Must We Vaccinate the Most Vulnerable? Efficiency, Priority, and Equality in the Distribution of Vaccines

Abstract

The UK’s Joint Committee on Vaccination and Immunisation (JCVI) is clear that “the first priorities for the COVID-19 vaccination programme should be the prevention of mortality and the maintenance of the health and social care systems” (JCVI, 2020). As such, it prioritises vaccinating those most vulnerable to COVID-19, primarily through age-based allocation. As with any decision about allocating scarce resources, this policy raises a series of questions. One set of worries, explored by Giublini, Savelescu and Wilkinson (2021) concerns the policy’s ends: why, for example, prioritise the prevention of mortality, rather than saving life-years? Why prioritise health-related goals at all, rather than the reopening of the economy? Maybe we should focus on the young, not the old. A second set concerns the means to this end: how do we decide who counts as ‘vulnerable’, and how does this category intersect with the JCVI’s own stated concerns about equity (JCVI 2021b)? For example, recent work by suggests that targeting vaccinations on disadvantaged communities would do more good and be more equitable than the JCVI’s age-based strategy (see also Schmidt et al 2021). Maybe we should ignore age entirely and focus on place. Finally, we might question whether the means of focusing on vulnerability is a good way of achieving the end of reducing mortality, as in Rhodes’ (2021) proposal of a “transmission” strategy, aimed at those who pose most risk, rather than the those who are at most at risk. Again, this would imply a focus on the young, not the old, but for a different reason