Ethical trade-offs in vaccine development and distribution—Response to Gurwitz

We agree with Gurwitz [1] that a global strategy is needed to effectively address the 2019 coronavirus disease (COVID-19) pandemic, and that ensuring equitable global access to proven safe and effective vaccines must be a key pillar of this strategy. Severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2)—the virus that causes COVID-19—does not know borders. This means that a global response to the pandemic is in every country’s public health, economic and political interests, either in the immediate or in the longer term. A global pandemic response is also a matter of global justice because COVID-19, as well as the measures taken to mitigate its toll, threaten the basic needs of people around the globe.

We are therefore encouraged that “my country first” approaches to distributing SARS-CoV-2 vaccines, which were dominant early in the pandemic [2], are now being supplemented with more global approaches. In particular, the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI) are co-leading “COVAX”, a multi-sectoral effort to “ensure that people in all corners of the world will get access to COVID-19 vaccines once they are available, regardless of their wealth”[3]. The ethics of achieving equitable global access to COVID-19 vaccines, especially in low- and middle-income countries, is also actively debated [4], [5], [6]. For example, an international working group has proposed a “fair priority model” for distributing vaccines across countries, according to which vaccines should be distributed first with a view to reducing premature deaths globally and then, in later stages of the pandemic, with a view to reducing serious economic and social deprivations and returning to full functioning [6].

The ethical justification for accelerating vaccine development rests on the public health and justice gains that can result when a proven vaccine is implemented sooner [7]. Yet without adequate planning, delays in vaccine manufacturing, distribution and implementation can cancel out time savings gained during the development process. Moreover, the public health and justice gains from accelerated vaccine development wane when proven vaccines do not reach the people who need or deserve them most. These challenges become all the greater once we recognize the need for a global approach to distributing the vaccine, highlighting the need to proactively determine how it can best be achieved. For example, time savings from faster clinical trials will matter little if vaccines are shared equitably across countries, but the countries do not distribute the vaccines efficiently and equitably within their population. Recognizing that researchers and research sponsors only have limited control of how vaccines are implemented, their efforts to accelerate SARS-CoV-2 vaccine development are valuable and ultimately justified only when proven safe and effective vaccines are used efficiently and equitably at both the global and national level.

Disclaimer

The views expressed are those of the authors and do not necessarily reflect those of the National Institutes of Health or the Department of Health and Human Services.

Funding

This work was partially funded by the National Institutes of Health (NIH) Clinical Center, Department of Bioethics.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.