By Nancy S. Jecker, Aaron G. Wightman, Douglas S. Diekema

Why should high-income nations help their global neighbors during a pandemic emergency?  If they help, what is a just way to distribute the goods and services they make available?  In “Vaccine Ethics: An Ethical Framework for Global Distribution of COVID-19 Vaccines,” we take up these crucial questions.  After defending a moderate duty to help global neighbors we set forth an ethical framework to guide the distribution of COVID-19 vaccines during an initial phase of scarcity.

The framework introduces for the first time global justice principles that home in on health disparity. It identifies “COVID-19 health disparity populations” as a way to operationalize a commitment to health equity and remove unjust avoidable barriers that affect the most disadvantaged groups disproportionately. The framework also shows the difference between risk of infection, risk of transmission, and risk of severe disease and death. It compares the application of these and other justice principles at various historical intervals when resource scarcity  arose, including the 1918 influenza pandemic, World War II, and during the 1960s. In response to those who defend saving the most life years before a standard number, we show that during the COVID-19 pandemic, this criterion would not favor younger over older people due to large difference in age-based fatality rates.

Comparing our framework to major alternative frameworks for global vaccine distribution, we pinpoint its advantages.  In contrast to the World Health Organization (WHO) proposal to allocate vaccines proportional to a nation’s population, we propose prioritizing frontline and essential workers, health disparity populations, and people at high risk of severe disease and death. Unlike the WHO/SAGE values framework, which emphasizes equal consideration of the moral interests of all human beings, we defend moderate cosmopolitanism and allow for  balancing duties to compatriots against duties to people beyond one’s borders. Finally, our framework differs from the allocation framework Emanuel, Persad, Kern et al. defend, which prioritizes allocating vaccines to maximize saving life years prior to a standard number, using the life expectancy of high-income nations as a model toward which most nations aspire. We argue that their approach would not in fact favor the young over the old, due to large differences in age-based fatality rates.  We also compare our framework against those designed for domestic vaccine allocation, including frameworks from the National Academy of Sciences Engineering and Medicine; the Advisory Committee on Immunization Practices During for COVID-19 Vaccine Implementation; and Johns Hopkins University.

When all is said and done, an infection anywhere can become an infection everywhere.  This lends urgency to efforts to make vaccines available to our global neighbors who are otherwise unable to obtain them. To do this fairly, we need a framework to guide the distribution of benefits and burdens not only at the domestic level, but between nations.

Paper title: Vaccine Ethics: An Ethical Framework for Global Distribution of COVID-19 Vaccines

Author(s): Nancy S. Jecker, Aaron G. Wightman, Douglas S. Diekema

Affiliations: University of Washington School of Medicine (NSJ, AGW, DSD) and Seattle Children’s Hospital and Research Institute (AGD, DSD)

Competing interests: None

Social media accounts of post author(s): Twitter/profjecker and Facebook/Nancy Jecker