The Ethics of COVID-19 Vaccine Administration

Several vaccines designed to prevent clinical infection with SARS-CoV-2 virus will soon be released. Given the limitations on production and distribution, priorities must be promptly established to determine who should have precedence for vaccination. Accordingly, the Advisory Committee on Immunization Practices (ACIP) has recommended a framework based on the following medical ethics principles: maximizing benefits and minimizing harm, promoting justice, mitigating health inequities, and fostering transparency in determining vaccination priorities.

To maximize the benefits of vaccination at the individual and population levels, the key goals are to minimize SARS-CoV-2 infection as well as the associated morbidity and mortality by addressing those most susceptible to infection and at excess risk for negative outcomes. In addition, the roles of various service groups that confer highest risk must be considered. The promotion of justice and mitigation of health inequities within and among priority groups would dictate equal opportunity for vaccination. Finally, transparency ensures that these principles are, indeed, being applied. Applying these tenets yields four groups who should receive initially limited vaccine: healthcare personnel, other essential workers, adults with high-risk conditions, and those aged ≥65 (including residents of long-term care facilities).