Who should get the COVID-19 vaccine first?

A group of global experts led by Penn offer a model that lays the groundwork for fair distribution and prioritize reducing premature deaths.

When effective COVID-19 vaccines are developed, their supply will inevitably be scarce. The World Health Organization (WHO), global leaders, and vaccine producers are already facing the question of how to appropriately allocate them across countries. And while there is vocal commitment to “fair and equitable” distribution, what exactly does “fair and equitable” look like in practice?

Multiple vaccine syringes standing upright on a surface.

Now, 19 global health experts from around the world have proposed a new, three-phase plan for vaccine distribution—called the Fair Priority Model—which aims to reduce premature deaths and other irreversible health consequences from COVID-19. Published in Science, the paper was led by Ezekiel J. Emanuel, vice provost for Global Initiatives and chair of Medical Ethics and Health Policy in the Perelman School of Medicine.

Though little progress has been made to describe a single, global distribution framework for COVID-19 vaccines, two main proposals have emerged: Some experts have argued that health care workers and high-risk populations, such as people over 65, should be immunized first. The WHO, on the other hand, suggests countries receive doses proportional to their populations.

From an ethical perspective, both of these strategies are “seriously flawed,” according to Emanuel and his collaborators.

“The idea of distributing vaccines by population appears to be an equitable strategy,” Emanuel says. “But the fact is that normally, we distribute things based on how severe there is suffering in a given place, and, in this case, we argue that the primary measure of suffering ought to be the number of premature deaths that a vaccine would prevent.”

In their proposal, the authors point to three fundamental values that must be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and giving equal moral concern for all individuals. The Fair Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as economic destruction.

Of all of these dimensions, preventing death—especially premature death—is particularly urgent, the authors argue.

This story is by Lauren Ingeno. Read more at Penn Medicine News.