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:Ethical Considerations in Healthcare in Administering the Covid-19 Vaccine
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.Ethical Considerations in Healthcare in Administering the Covid-19 Vaccine
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The COVID-19 pandemic has critically strained nearly every aspect of society within the USA and across the globe. Healthcare organisations are scrambling to stretch limited resources, and the rapid growth in cases of the disease has precipitated the need for tremendous planning. COVID-19 has also impacted national economies, causing rates of unemployment and business closures not seen since the Great Depression.1 While promising therapies are being researched, many experts speculate that widespread vaccination ultimately will be required to enable significant recovery from the pandemic.2 Ethical Considerations in Healthcare in Administering the Covid-19 Vaccine
With the elucidation of the genetic sequence of SARS-CoV-2, the virus responsible for COVID-19, major strides have been made in vaccine development.3 As of November 2020, there are over 300 COVID-19 vaccine candidates worldwide.4 Among these vaccines, the methodologies employed to create an immunological response are highly variable and include the use of nucleic acids, viral-like particles, peptides, viral vectors, recombinant proteins and inactivated virus.5 Several vaccine candidates have moved forward into clinical testing, and in the USA, vaccines from Pfizer/BioNTech and Moderna are scheduled to be evaluated for emergency use authorisation by the US Food and Drug Administration (FDA).6 Despite promising advancements in vaccine development, the timeline for public availability remains uncertain, pending adequate safety testing and rigorous proof of effectiveness.Ethical Considerations in Healthcare in Administering the Covid-19 Vaccine 7 This is further complicated by the fact that a number COVID-19 clinical characteristics relevant to vaccine efforts are still unclear, and vaccine manufacturing and distribution issues such as adequate storage/transportation may further delay dissemination.8
Although there are many unknowns surrounding COVID-19 vaccine development, proactive planning is critical to ensure equitable and prudent distribution. Healthcare leaders have a moral duty to plan for the challenges presented by this pandemic. Even with unprecedented speed in vaccine development and testing, epidemiologists anticipate there will be a major shortage of COVID-19 vaccines, both within the USA and worldwide.9 Discussion surrounding vaccine allocation both nationally and globally has already begun, and the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunisation Practices is actively deliberating allocation.10 11 By prospectively evaluating the factors that will impact vaccine allocation, we will be better equipped to ensure distribution best addresses the substantial health, economic and social impacts of COVID-19.Ethical Considerations in Healthcare in Administering the Covid-19 Vaccine
To this end, we identify the ethical goals that vaccine distribution should ai
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