COVID-19 Vaccine Allocation: Ethical Concerns, Practical Challenges

Another example is that pregnant women are typically not included in trials because it is ethically hard to make a case for exposing a fetus to a potentially unsafe vaccine. So we do not know how to predict the response to the vaccine in pregnant women. Will they be protected against the virus? Will the fetus be impacted? These questions will not be answered until the vaccine has been around for much longer.

The National Academy of Sciences, Engineering, and Medicine’s statement does raise this concern, noting that pregnant women are not generally prioritized to receive new vaccines, in light of the potential for fetal harm, and have also been excluded from trials for the same reason. On the other hand, some research suggests that pregnant women are at greater risk for contracting COVID-19, or having a more serious disease course, and for giving birth to preterm babies, or babies who require neonatal intensive care.¹⁰

Beyond ethical concerns, do you see any practical challenges in bringing the vaccines to the public?

Vaccination programs only work if they are widely adopted. Once vaccination rates go down, herd immunity is lost and small local outbreaks can turn into larger outbreaks.¹¹ There are rough estimates, suggesting that the immunity rate for COVID-19 might be around 70% to 80%, but this is not clear.¹² The current skepticism of vaccination is likely one of the greatest obstacles in bringing vaccines to the public.

One of the antidotes to this is education. Once a vaccine has been shown to be safe, the risk to an individual is almost negligible, while the risk from COVID-19 is significantly higher.

I know many people who have become very ill or have died of COVID-19, not only patients but also family and friends. Similar to concerns about the MMR [measles-mumps-rubella] vaccine, where some parents are concerned that it might cause autism, based on manipulated and false data, education is needed to clarify misunderstandings. This can be done not only with one’s own patients but via social media, which is a source of a great deal of misinformation. I frequently use social media for this purpose.

References

1. Alberto Giubilini, Julian Savulescu, Dominic Wilkinson, COVID-19 vaccine: vaccinate the young to protect the old? Journal of Law and the Biosciences, Volume 7, Issue 1, January-June 2020.
2. National Academies of Sciences, Engineering, and Medicine 2020. Framework for Equitable Allocation of COVID-19 Vaccine. Washington, DC: The National Academies Press. https://doi.org/10.17226/25917.
3. World Health Organization (WHO). WHO SAGE values framework for the allocation and prioritization of COVID-19 vaccination, 14 September 2020. Available at: https://apps.who.int/iris/handle/10665/334299. Accessed: October 14, 2020.
4. Centers for Disease Control and Prevention (CDC). ACIP COVID-19 Work Group. Available at: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-08/COVID-08-Dooling.pdf. Accessed: September 24, 2020.
5. Centers for Disease Control and Prevention (CDC). Health Equity Considerations and Racial and Ethnic Minority Groups. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html. Accessed: September 20, 2020.
6. Boodman E. In the Covid-19 death of a hospital food worker, a microcosm of the pandemic. Stat. June 30, 2020. Available at: https://www.statnews.com/2020/06/30/covid19-death-of-hospital-food-worker-a-microcosm-of-pandemic/. Accessed: October 21, 2020.
7. Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States. Clin Infect Dis. 2020 Jun 20:ciaa815.
8. Tyan K, Cohen PA. Investing in Our First Line of Defense: Environmental Services Workers. Ann Intern Med. 2020 Aug 18;173(4):306-307. 
9. US Food and Drug Administration (FDA). COVID-19 vaccines. Available at: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines. Accessed: October 20, 2020.
10. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020 Sep 1;370:m3320. 
11. Randolph HE, Barreiro LB. Herd Immunity: Understanding COVID-19. Immunity. 2020 May 19;52(5):737-741.
12. Kwok KO, Lai F, Wei WI, Wong SYS, Tang JWT. Herd immunity – estimating the level required to halt the COVID-19 epidemics in affected countries. J Infect. 2020;80(6):e32-e33.

This article originally appeared on MPR