Analysis: How to decide who gets a vaccine


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When (and if) a viable vaccine to fight COVID-19 becomes available, who gets it first? It’s not as if hundreds of millions of doses will magically appear. We’d like to think Oprah Winfrey will tell us to look under our chairs while shouting “you get a vaccine, you get a vaccine,” but it’s just not going to happen.


It will take time to scale up and, meanwhile, some people will get vaccinated and others will have to wait. So, what matters (or, rather, what should matter) when dividing the population into those two groups?

The defining factor, argues a trio of legal and public health experts in a recently published viewpoint, should be that oh-so-rare and elusive beast known as ethics.



In fact, the three authors argue for the focus to be on three particular ethical values.

The first (and most obvious one) is the do-no-harm cliche. The most basic ethical consideration as you allocate vaccine doses, they say, should be how you can best benefit public health and, you know, not hurt anyone in the process.


It gets a bit more in depth from there on in. Number two on the list of ethical values is “prioritizing disadvantaged populations.” That way you’re making sure that socioeconomic factors and medical vulnerability don’t stand in the way of preventing deaths.

Lastly, there’s the issue of “equal concern,” which “precludes consideration of differences, such as gender, race, or religion, when doing so would not help prevent harm or prioritize disadvantaged groups,” the authors wrote.


Interestingly, distributing a vaccine to certain socioeconomic or ethnic groups might be unconstitutional, the authors wrote, despite the fact, for example, that the disease has disproportionately impacted the Black community in this country.

A lottery, you say? Roll the dice or spin the wheel and get your vaccine? No … because that would not take into account medical need or the disparity among disadvantaged populations.

The trick, then, is to focus not on race or ethnicity, but on other risk factors. Do you, for example, work in an occupation that puts you at higher risk for infection? You get a vaccine.


Focusing on these ethical concerns, the authors wrote, “would support prioritizing health care workers, people in high-risk occupations and housing, and people with high-risk conditions.”

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