Vaccination

Emerging concerns

• Some states are experiencing more vaccine supply than demand, whereas in other states demand outpaces supply. National Public Radio, April 12, 2021; New York Times, April 18, 2021.
• COVID vaccines: Who’s hoarding and who’s helping? Politico, February 12, 2021
• COVID-19 has had a disproportionate impact on people of color in the United States. The COVID Racial Data Tracker
• Controversy over when to vaccinate incarcerated people. Washington Post, January 2, 2021.
• Though CDC has recommended priority groups for vaccination, states are free to determine how to allocate their vaccine doses. New York Times, December 23, 2020.

Ethical principles

• [consider] prioritizing groups of people known to be central to spreading infection or “super-spreaders.” WHO Ethics in Pandemic Flu
• [consider] prioritizing persons at increased risk of death if infected. WHO Ethics in Pandemic Flu
• [consider] prioritizing children and young adults based on the fair innings argument. WHO Ethics in Pandemic Flu
• [consider] prioritizing health-care workers and other essential service providers to help sustain the health-care system. WHO Ethics in Pandemic Flu
• Some theoretical distribution criteria that would generally not be ethically supported are: to each according to purchasing power, to each according to what he or she deserves; first come, first served; race, ethnicity, religious belief, gender, sexual orientation, or IQ. CDC Ethics in Pandemic Flu
• Governments and the health care sectors should engage stakeholders in determining what criteria should be used to make resource allocation decisions, should ensure that clear rationales for allocation decisions are publicly accessible and should provide a justification for any deviation from the predetermined criteria. University of Toronto

Recommendations and practices

• As of October 29, 2021, all Americans age 5 and older are eligible to receive a COVID-19 vaccine. FDA, October 29, 2021.
• Deciding who gets the vaccine first. A brief explanation of how priorities are determined. Jim Thomas, WRAL, December 4, 2020.
• CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that initial supplies of COVID-19 vaccine should be allocated based on the ethical principles of maximizing benefits and minimizing harms, promoting justice, mitigating health inequities, and supporting the early vaccination of health care personnel and long-term care facility residents. The Advisory Committee on Immunization Practices’ Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine, CDC, December 11, 2020.
• Populations should be prioritized for vaccination according to their risk of acquiring infection, of severe morbidity and mortality, negative societal impact, and risk of transmitting infection to others. Framework for Equitable Allocation of COVID-19 Vaccine, National Academies of Science, Engineering and Medicine, Box 3-3

Emerging concerns

• Approximately half of incarcerated people have been vaccinated. Prison Policy Initiative, May 18, 2021.
• Algorithms designed to determine vaccination priority may fail to prioritize most vulnerable populations. Washington Post, December 23, 2020.
• Differences in vaccination rates between whites and people of color decreased from April to September, 2021. Upper end estimates of differences in September were an 8 point difference in percent vaccinated for Blacks and a 4 point difference for Hispanics. Kaiser Family Foundation, October 6, 2021.

Ethical principles

• Those responsible for infectious disease outbreak response should ensure that all individuals are treated fairly and equitably regardless of their social status or perceived “worth” to society. WHO Ethics in an Outbreak
• Particular consideration must be given to individuals who are confined in institutional settings, where they are highly dependent on others and potentially exposed to much higher risks of infection than persons living in the community. WHO Ethics in an Outbreak
• Ensure that public health policies and plans are sensitive to race, ethnicity, sex, sexual orientation, gender identity, and other unique characteristics of individuals affected by the policies or plans. APHA Code of Ethics, 4.5.11.

Recommendations and practices

• State, tribal, local, and territorial authorities should use the CDC’s Social Vulnerability Index or the COVID-19 Community Vulnerability Index to ensure that vaccine distribution prioritizes the most vulnerable regions. National Academies of Sciences, Engineering, and Medicine, October 2, 2020.
• Tennessee allocated five percent of their vaccine supply for areas with high scores on the CDC social vulnerability index. Washington Post, December 18, 2020.
• Unauthorized immigrants are eligible for free COVID vaccination without fear of deportation. Congressional Research Service, February 25, 2021.

