Table 1.

Selected guidelines for COVID-19 vaccine allocation.

Proposal/organization	Ethical principles	Goals	Prioritization
US National Academies of Sciences, Engineering, and Medicine [31]	•Maximum benefits •Equal concern •Mitigation of health inequities •Procedural principles of fairness, transparency, and evidence-based	•Reduce severe morbidity, mortality, and negative societal impact due to the transmission of SARS-CoV-2	Phase 1a (5% of the population): high-risk health workers and first responders Phase 1b (10% of the population): people of all ages with comorbid and underlying conditions that put them at significantly higher risk; older adults living in congregate or overcrowded settings Phase 2 (30%–35% of the population): K–12 teachers, school staff, and childcare workers; critical workers in high-risk settings (e.g., food-processing facilities); all older adults; individuals of all ages with health conditions that put them at moderately higher risk of severe COVID-19 disease; people in homeless shelters, group homes for individuals for disabilities, and correctional facilities, and the staff working in those settings Phase 3 (40%–45% of the population): young adults and children; workers in industries and occupations important to the functioning of society and at increased risk of exposure Phase 4: everyone else Within each specified population group (e.g., “all older adults” or “critical workers in high-risk settings”), a vulnerability index, such as the Centers for Disease Control (CDC). CDC’s Social Vulnerability Index, should be used to identify and prioritize geographic areas that have attributes that are associated with increased vulnerability to severe COVID-19 outcomes.
Johns Hopkins Center for Health Security [32]	•Promote the common good •Treat people fairly and promote equity •Promote legitimacy, trust, and sense of ownership in a pluralistic society		Tier 1: individuals at greatest risk of severe illness and death and their caregivers; people essential to sustaining the ongoing COVID-19 response; individuals most essential to maintaining core societal functions Tier 2: people at elevated risk of infection; individuals essential to broader health provision and to maintaining other essential services; individuals with least access to healthcare
US Centers for Disease Control and Prevention interim guidelines, December 22, 2020 [33]	•Maximize benefits and minimize harms •Mitigate health inequities •Promote justice •Promote transparency	•Decrease death and serious disease as much as possible •Preserve functioning of society •Reduce the extra burden the disease is having on people already facing disparities •Increase the chance for everyone to enjoy health and well-being	Phase 1a: healthcare personnel and residents of long-term facilities Phase 1b: frontline essential workers and adults 75+ Phase 1c: adults with high-risk medical conditions; adults 65+; other essential workers
UK Joint Committee on Vaccination and Immunisation [34]	None stated	•Main goal: prevent COVID-19 mortality and protect health and social care staff and systems •Secondary goal: protect those at increased risk of hospitalization and exposure and maintain resilience in essential public services	(1) Residents in a care home for older adults and their caretakers (2) All those 80 years of age and over and frontline health and social care workers (3) All those 75 years of age and over (4) All those 70 years of age and over and clinically extremely vulnerable individuals (5) All those 65 years of age and over (6) All individuals aged 16 years to 64 years with underlying health conditions that put them at higher risk of serious disease and mortality (7) All those 60 years of age and over (8) All those 55 years of age and over (9) All those 50 years of age and over
World Health Organization (WHO) COVID-19 Vaccine Global Access Facility (COVAX) guidelines [35]	None stated	•Protect public health and minimize societal and economic impacts by reducing COVID-19 mortality	(1)Each country gets doses in proportion to its population, at the same rate (until every country has vaccinated 20% of the population) (2)After the first 20% is vaccinated, allocation is based on country need (3)The first 3% of doses goes to frontline workers in health and social care settings (4)The first 20% must cover high-risk adults (elderly, adults with comorbidities)
WHO Strategic Advisory Group of Experts on Immunization Values Framework [36]	•Enhance well-being •Equal respect •Global and national equity •Reciprocity •Legitimacy	•Contribute significantly to the equitable protection and promotion of human well-being	High risk of severe disease and death; high risk of being infected; high transmission risk; vulnerable groups at risk of disproportionate burden; those who bear significant additional risks and burdens of COVID-19 to safeguard the welfare of others (e.g., health workers and essential workers)

COVAX is an initiative coordinated by the WHO, Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations to support the research, development, and manufacturing of COVID-19 vaccine candidates and to promote the fair distribution of vaccines among participating countries.