Ethics: COVID-19 Vaccine
Question: When a safe and effective vaccine for COVID-19 is available how should we distribute the initial vaccines when there is limited supply?
This is a classic high demand but limited supply resource allocation ethical dilemma, similar to the question of deciding who gets an organ transplant or who should get limited PPE or limited resource of ventilators?
How would you approach this issue? How is vaccine different than an organ or protective equipment?
This article starts with asking the question: what is the goal of vaccination? Vaccination is not only for the protection of the individual patient (direct benefit) but it is also for the protection of the population at large (indirect benefit) by reducing transmission through herd immunity. The premise is this is what differentiates vaccines from ventilators or available organs which only benefit the individual receiving that scarce resource.
Healthcare workers are both high risk and vectors for spread of disease so the direct and indirect benefits are high for this population. Who is next after healthcare workers? That would require the answer to the following questions:
1) Who had the largest morbidity and mortality from the disease? The benefit here is to save individual lives.
AND
2) Who is most likely to spread the disease? The benefit here is to save the most number of lives.
Unlike ventilators, where favoring those most likely to survive to discharge leads to the most lives saved, allocating vaccine to improve survivability may not lead to most lives saved. Another consideration is that those with largest disease burden are largest in populations who suffer unequal healthcare access. This is put forth as a rational for a lottery approach so not to further these health inequities.
This article is an example of a very systematic approach to a common allocation of scarce resources dilemma. The easy answer is to allocate based on largest benefit - but in the case of a vaccine - those who benefit the most are unlikely to save the most lives overall.
