Eight Principles and Practices for Ethical Vaccine Distribution: A Proposal

The COVID-19, once-in-a-century, pandemic has now exceeded a year in duration. Nerves are frayed and relationships are strained. This is evident within families, communities, healthcare systems, and institutions of government. Hope, in the form of declining cases and hospitalizations and a vaccine, is on the horizon and yet we are literally at our wits end. Now more than ever, we need to think carefully and not just emote. We need more dialogue and less monologue, civil discourse instead of incivility posted to social media. We need to take the time to deliberate and exhibit virtue rather than vice, to replace narcissism with altruism. This is particularly true now in regard to vaccine allocation, hesitation, and resistance.

As a public health physician-leader and a bioethicist, we, like everyone else, are also citizens, impatient with pandemic restrictions and the scarcity of COVID vaccine. Having put aside our own frayed nerves and emotions so as to think and to dialogue, we have come to agreement on a set of principles and practices for ethical vaccine distribution that we hope might be helpful even beyond this pandemic. All of us bear responsibility; and we call upon our leaders especially—in state government, county or municipal health departments, and all healthcare institutions—to demonstrate fidelity to the following commitments:

1. Allocate and distribute vaccine in keeping with agreed upon protocols and without ethically unjustifiable deviation. Seek community member input to establish local protocols and factor the social determinants of health into risk stratification. If examples are needed, it is hard to imagine ethical justification for offering scarce vaccine to one’s institutional benefactors, boards of directors, or most others who fall outside of the agreed upon protocols.

2. If there seems justifiable reason to engage in practices of vaccination that fall outside of agreed upon protocols, first engage in dialogue with colleagues who have fully acknowledged their conflicts of interest so as to check one’s assumptions and build collegial trust rather than erode it.

3. Vaccinate the greatest number possible in the shortest time possible—and not without regard to other fundamental ethics commitments related to equity and justice.

4. Exercise transparency through frequent and voluntary release of all vaccination data for public analysis. Engage with local community representatives and stakeholders in a discussion of these data and in an effort to adjust protocols as necessary in response to this data and in an effort to further promote equity.

5. Reassess vaccine allotments to county/municipal health departments in comparison with those allotted to healthcare institutions, local pharmacies, and others. Build communication channels now so as to ensure equity of vaccine access to those most vulnerable to this coronavirus.

6. Seek new and improved means for getting vaccine to vulnerable persons who lack equitable access for appointment sign-ups, transportation to vaccination sites, or even news of availability. Talk to community members and test innovations until every possible individual, even those initially hesitant or resistant to vaccination has been repeatedly offered the vaccine at no cost and at a convenient time and location.

7. Assess practices pertaining to distribution of vaccine “leftovers”. Strategize means of avoiding waste while maximizing opportunity of access to those who most need the life-saving protection that vaccines promise.

8. Address vaccine hesitancy among individuals and groups with respect, acknowledging that some distrust of vaccine may be justified and is grounded in misinformation or disinformation, while much hearkens back understandably to historic racism and systemic injustice. Repeatedly dialogue with those who are hesitant over time, so that they have multiple opportunities to reconsider and until the pandemic is completely over and can no longer impact the most vulnerable, even in small numbers. Consider intense involvement of trusted health care professionals and primary care providers in this effort.

We acknowledge that the healthcare leaders, institutions and organizations of our country are well intended, perhaps more so than many of us who are simply impatient and too often self-absorbed. Healthcare facilities and professionals have been battered and pummeled over the last twelve months. Despite intense pandemic stress they have done their best in the hardest of times with insufficient resources; and now they face a massive shortfall of vaccine. Logistics are challenging, to say the least. Form the beginning, our healthcare system has done much with far too little, from PPE to staffing. And yet our society can and must do this better, with more collegiality, communication, empathy and professionalism. Each of us as citizens are responsible for promoting justice as well. We are making a commitment to vaccine equity, to personal altruism and community solidarity. We call upon our friends, neighbors, colleagues, and acquaintances in many places to do likewise.

By K. Allen Greiner, MD, and Tarris Rosell, PhD, DMin

About the Authors:

K. Allen Greiner, MD, MPH is Chief Medical Officer with the Unified Government Public Health Department, Kansas City, Kansas.

Tarris Rosell, PhD, DMin holds the Rosemary Flanigan Chair at the Center for Practical Bioethics, Kansas City, Missouri.