker, which goes by a certain ethical framework put forth by NASEM to predict where an individual falls in the vaccine "line" of Americans. The other is a Google form that asks you to create your own framework for vaccine allocation given several groups. Do the Google Form first, then, get the scientists' opinions on the NYT tool. Then, explore this site to see the ethical pros and cons of those prioritizations. At the end, come back to this page, and take another Google Form quiz (directly under the site navigation buttons below).
Site Navigation
I've identified seven stakeholder groups for vaccine allocation. The buttons below link to pages on this site that explore the ethical pros and cons of allocating vaccine to a certain group before others. Explore each group at your leisure, clicking between this page and the sub-pages that detail stakeholder groups. When you're done, come back to this home page to fill out the conclusion form and make your own ethical perspectives known.
After Exploring The Site
Make sure you fill out the conclusion form by clicking the button above. The quiz will ask you how your opinions have changed after learning a little about vaccine policy.
Figure 4. Worker in PPE holds up sign. "8 Coping Tips for Health Care Workers During Pandemic." Scripps Health, 20 August 2020, https://www.scripps.org/news_items/7028-8-coping-tips-for-health-care-workers-during-pandemic. Accessed 17 December 2020.
Conclusions
Of course, there's no way to prioritize every ethical stakeholder for COVID vaccination. However, consideration of the ethics behind vaccination is a good exercise in looking at the data and drawing conclusions. As shown, the mechanisms that the CDC is using for vaccine allocation do align with the fundamental principles of Western ethics. Looking forward, eventually, everyone who wants the shot will be able to get it. In the meantime, it's pretty clear that public health departments and organizations are following ethical frameworks as best as they can, even through the inherent controversy and clashes that have arisen.