Covid-19 Vaccination Line-up

Public support for ranked vaccine allocation will help ensure that funds and distribution efforts target high-risk groups.

a graph of a number of people with a number of marks

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Almost 10 years after release, the pandemic film, Contagion, became reality. Scenes of empty grocery store shelves, public outcry over government mandates, and characters touting false cures now feel eerily familiar. One part the movie got wrong, however, was the ending — how the vaccine was distributed once developed.

The US is desperate for a vaccine after failing to effectively implement and adhere to public health measures such as masks, social distancing, testing, and contact tracing in order to control the spread of Covid-19. The pharmaceutical companies Moderna and Pfizer both have effective vaccines in development that are expected to be approved in the next month and distributed throughout 2021. Demand will undoubtedly outweigh supply. Public health experts, including Dr. Anthony Fauci, estimate that it could take a full year before everyone has access to a vaccine.

How do we ethically allocate a vaccine that is in short supply? In Contagion, a birthday lottery decided which date each person would receive the vaccine. Although entertaining, the lottery method is an ineffective strategy for minimizing disease spread. Rather, experts recommend that first in line for a vaccine should be those at highest risk for exposure and serious illness.

For Covid-19, this means elderly people, front-line health care workers, and people with existing medical conditions.

In a survey of public preference for vaccine allocation, over 1,000 US adults were asked to categorize each subgroup of people as low, medium, or high priority for vaccination. As the Figure shows, respondents ranked the different groups in line with expert recommendations.

Public support for ranked vaccine allocation will help ensure that funds and distribution efforts target high-risk groups, and help low-risk groups remain patient while they wait. Allocation based on risk may not be as cinematic as a birthday lottery, but it will save lives, prevent serious illness, and slow the spread while supply catches up with demand.

Databyte via Gollust SE, Saloner B, Hest R, Blewett LA. US Adults’ Preferences for Public Allocation of a Vaccine for Coronavirus Disease 2019. JAMA Netw Open. 2020;3(9):e2023020.