Enhancing the WHO's proposed framework for distributing COVID-19 vaccines among countries

Abstract

As the global death toll of COVID-19 exceeds 2 million the distribution of a vaccine continues to be an urgent global priority. A key question in regard to this is which countries should get the vaccine first? The framework for distributing the COVID-19 vaccine among countries will have both ethical and life or death consequences. One of the most prominent frameworks is the one adopted by COVAX (COVID-19 Vaccines Global Access Facility), which is co-led by Gavi (the Vaccine Alliance), the Coalition for Epidemic Preparedness Innovations, and the World Health Organization (WHO) and aims to guarantee fair and equitable access to every country in the world. As of January 2021, 190 countries are engaged with COVAX. Although the United States is not at present a party to COVAX, the Biden administration is likely to reconsider entering COVAX. COVAX is taking the lead in ensuring an equitable distribution of vaccine among countries. Its allocation formula will affect billions of people throughout the world.COVAX has adopted the WHO's recently proposed fair allocation mechanism, which is based on the principle of equal proportional share per country. After 20% of each countries? population is vaccinated, allocation becomes based on health need.1 This framework is motivated by concerns about international fairness, and it attempts to provide a check against vaccine nationalism in which richer countries would hoard vaccines to the detriment of poorer countries.2 Although equal proportion may seem like an appealing starting point, it has significant ethical limitations even by the WHO and COVAX's own standards. If the WHO and COVAX framework is to serve as the global standard for fair vaccine distribution, it requires supplementation by other principles. The fair priority model (FPM) can bring the WHO and COVAX approach more in line with their own ethical framework.