Fairly Prioritizing Groups for Access to COVID-19 Vaccines

Govind Persad, JD, PhD1; Monica E. Peek, MD, MPH, MS2; Ezekiel J. Emanuel, MD, PhD3

JAMA. Published online September 10, 2020. doi:10.1001/jama.2020.18513

The supply of any successful vaccine for coronavirus disease 2019 (COVID-19) will initially be limited. Who should have access first? The US National Academy of Medicine (NAM) has proposed a framework for COVID-19 vaccine allocation.1 Others have discussed distributing vaccine among countries.2 This Viewpoint delineates how ethical values should guide prioritization of a COVID-19 vaccine among populations within the US. The discussion may be relevant to other countries as well.

In vaccine prioritization, ethics interacts with important scientific and practical questions. These include whether a vaccine will prevent SARS-CoV-2 transmission and what medical factors affect vaccine effectiveness, dosing, and durability, as well as COVID-19 infection rates and outcomes among those not vaccinated. To the extent that a vaccine does not prevent transmission, but just reduces the severity of illness, its effect and distribution should resemble therapeutics that only protect direct recipients.

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