Emerging concerns

• The unvaccinated are 29 times more likely to be hospitalized with COVID than the vaccinated. CNBC, August 24, 2021.
• Should the unvaccinated be a lower priority for health care? NC Policy Watch, August 12, 2021.
• The unvaccinated deserve medical care too. The Washington Post, August 23, 2021; WUNC, September 23, 2021.
• Doctors should be allowed to give priority to vaccinated patients when resources are scarce. The Washington Post, September 3, 2021.

Ethical principles

• [Consider] the likelihood that an infected individual will infect other persons if not given access to treatment or prophylaxis and infection control measures. WHO Ethics in Pandemic Flu
• Some theoretical distribution criteria that would generally not be ethically supported are: to each according to purchasing power; to each according to what he or she deserves; first come, first served; race, ethnicity, religious belief, gender, sexual orientation, or IQ. CDC Ethics in Pandemic Flu
• Ensure that resulting interventions do not have a disproportionately negative impact on minority or otherwise vulnerable populations (including children and elders) and that there is an effort to enhance the resilience of populations and ecosystems to prevent future harm. APHA Code of Ethics, 4.2.9.

Recommendations and practices

• Germany puts major restrictions on the unvaccinated. BBC, December 3, 2021.
• Europe toughens rules for the unvaccinated. New York Times, November 15, 2021.
• Colorado’s executive order permitting hospital triage does not include non-vaccination as a criterion. AP News, November 6, 2021.

Emerging concerns

• Vaccine disinformation and conspiracy theories are spreading rapidly. Washington Post, February 22, 2021; Washington Post, February 11, 2021.
• Just 12 people behind most vaccine hoaxes on social media. NPR, May 14, 2021.
• INTERPOL warns of attempts to disrupt the vaccine supply chain and the sale of illicit medical supplies . INTERPOL, December 2, 2020.
• A Russian disinformation campaign is spreading falsehoods about the forced inoculations against COVID-19. New York Times, August 5, 2021.
• A pharmacist rendered more than 500 doses of the vaccine useless because of anti-vaccination conspiracy beliefs. New York Times, January 4, 2021.
• Social media companies are largely unable to prevent spread of COVID-19 vaccine misinformation on their platforms. Washington Post, December 18, 2020.

Ethical principles

• When decisions must be made in the face of uncertain information, the uncertainties should be explicitly acknowledged and conveyed to the public. WHO Ethics in an Outbreak
• Governments, nongovernmental organizations, and academic institutions should make efforts to support media training in relevant scientific concepts and techniques for communicating risk information without raising unnecessary alarm. WHO Ethics in an Outbreak

Recommendations and practices

• Trusted community stakeholders should participate in efforts to amplify meaningful and relevant vaccine-affirming messages to crowd out misinformation about the COVID-19 vaccine. Johns Hopkins Center for Health Security, July 9, 2020.
• CDC has produced a social media toolkit to talk about COVID-19 vaccinations.
• How to address COVID-19 vaccine misinformation. CDC
• Black doctors are sharing accurate information about COVID-19 vaccines on social media. National Public Radio, January 1, 2021.
• Recommendations for fighting vaccine disinformation. CNN, September 1, 2021.

Emerging concerns

• Usability, privacy, and equity must be considered in the context of vaccine passports. Washington Post, April 7, 2021.
• Vaccine passports could exacerbate a two-tiered system of haves and have nots; those who can travel and those who cannot. New York Times, April 9. 2021.
• Federal vaccine monitoring program is limited to English speakers. The Verge, December 17, 2020.
• US states that have required, not required, or banned vaccine passports. US News and World Report, June 1, 2021.

Ethical principles

• Countries should develop core capacities for public health surveillance and response that comply with the international legal obligations in the framework of the International Health Regulations (IHR) 2005. WHO Ethics in Pandemic Flu
• Systematic observation and data collection are essential components of emergency response measures, both to guide the management of the current outbreak and help prevent and respond to outbreaks in the future. Even if these activities are not characterized as research for regulatory purposes, an ethical analysis should be undertaken to ensure that personal information is protected from physical, legal, psychological, and other harm. WHO Ethics in an Outbreak
• Collecting surveillance information on a mandatory basis is ethically appropriate on the grounds of public interest if an accountable governmental authority has determined that universal participation is necessary to achieve compelling public health objectives. WHO Ethics in an Outbreak
• Regardless of whether individuals are given the choice to opt out of surveillance activities, the process of surveillance should be conducted on a transparent basis. WHO Ethics in an Outbreak

