Ethical allocation of COVID-19 vaccine in the United States: an evaluation of competing frameworks for the current pandemic and future events

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, created the need for an effective vaccine. Questions arose about allocating the initial limited supplies in the United States. We present four allocation models and compare their characteristics for ethically meeting the health needs of the population. The literature shares broad agreement on guiding ethical principles with those of the four proposed models for vaccine allocation, featuring the concepts of utilitarianism, prioritarianism, equity, and reciprocity. We conclude that the “Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States” from the Johns Hopkins Bloomberg School of Public Health is the most comprehensive and ethically sound. We recommend government officials and policymakers at all levels consider the principles and objectives in this model as US COVID-19 vaccination distribution efforts continue. This model may serve as an effective framework for initial vaccine distribution efforts during future epidemic and pandemic events.