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Rutgers professor discusses ethics of who will receive coronavirus vaccine first

Michael Gusmano, professor in the Department of Health Behavior, Society and Policy and Director of the Health Systems and Policy Concentration, said most public health experts say healthcare workers and high-risk groups should receive the vaccines first. – Photo by null

Michael Gusmano, professor in the Department of Health Behavior, Society and Policy and Director of the Health Systems and Policy Concentration, said most public health experts say healthcare workers and high-risk groups should receive the vaccines first.

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With the impending return of the flu season this fall, researchers and health experts continue to search for a vaccine for the coronavirus disease (COVID-19) to combat what could end up being a season with two widespread diseases.

Michael Gusmano, professor in the Department of Health Behavior, Society and Policy and Director of the Health Systems and Policy Concentration, said there are still a lot of uncertainties regarding the ethics deciding what groups will be among the first to receive a vaccine for COVID-19, once it becomes available though. 

“The World Health Organization (WHO), countries around the world and pharmaceutical companies have been wrestling with this question for some time and there is disagreement about what a fair allocation of a COVID-19 vaccine, or vaccines, would involve,” Gusmano said. “As of now, the WHO has suggested that countries should receive vaccine doses in proportion to their population, but this ignores the fact that not all countries have suffered at the same rate, so many scholars do not believe this is an equitable solution.” 

Most public health experts argue that health care workers and high-risk populations should be receiving the vaccines first, he said.

He also said a group of scholars from the University of Pennsylvania led by Ezekiel Emanuel developed the fair priority model, which argues for vaccine distribution designed to decrease the amount of premature deaths and other irreversible health consequences from COVID-19 by considering the extent to which a country has experienced serious illness and death, as well as the effects its economy has suffered as a result of the pandemic.

It is hard to say approximately how many people will be able to receive the approved vaccine without knowing the safety and effectiveness of the new vaccine once it has been tested on a large number of people, Gusmano said. 

“Eventually, we will want to produce billions of doses, but the speed with which this can be done will depend, in part on the nature of the vaccine and its production process. It will also depend on the requirements of distribution. If the vaccine requires refrigeration, for example, this could reduce the number of people who could receive it immediately,” he said. “The vaccine developed in Russia, for example, is being distributed before large human clinical trials have been completed. If certain groups (e.g. health care workers) face vaccine mandates to a vaccine that has not been tested properly, this is obviously a violation of broadly held ethical principles.” 

Gusmano said the applied criteria to distribution of the vaccine along with the number of doses that can be produced and distributed quickly will play a part in the possibility that people who are high priority for the vaccine will have to be denied due to limited supplies.  

He also said the decisions regarding who will be among the first within a high-risk group to get the vaccine will depend on rules put in place by political leaders.

“The WHO and other (United Nations) organizations may have some influence on this, but that is not certain,” he said. “This may depend, in part, on which company develops an accepted vaccine. The answer may be very different if this is a U.S.-based company than if it is one based in China.”

Whether people should rush out to get a vaccine once it is made available is dependent on the public’s confidence in the regulatory process, Gusmano said.

“If government officials pressure companies and/or regulators to take inappropriate short cuts, this will discourage people who may benefit from getting vaccinated,” he said. “It could also further undermine confidence in other vaccines that are highly safe and effective. It is crucial for public health that we allow science to drive these decisions.”

Gusmano said there is broad agreement that it would be unfair for wealthier countries to end up with a disproportionate share of vaccine doses.

“Given the lack of consensus about what justice requires, it is almost inevitable that some people will be unhappy with who is chosen first,” he said. “My biggest concern is that governments around the world work to make sure that science drives the testing process and that we avoid politicizing vaccine development.”

It is crucial that there is evidence that the vaccine is both safe and effective to elevate the public’s confidence in and acceptance of the vaccine to help the world recover from the pandemic when the vaccine can be produced and distributed in ample quantities, Gusmano said. 

“It will be very surprising if a vaccine is ready for distribution before early 2021 — and that is an historically aggressive timetable,” Gusmano said. “It is important to remember that we have been unable to develop safe and effective vaccines for many viruses and it usually takes several years to successfully develop these products. We have already made remarkable progress in our understanding of this virus and the testing has advanced rapidly, but there are limits on what is realistic.” 



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