Allocating Scarce Unproven Interventions during Public Health Emergencies: Insights from the WHO MEURI Framework

Abstract

The global context within which unproven interventions are used is diverse, having varying capacities and regulatory environments. Consequently, to be considered fair, it is critical that scarce resource allocation frameworks be sensitive to context. Where robust regulatory structures exist that can anchor and support systems of fair allocation, like in the United States for Pre-Approval Access and Emergency Use Authorization, Webb et al.?s proposal is more likely to be adequate. In this and other high-income country settings, the MEURI framework may have more limited utility. However, some of its recommendations are extremely useful for the management of ?off labeluse? of unproven interventions outside clinical trials (PAHO 2020; WHO 2020). In the absence of strong regulatory structures and governance, the MEURI framework, which emphasizes procedural principles such as avoiding corruption and the need for timely and meaningful community engagement, may provide the most helpful framework for the use and allocation of unproven interventions. No country has a complete and developed set of regulations for governing unproven interventions outside clinical trials. The COVID-19 pandemic presents an opportunity to(re)build a better and a more coherent framework for all countries that can govern the use of unproven interventions in this context.