With half the world awaiting the date on which the vaccine to protect us from the coronavirus becomes a reality and with a supply that a priori is expected to be scarce, the next question will be how to properly allocate it between countries and which people will be the first to be vaccinated .
The World Health Organization (WHO), world leaders and vaccine producers are already thinking about it. Although there is an express commitment to “fair and equitable” distribution, how would it be implemented?
So far, 19 world health experts have proposed a three-phase plan for vaccine delivery. It’s called the Fair Priority Model and its goal is to reduce premature deaths and other irreversible health consequences of COVID-19 . The article appeared this week in Science and was led by Dr. Ezekiel J. Emanuel, Vice Chancellor for Global Initiatives and President of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania.
Although little progress has been made in describing a single, global distribution framework for COVID-19 vaccines, two main proposals have emerged. On the one hand, some experts argue that the first to be vaccinated should be healthcare workers and high-risk populations, such as people over 65 . The WHO, for its part, suggests that countries receive doses proportional to their populations.
For Dr. Ezekiel J. Emanuel, from the ethical point of view, both strategies are “seriously flawed.” “The idea of distributing vaccines by population appears to be an equitable strategy,” Emanuel said. “But the fact is that normally, we distribute things based on the severity of suffering in a given place, and in this case, we argue that the main measure of suffering should be the number of premature deaths that a vaccine would prevent.”
In the Fair Priority Model, Emanuel and his team point out three fundamental aspects that they believe should be considered when distributing a COVID-19 vaccine among countries: benefit the people and limit the harm, prioritize the disadvantaged, and give the same moral concern to all individuals . The Fair Priority Model addresses these issues by focusing on mitigating three types of damage caused by the coronavirus: death and permanent organ damage, indirect health consequences, such as strain and stress on the health care system. health and economic destruction.
Of these three damages, the authors focus on the prevention of death, especially premature death, a fact that they consider particularly urgent . Premature death from COVID-19 is calculated by looking at “years of expected life lost,” a commonly used global health measure. Premature death is therefore part of phase 1 of the Just Priority Model. In phase 2 the authors propose two measures that capture the overall economic improvement and the extent to which people would escape poverty. In phase 3, priority would be given to countries with the highest transmission rates. Regarding the latter, the authors point out that all countries should receive enough vaccines to stop transmission, which is projected to require that between 60% and 70% of the population be immune.
Returning to the suggestion proposed by the WHO, its plan consists of starting with 3% of the population of each country receiving the vaccines . The allocation proportional to the population will continue until each country has vaccinated 20% of its citizens. Emanuel and his colleagues argue that, although the plan may be politically defensible, “it erroneously assumes that equality requires treating countries in different situations identically, rather than responding equitably to their different needs.” In reality, equally populous countries face dramatically different levels of death and economic devastation from the pandemic, they say.
The authors also oppose the plan that would prioritize countries based on the number of frontline health care workers, the proportion of the population older than 65, and the number of people with comorbidities (presence of one or more diseases in addition to the primary disease or disorder) within each country. They are against it because they claim that preferentially immunizing healthcare workers, who already have access to personal protective equipment (PPE) and other advanced methods of infectious disease prevention, would probably not substantially reduce harm in higher-income countries . Similarly, they argue that focusing on vaccinating countries with older populations would not necessarily reduce the spread of the virus or minimize death . Additionally, low- and middle-income countries have fewer elderly residents and health workers per capita than higher-income countries, they say.
“What you end up doing is administering a lot of vaccines to rich countries, which does not seem to be the goal of a fair and equitable distribution ,” Emanuel said. The authors conclude that the Fair Priority Model is the best embodiment of the ethical values of limiting harm, benefiting the disadvantaged, and recognizing equal concern for all people.
“It will be up to political leaders, WHO and manufacturers to implement this model,” Emanuel said. “Decision makers are looking for a framework to ensure that everyone around the world can be vaccinated so that we can stop the spread of this virus.”
