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Fairly Prioritizing Groups for Access to COVID-19 Vaccines

Educational Objective
To understand how to prioritize first access to the COVID-19 vaccines
1 Credit CME

The supply of any successful vaccine for coronavirus disease 2019 (COVID-19) will initially be limited. Who should have access first? The US National Academy of Medicine (NAM) has proposed a framework for COVID-19 vaccine allocation.1 Others have discussed distributing vaccine among countries.2 This Viewpoint delineates how ethical values should guide prioritization of a COVID-19 vaccine among populations within the US. The discussion may be relevant to other countries as well.

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Article Information

Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Perelman School of Medicine, University of Pennsylvania, Medical Ethics and Health Policy, 423 Guardian Dr, Blockley Hall, Ste 1412, Philadelphia, PA 19104 (MEHPchair@upenn.edu).

Published Online: September 10, 2020. doi:10.1001/jama.2020.18513

Correction: This article was corrected on October 20, 2020, to add 2 additional financial disclosures for Dr Emanuel, which were inadvertently omitted.

Conflict of Interest Disclosures: Dr Persad and Dr Peek report receiving grants from the Greenwall Foundation. Dr Persad reports pay from the ASCO Post and previous consulting work for WHO regarding pandemic influenza guidance. Dr Peek reports receiving grants from the Merck Foundation. Dr Emanuel reported receiving personal fees, nonfinancial support, or both from companies, organizations, and professional health care meetings. Dr Emanuel is also a venture partner at Oak HC/FT and a partner at Embedded Healthcare LLC and COVID-19 Recovery Consulting.

Funding/Support: This article was partially financially supported by the Colton Foundation.

Role of the Funder/Sponsor: The Colton Foundation had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.

References
1.
National Academy of Sciences. A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus. August 2020. Accessed September 3, 2020. https://www.nationalacademies.org/our-work/a-framework-for-equitable-allocation-of-vaccine-for-the-novel-coronavirus
2.
Emanuel  EJ , Persad  G , Kern  A ,  et al.  An ethical framework for global vaccine allocation.   Science. 2020;eabe2803. doi:10.1126/science.abe2803PubMedGoogle Scholar
3.
Abu-Raya  B , Gantt  S , Sadarangani  M .  Challenges in evaluating SARS-CoV-2 vaccines during the COVID-19 pandemic.   CMAJ. 2020;192(34):E982-E985. doi:10.1503/cmaj.201237PubMedGoogle ScholarCrossref
4.
Persad  G , Wertheimer  A , Emanuel  EJ .  Principles for allocation of scarce medical interventions.   Lancet. 2009;373(9661):423-431. doi:10.1016/S0140-6736(09)60137-9 PubMedGoogle ScholarCrossref
5.
World Health Organization. A Global Framework to Ensure Equitable and Fair Allocation of COVID-19 Products and Potential implications for COVID-19 Vaccines. June 18, 2020. https://bit.ly/32rhHPb
6.
Chetty  R , Stepner  M , Abraham  S ,  et al.  The association between income and life expectancy in the United States, 2001-2014.   JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226 PubMedGoogle ScholarCrossref
7.
Wortham  JM , Lee  JT , Althomsons  S ,  et al.  Characteristics of persons who died with COVID-19—United States, February 12-May 18, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(28):923-929. doi:10.15585/mmwr.mm6928e1 PubMedGoogle ScholarCrossref
8.
Office of the Chief Actuary, Social Security Administration. Accessed September 3, 2020. https://www.ssa.gov/oact/HistEst/CohLifeTables/2020/CohLifeTables2020.html
9.
Feuerstein  A , Garde  D , Robbins  R. Covid-19 clinical trials are failing to enroll diverse populations, despite awareness efforts. STATNEWS. August 14, 2020. Accessed September 3, 2020. https://www.statnews.com/2020/08/14/covid-19-clinical-trials-are-are-failing-to-enroll-diverse-populations-despite-awareness-efforts/
10.
Pathak  PA , Sönmez  T , Unver  MU , Yenmez  MB . Leaving no ethical value behind: triage protocol design for pandemic rationing. NBER Working Paper No. 26951. April 2020. Accessed September 3, 2020. https://www.nber.org/papers/w26951
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