Gupta Rohit, Morain Stephanie R
School of Medicine, Baylor College of Medicine, Houston, Texas, USA
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA.
J Med Ethics. 2020 Dec 17. doi: 10.1136/medethics-2020-106850.
The COVID-19 pandemic will likely recede only through development and distribution of an effective vaccine. Although there are many unknowns surrounding COVID-19 vaccine development, vaccine demand will likely outstrip early supply, making prospective planning for vaccine allocation critical for ensuring the ethical distribution of COVID-19 vaccines. Here, we propose three central goals for COVID-19 vaccination campaigns: to reduce morbidity and mortality, to minimise additional economic and societal burdens related to the pandemic and to narrow unjust health inequalities. We evaluate five prioritisation approaches, assess their likely impact on advancing the three goals of vaccine allocation and identify open scientific questions that may alter their outcomes. We argue that no single prioritisation approach will advance all three goals. Instead, we propose a multipronged approach that considers the risk of serious COVID-19 illness, instrumental value and the risk of transmission, and is guided by future research on COVID-19-specific clinical and vaccine characteristics. While we focus this assessment on the USA, our analysis can inform allocation in other contexts.
只有通过研发和分发有效的疫苗，新冠疫情才可能消退。尽管围绕新冠疫苗研发存在诸多未知因素，但疫苗需求可能会超过早期供应，因此对疫苗分配进行前瞻性规划对于确保新冠疫苗的伦理分配至关重要。在此，我们提出新冠疫苗接种运动的三个核心目标：降低发病率和死亡率，尽量减少与疫情相关的额外经济和社会负担，以及缩小不公正的健康不平等差距。我们评估了五种优先排序方法，评估它们对推进疫苗分配的三个目标可能产生的影响，并确定可能改变其结果的开放性科学问题。我们认为，没有一种单一的优先排序方法能推进所有三个目标。相反，我们提出一种多管齐下的方法，该方法考虑了新冠重症的风险、工具价值和传播风险，并以未来关于新冠特定临床和疫苗特征的研究为指导。虽然我们将这一评估重点放在美国，但我们的分析可为其他情况的分配提供参考。