Recommendations and practices

• World Health Organization’s Smart Vaccination Certificate Working Group is focused on establishing standards for a common architecture for a digital smart vaccination certificate.
• The Vaccination Credential Initiative is a voluntary coalition of public and private organizations committed to empowering individuals with access to a trustworthy and verifiable copy of their vaccination records in digital or paper form using open, interoperable standards.
• The ACLU has published a list of criteria to abide by in the creation of vaccine passports to ensure equity and protection of privacy. ACLU, March 31, 2021.
• The Biden administration will not oversee the creation and implementation of vaccine passports. The Hill, April 6, 2021.
• New York state has piloted the voluntary and free Excelsior Pass, a vaccine passport developed in collaboration with IBM that relies on blockchain technology to securely verify vaccine status without the transfer of private information. National Public Radio, April 12, 2021.
• Vaccine passports are taking off in the US. CNN Business, August 9, 2021.

Emerging concerns

• Less than 2% of the global COVID-19 vaccine supply has been administered in Africa. Relief Web, April 8, 2021.
• Only 1% of Africans have been fully vaccinated. New York Times, July 16, 20201.
• High-income countries have purchased enough COVID-19 vaccine to vaccinate their populations many times over while other nations have failed to secure adequate supplies. National Public Radio, December 3, 2020.
• Economic recovery from the pandemic has been limited in countries unable to vaccinate their population. New York Times, December 25, 2020.
• COVAX, the WHO backed global initiative to provide vaccines to low- and middle- income countries, has been hampered by production problems, export bans, and vaccine hoarding by wealthy nations. New York Times, September 8, 2021.
• Only seven African countries have companies operating across the vaccine-manufacturing value chain. Tony Blair Institute for Global Change, April 1, 2021.
• Waiving COVID vaccine patent rights? It’s complicated. Harvard Law Today, May 4, 2021.
• WHO says first COVID-19 shots are more important than boosters. GlobalSecurity.org, August 18, 2021.

Ethical principles

• Countries that have the resources to provide foreign assistance should support global epidemic preparedness and response efforts, including research and development on diagnostics, therapeutics, and vaccines for pathogens with epidemic potential. WHO Ethics in an Outbreak
• Broad international cooperation in the development and dissemination of vaccines and treatments is in the interests of all countries as such cooperation offers the best chance of minimizing the global impact of an influenza pandemic. WHO Ethics in Pandemic Flu
• According to the principle of reciprocity, each country should do what it can to contribute to this effort, with the understanding that it can expect the same from the rest of the international community. WHO Ethics in Pandemic Flu
• Countries should participate in the development and implementation of frameworks and mechanisms that aim to ensure fair and equitable sharing of benefits, in support of public health, among all countries, taking into particular consideration the specific needs of developing countries. WHO Ethics in Pandemic Flu
• The United States recognizes its membership in the global community, and the pandemic planning process acknowledges the importance of working with and learning from preparedness efforts globally. CDC Ethics in Pandemic Flu
• First, the ethical principle of solidarity suggests that countries should respond collectively when natural threats to health are identified. Second, countries have obligations to help one another under inter- national laws, including human rights laws; many of these obligations are affirmed and elaborated upon in IHR (2005) (12). Finally, an influenza pandemic is inherently a global crisis; lack of response to a pandemic threat in one country puts all other countries at increased risk.  WHO Ethics in Pandemic Flu

Recommendations and practices

• Vaccine donation tracker. Kaiser Family Foundation.
• All countries should receive doses in proportion to their population size in order to immunize the highest-priority groups. World Health Organization
• AstraZeneca pledged to provide their COVID-19 vaccine on a not-for-profit basis to low- and middle-income countries. Nature, November 30, 2020.
• Six countries that have pledged to donate WHO-approved COVID-19 vaccines to developing countries. Global Citizen, March 17, 2021.
• US International COVID-19 vaccine donations tracker. Kaiser Family Foundation, November 9, 2021.
• Biden commits to waiving vaccine patents. Washington Post, May 5, 2021.