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Examining The Ethics Involved When Distributing A COVID-19 Vaccine


OK. Here's a life-or-death question - who gets the first doses of the coronavirus vaccine? To be clear, there is not a vaccine to argue about right now, but it is by no means too early to ask who gets priority in the early phase when a vaccine is approved, but there is not enough for everyone. Today, a CDC advisory committee is considering what to recommend. NPR's Pien Huang reports.

PIEN HUANG, BYLINE: It's still unknown when a COVID-19 vaccine might be available in the U.S. But when it is, at first, there may only be 10 to 15 million doses available. That's according to Operation Warp Speed, the government's vaccine project. And it's just enough to cover about 3% to 5% of the U.S. population. Dr. Grace Lee, a medical officer at Stanford Children's Hospital who's also on the CDC committee, says there's a lot of people who could really benefit from it.

GRACE LEE: Those who have the highest risk of exposure, those who are at risk for severe morbidity and mortality.

HUANG: Also, she says, people whose jobs are critical to keeping our health care systems and society running. And if you add those all together...


KATHLEEN DOOLING: We are talking about a lot of people. This accounts for more than half of U.S. adults.

HUANG: That's the CDC's Kathleen Dooling presenting at last month's meeting of the CDC is Advisory Committee on Immunization Practices. The question before the committee is when you only have vaccines for 3% to 5% of the population, who gets it first? Ruth Faden is a bioethicist at Johns Hopkins consulting on the World Health Organization's vaccine guidelines. She represents a consensus when she says those first doses should go to front-line health workers who are directly exposed to COVID-19.

RUTH FADEN: Obviously, they are being placed at high risk of infection because they're taking care of people who are infected and infectious.

HUANG: But even within this seemingly clear category, there are questions about who a front-line health worker is. It's a doctor, a nurse, it's also hospital staff that care for and clean up after COVID patients. Faden says nursing home workers are in this category, too.

FADEN: They also are taking care of people who are vulnerable in many cases to serious disease and death if they contract COVID.

HUANG: Preliminary guidelines from the CDC say it may also include pharmacy staff and emergency medical responders. A draft report from the National Academy of Sciences suggests that morticians and funeral home workers are also front-line health workers because they handle COVID victims' bodies. And if everyone who might qualify as a health worker exceeds the initial supply, Lee at Stanford says that state and local authorities might have to focus it more.

LEE: Health care worker vaccination - sounds so simple, but if we don't have enough doses, we still have to be really judicious in how we're implementing.

HUANG: This could mean restricting the vaccine to parts of a state that are being hit the hardest, for example. And that's just for the first 15 million doses. Within a few weeks, as manufacturing kicks into gear, more vaccines should be available. So who gets it next? Does it go to essential workers who keep the buses running and the grocery shelves stocked? Does it go to the elderly or people with preexisting conditions who are more likely to get very sick? Lee says a lot of the decisions will depend on the characteristics of the vaccine itself.

LEE: These recommendations are not in a vacuum. They are meant for the real world, and I think that's what makes it so complex.

HUANG: Who does it work best in? Who can it reasonably be given to? Will people line up in droves to get it? It's information that's still unknown. But even if you're a healthy adult cloistered in your house waiting out the pandemic, Faden from Johns Hopkins says the line for the vaccine won't last forever.

FADEN: In a reasonable period of time, if all goes well, we will have enough vaccine that's safe and effective for everyone in the country who wants one.

HUANG: The National Academies suggests that a vaccine could be available to all Americans within 12 to 18 months of its approval. Pien Huang, NPR News. Transcript provided by NPR, Copyright NPR.

Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.