• Society of Bioethics and Medicine

Who should get the COVID-19 vaccine first?

By - Pooja Suganthan, Edited By - Melissa -Maria Kulaprathazhe

For a majority of 2020, one of the biggest battles scientists and public health experts have been facing is developing a safe and effective COVID-19 vaccine. As researchers move forward in clinical and vaccine trials, a new issue arises: who should get the COVID-19 vaccine first?

A policy briefing from the Nuffield Council on Bioethics emphasized that distribution policies should “ensure fair and equitable access to treatments and vaccines” (Robbins & Gelles, 2020). How exactly will this allocation be “fair and equitable?”

Some leading distribution proposals include vaccinating healthcare workers and at risk populations. The World Health Organization recommends distributing dosages based on countries’ populations. According to Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives and Chair of Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania, “Normally, we distribute things based on how severe there is suffering in a given place, and, in this case, we argue that the primary measure of suffering ought to be the number of premature deaths that a vaccine would prevent” (University of Pennsylvania School of Medicine, 2020). This idea aligns with the Fair Priority Model.

The Fair Priority Model was proposed by nineteen public health experts and focuses on three main principles: “benefiting people and limiting harm, prioritizing countries already disadvantaged by poverty or low life expectancy, and avoiding discrimination” (Daley, 2020). The model also has three phases. The first phase is to prevent premature death which is a calculation of standard expected years of lives lost per country. Phase 2 involves improving social and economic conditions. The last phase prioritizes countries with higher rates of transmission, but all countries would eventually receive enough dosages to limit the spread of COVID-19 (University of Pennsylvania School of Medicine, 2020).

The Fair Priority Model is a promising plan for COVID-19 vaccination distribution because it supersedes nationalism. Unlike the Fair Priority Model, the WHO plan “begins with 3 percent of each country's population receiving vaccines, and continues with population-proportional allocation until every country has vaccinated 20 percent of its citizens” (University of Pennsylvania School of Medicine, 2020). This may sound like a reasonable plan, but it is mistakenly assuming that all countries are experiencing COVID-19 to the same extent.

Some argue that the Fair Priority Model is ageist because it prioritizes younger individuals over older individuals (Green, 2020). However, the Fair Priority Model believes that distributing COVID-19 vaccines to communities with high elderly populations would result in giving much more dosages to rich countries (University of Pennsylvania School of Medicine, 2020). The model has a similar reasoning for not prioritizing health care workers. I personally find this to be a bit troubling because healthcare workers and other essential workers are putting their lives at risk to support their communities. If the vaccines are in low supply (as they most likely will be), I believe that the government should do its part and ensure that workers in high risk areas have proper protection against the virus. Despite this, the Fair Priority Model proposes a fair and equitable means of distributing the long awaited COVID-19 vaccine. It is important that public health experts, national leaders, and researchers work together to finetune their distribution policies before a vaccine is developed to ensure we are distributing vaccinations as fairly as possible and in turn saving as many lives as possible.


Daley, J. (2020, September 3). How to Decide Who Should Get a COVID-19 Vaccine First. Scientific American. Green, L. (2020, October 29). Why Ageist COVID-19 Vaccine Policies Could Kill. Next Avenue. Robbins, R., & Gelles, D. (2020, November 12). How Pfizer Plans to Distribute Its Vaccine (It’s Complicated). The New York Times. University of Pennsylvania School of Medicine. (2020, September 3). Who should get the COVID-19 vaccine first? Team of global experts offer a model that would prioritize reducing premature deaths. ScienceDaily.