Just allocation of COVID-19 vaccines

Abstract

Authorized COVID-19 vaccines must be distributed fairly. Several proposals have emerged offering guidelines for how to do this. However, insofar as the aim is to have the greatest health impact, these proposals fall short. We offer three suggestions to strengthen them The most advanced attempt at coordinating vaccine distribution is the COVID-19 Vaccines Global Access (COVAX) facility, a collaboration that brings together governments, companies, international organisations and others to accelerate the development and manufacture of COVID-19 vaccines.1 A total of 182 countries have joined the facility so far, which has secured about US$2 billion for its advance market commitment (AMC). The AMC will allow 92 low-income and middle-income countries to obtain vaccine doses as they are approved or authorised. Currently, COVAX is set up so that in a first phase poor countries can vaccinate 3% of their populations, while rich countries can vaccinate up to 50%. Though the facility hopes to allow all members to vaccinate at least 20% of their populations by the end of 2021.2 3 Other proposals by the WHO suggest prioritising healthcare workers, the elderly and, those with comorbidities that put them at greater risk of severe illness if infected with COVID-19, people from certain high-risk sociodemographic groups and some teachers. Another sophisticated proposal, the 'Fair Priority' Model, suggests countries with vaccines contribute to global distribution once their COVID-19 transmission rates drop to R<1. In phase I, they argue that vaccines should primarily be distributed to minimise standard expected years of lives lost. Other considerations, such as gross national income and poverty rates, can and should …

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