COVID-19 Vaccine Allocation: Ethical Concerns, Practical Challenges

What factors contribute to the vulnerability of these populations to excessive morbidity, mortality, and disease transmission in COVID-19?

The vulnerability to the severe impact of COVID-19 in these populations is multifactorial. According to the CDC, the disproportionate impact reflects social determinants of health, such as poverty and health care access, discrimination, and crowded housing. Additionally, more people from ethnic and racial minorities are employed in “essential” occupations in high-risk settings, such as health care facilities, farms, factories, grocery stores, and public transportation.5

For example, some reports6 suggest that early in the pandemic, the rates of COVID-19 diagnosis were higher among employees in health care settings (eg, housekeeping, maintenance, and food and nutrition services), who were not working in “patient facing” roles and therefore could not be expected to face as high a risk. There appears to be evidence that many of these infections are more attributable to social determinants of health, since they all had the same personal protective equipment.7,8

What role do these factors play in the overall framework proposed by the National Academy of Sciences, Engineering, and Medicine?

The National Academy of Sciences, Engineering, and Medicine’s statement lays out 4 risk-based criteria in the “foundational principles” used to inform the framework. The first is the risk of contracting COVID-19, which looks specifically at settings where the virus is circulating and people could have greater exposure as a result.

The second prioritizes individuals with a higher risk of severe morbidity and mortality if they acquire the infection. The third looks at the role of an individual in the lives of others, for example, those who perform functions in which societal or family lives or livelihoods depend on them and would be endangered if they are unable to perform those functions should be given priority.

Lastly, people who have a high likelihood of transmitting the infection to others should also be prioritized.

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You mentioned earlier “assuming a vaccine is safe.” What are your concerns?

One concern is the timeline for vaccine availability. There is a strong push to make a vaccine available sooner without sufficient time for phase 3 and phase 4 clinical trials. Will we be bypassing our standards under political pressure, or will the speed of getting the vaccine out genuinely offer benefit, meaning that it would be efficacious in disease prevention and also safe.

The first few years after a new vaccination may be considered a “trial,” although a much larger trial. Once the vaccine has been established as safe and effective in several thousands of people, it can be distributed to millions of people, but the first recipients are potentially subject to very rare complications that may not have been seen before general distribution.

Fortunately, the US Food and Drug Administration (FDA) is putting the breaks on too-rapid vaccine approval. A statement issued by the FDA was reassuring. “We are committed to expediting the development of COVID-19 vaccines, but not at the expense of sound science and decision making. We will not jeopardize the public’s trust in our science-based, independent review of these or any vaccines. There’s too much at stake.”9

This article originally appeared on MPR