Suchergebnisse

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents (FPR) framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This "flu-risk standard" is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: (1) having developed a vaccine, (2) raising taxes to pay for vaccine research and purchase, (3) wanting to eliminate economic and social burdens, and (4) being ineffective in combating COVID-19 through public health interventions.

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents (FPR) framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This "flu-risk standard" is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: (1) having developed a vaccine, (2) raising taxes to pay for vaccine research and purchase, (3) wanting to eliminate economic and social burdens, and (4) being ineffective in combating COVID-19 through public health interventions.

Once effective coronavirus disease 2019 (COVID-19) vaccines are developed, they will be scarce. This presents the question of how to distribute them fairly across countries. Vaccine allocation among countries raises complex and controversial issues involving public opinion, diplomacy, economics, public health, and other considerations. Nevertheless, many national leaders, international organizations, and vaccine producers recognize that one central factor in this decision-making is ethics (1, 2). Yet little progress has been made toward delineating what constitutes fair international distribution of vaccine. Many have endorsed ?equitable distribution of COVID-19?vaccine? without describing a framework or recommendations (3, 4). Two substantive proposals for the international allocation of a COVID-19 vaccine have been advanced, but are seriously flawed. We offer a more ethically defensible and practical proposal for the fair distribution of COVID-19 vaccine: the Fair Priority Model.The Fair Priority Model is primarily addressed to three groups. One is the COVAX facility?led by Gavi, the World Health Organization (WHO), and the Coalition for Epidemic Preparedness Innovations (CEPI)?which intends to purchase vaccines for fair distribution across countries (5). A second group is vaccine producers. Thankfully, many producers have publicly committed to a ?broad and equitable? international distribution of vaccine (2). The last group is national governments, some of whom have also publicly committed to a fair distribution (1).These groups need a clear framework for reconciling competing values, one that they and others will rightly accept as ethical and not just as an assertion of power. The Fair Priority Model specifies what a fair distribution of vaccines entails, giving content to their commitments. Moreover, acceptance of this common ethical framework will reduce duplication and waste, easing efforts at a fair distribution. That, in turn, will enhance producers' confidence that vaccines will be fairly allocated to benefit people, thereby motivating an increase in vaccine supply for international distribution. ; Fil: Emanuel, Ezekiel J. University of Pennsylvania; Estados Unidos ; Fil: Persad, Govind. University of Denver.; Estados Unidos ; Fil: Kern, Adam. University of Princeton; Estados Unidos ; Fil: Buchanan, Allen. University of Arizona; Estados Unidos ; Fil: Fabre, Cécile. All Souls College; Reino Unido ; Fil: Halliday, Daniel. University of Melbourne; Australia ; Fil: Heath, Joseph. University of Toronto; Canadá ; Fil: Herzog, Lisa. University of Groningen; Países Bajos ; Fil: Leland, R. J. University of Manitoba; Canadá ; Fil: Lemango, Ephrem T. No especifíca; ; Fil: Luna, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales; Argentina ; Fil: McCoy, Matthew S. University of Pennsylvania; Estados Unidos ; Fil: Norheim, Ole F. University of Bergen; Noruega ; Fil: Ottersen, Trygve. Norwegian Institute Of Public Health; Noruega ; Fil: Schaefer, G. Owen. Yong Loo Lin School Of Medicine; Singapur ; Fil: Tan, Kok-Chor. University of Pennsylvania; Estados Unidos ; Fil: Wellman, Christopher Heath. Washington University in St. Louis; Estados Unidos ; Fil: Wolff, Jonathan. University of Oxford; Reino Unido ; Fil: Richardson, Henry S. Kennedy Institute Of Ethics; Estados Unidos