Who Gets To Be First In Line For Covid-19 Vaccine?

Vaccine development has been moving at lightning speed, and a handful of candidates have had promising results. But someone will have to decide which of the world’s 7.8 billion people gets first crack at returning to a more normal life

- Stacey Burling

Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.

Someone will have to decide which of the world’s 7.8 billion people gets first crack at returning to a more normal life. Infectious disease experts and medical ethicists say this exceptionally complex decision must weigh not only who is most at risk from the virus and who is most likely to spread it, but also who is most important for maintaining the medical and financial health of a nation as well as its safety.

This pandemic has also added a new quandary: how to address the fact that people of colour have suffered higher rates of serious illness and death than white people.

“It’s going to be very, very hard,” Harald Schmidt, a University of Pennsylvania bioethicist, said of the priority-setting process. There will likely be more than one type of vaccine. One may work better in certain groups, say, older adults, than another.

“We don’t only have to make this decision once, but multiple times for multiple vaccines,” Schmidt said. “They won’t all be there at the same time, and they will have different profiles.”

Arthur Caplan, a bioethicist at New York University, said the rush to bring vaccines to market likely will leave many questions unanswered at first about how well they work in different groups. He sees the first public doses as an extension of clinical trials. That will require careful tracking of recipients. “We keep acting as if the race to get FDA approval is the end of things,” he said. “I would say it’s just the start.”