Ethical Challenges in the Middle Tier of COVID-19 Vaccine Allocation: Guidance for Organizational Decision-Making

The Hastings Center Supplement to Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19), with Guidelines for Institutional Ethics Services Responding to COVID-19: Managing Uncertainty, Safeguarding Communities, Guiding Practice

Texas A&M University School of Law Legal Studies Research Paper No. 21-23

13 Pages Posted: 7 Jul 2021 Last revised: 20 Sep 2021

See all articles by Nancy Berlinger

Nancy Berlinger

The Hastings Center

Matthew Wynia

University of Colorado at Denver - Department of Medicine

Tia Powell

Montefiore Medical Center - Montefiore Einstein Center for Bioethics, Albert Einstein College of Medicine

Aimee Milliken

affiliation not provided to SSRN

Parinda Khatri

affiliation not provided to SSRN

Fatma E. Marouf

Texas A&M University School of Law

Keisha Ray

affiliation not provided to SSRN

Johanna Crane

affiliation not provided to SSRN

Date Written: January 1, 2021

Abstract

This supplement to The Hastings Center’s “Ethical Framework” aims to help structure time-sensitive discussion of significant, foreseeable ethical concerns in responding to COVID-19 and to support collaboration across institutions throughout pandemic response and recovery. It is designed for use by county health systems and by hospitals, community health centers, and other health care organizations responsible for patient care or preventive health, including vaccine education, vaccine distribution, and vaccination. This document aims to support formal and informal convening and policy work within the same geographic region, such as a municipality, county, metropolitan area, state, or multistate area, led by public health authorities, health care institutions, or other groups involved in vaccine allocation. The document’s scope is limited to the ethics of vaccine distribution within the United States; it does not address the ethics of international cooperation and sharing vaccines versus focusing solely on ensuring vaccine access in one’s own nation (“vaccine nationalism”).

The focus of this document is the middle tier of vaccine allocation and the ethical challenges arising in the U.S. in the first half of 2021. This focus reflects general consensus and ongoing implementation concerning highest-priority vaccination of two populations: frontline health care workers and residents of long-term care facilities (the groups constituting “Phase 1a in recommendations from the Advisory Committee on Immunization Practices [ACIP]).The ethical justification for prioritizing these populations was their high risk of contracting the virus, of passing it to others at high risk of severe disease, and, in the case of long-term care residents, of dying of severe COVID-19. Additional justifications include the relatively small size of these initial cohorts, the relative ease of locating them and providing the vaccine, and the value of public trust created by witnessing health professionals receiving the vaccine. There is also broad consensus that vaccine allocation to the general public—people without major risk factors and who can reasonably protect themselves through masking and physical distancing—should occur only after the vaccination of groups at high risk of infection or at high risk of severe illness or death if infected. This document therefore does not address the final stages of vaccine distribution to lower-risk members of the public.

Note: Funding Statement: This rapid-response work is made possible by The Hastings Center Impact Fund.

Declaration of Interests: No competing interests.

Suggested Citation

Berlinger, Nancy and Wynia, Matthew and Powell, Tia and Milliken, Aimee and Khatri, Parinda and Marouf, Fatma E. and Ray, Keisha and Crane, Johanna, Ethical Challenges in the Middle Tier of COVID-19 Vaccine Allocation: Guidance for Organizational Decision-Making (January 1, 2021). The Hastings Center Supplement to Ethical Framework for Health Care Institutions Responding to Novel Coronavirus SARS-CoV-2 (COVID-19), with Guidelines for Institutional Ethics Services Responding to COVID-19: Managing Uncertainty, Safeguarding Communities, Guiding Practice, Texas A&M University School of Law Legal Studies Research Paper No. 21-23, Available at SSRN: https://ssrn.com/abstract=3859741

Nancy Berlinger (Contact Author)

The Hastings Center ( email )

21 Malcolm Gordon Road
Garrison, NY 10524
United States
(845) 424-4040 ext. 210 (Phone)
(845) 424-4545 (Fax)

Matthew Wynia

University of Colorado at Denver - Department of Medicine ( email )

Box 173364
1250 14th Street
Denver, CO 80217
United States

Tia Powell

Montefiore Medical Center - Montefiore Einstein Center for Bioethics, Albert Einstein College of Medicine ( email )

111 East 210th Street
Bronx, NY 10467
United States

Aimee Milliken

affiliation not provided to SSRN

Parinda Khatri

affiliation not provided to SSRN

Fatma E. Marouf

Texas A&M University School of Law ( email )

1515 Commerce St.
Fort Worth, TX 76102
United States

Keisha Ray

affiliation not provided to SSRN

Johanna Crane

affiliation not provided to SSRN

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