How ought we allocate unanticipated doses of COVID-19 vaccines? A proposal based on experience in the United States, 2020–2022

With vaccination against COVID-19 well underway, providers in the United States (U.S.) found that vials of the Pfizer/BioNTech and Moderna vaccines contained more doses than listed. Because of limited vaccine shelf life, vaccine-providing institutions have thrown extra doses away or quickly distributed them using ad-hoc allocation schemes (drawing names from waiting lists or administering doses to whomever happened to be nearby). This Viewpoint argues that these practices are ethically inadequate and proposes an alternate distribution scheme based on the system in the U.S. to allocate donated organs. The proposal allows for the allocation of unanticipated doses in a way that maximizes societal benefits, is fair, and considerate of the sensitive time constraints for preserving vaccine effectiveness.