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As the possibility of a widely available COVID-19 vaccine steadily looms closer, initial limitations in supply have made experts around the world wonder: Who gets the vaccine first?
The World Health Organization and its Strategic Advisory Group of Experts on Immunization, or SAGE, have published a global vaccine distribution plan: it rejects so-called vaccine nationalism, the idea that each country should prioritize its own citizens.
Instead, the WHO promotes a global approach, prioritizing vaccination among the most vulnerable people around the world.
“The first priority should be to vaccinate some people in all countries, rather than all people in some countries,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said Friday in Geneva. “Vaccine nationalism will prolong the pandemic, not shorten it.”
The vaccine distribution framework proposed by the WHO guarantees access by all countries to the new coronavirus vaccine once it is available. Participating high- and middle-income countries, also called “self-funded” countries, will provide funding for the vaccine accelerator program, abbreviated COVAX, knowing that the long-term goal is global prosperity.
Seventy-eight richer countries have endorsed the program, and Germany, Japan, Norway and the European Commission this week expressed interest in participating in the COVAX facility as self-funded countries. So far, a total of 170 nations intend to participate in COVAX, representing approximately 70% of the world’s population. The United States is not among them.
“The idea behind the installation of COVAX is for the global community to come together in a smart and self-serving way to incentivize and then distribute the vaccine, so that there is no country in the world where there are no vaccines available from the start “said Dr. Ruth Faden, Ph.D., MPH, founder of the Johns Hopkins Berman Institute for Bioethics. “Countries that come in and are self-financing are essentially helping themselves by helping the world.”
In addition to designing an equitable distribution strategy among countries, the WHO framework also examines vaccination priorities within each country.
By comparison, last week a committee advising the U.S. Centers for Disease Control and Prevention proposed four sequential phases of vaccine prioritization within the U.S., starting with senior healthcare workers. risk, people with serious medical conditions, and older people living in crowded facilities.
The WHO guidelines do not include the order in which certain groups would receive the vaccine, but the plan highlights certain vulnerable groups as a higher priority for global impact, with some flexibility based on the unique needs of each country.
“We didn’t specifically say which groups should be prioritized first, second, and third. That will come later. Not long from now, but that will come later,” continued Faden, who consults as a member of the working group that helped draft the framework but does not represent the international agency.
Local transmission patterns, the overall quantity of vaccine supplies, and a nation’s infrastructure will influence distribution tactics, Faden added. These are likely to change between now and when a vaccine is approved, so as more information becomes available, the SAGE group will begin to prioritize specific groups.
The flexible approach of the framework is perhaps exemplified in the way that children will be considered for vaccination.
“There is a huge focus in our value structure around the negative impact that the pandemic has had on the well-being of children – there are 1.5 billion children out of school,” Faden said. “It is staggering, globally, the number of children whose lives have been disrupted. The goal is for children to go to school, full time, as quickly as possible.
“As the vaccine becomes available, the first-line strategy may be to vaccinate teachers and school personnel and not children, if only because data will come first in adults.”
In the United States, Pfizer / Biontech recently announced plans to expand testing to teens as young as 16 years old.
“The WHO framework is particularly notable for its emphasis on global equity,” Faden explained, “with specific targets targeting wealthy countries. … The framework considers not only the public health impact of vaccine allocation , but also the social and economic impacts. “
Dr. Dave Harrison is a pediatric cardiology fellow in Boston and a contributor to the ABC News Medical Unit. Sony Salzman, the unit’s coordinating producer, contributed to this report.
